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1.  Quantitative neurosensory findings, symptoms and signs in young vibration exposed workers 
Background
Long-term exposure to hand-held vibrating tools may cause the hand arm vibration syndrome (HAVS) including vibration induced white fingers and sensorineural symptoms. The aim was to study early neurosensory effects by quantitative vibrotactile and monofilament tests in young workers with hand-held vibration exposure.
Methods
This cross-sectional study consisted of 142 young, male machine shop and construction workers with hand-held exposure to vibrating tools. They were compared with 41 non-vibration exposed subjects of the same age-group. All participants passed a structured interview, answered several questionnaires and had a physical examination including the determination of vibrotactile perception thresholds (VPTs) at two frequencies (31.5 and 125 Hz) and Semmes Weinstein’s Monofilament test.
Results
In the vibration exposed group 8% of the workers reported episodes of tingling sensations and 10% numbness in their fingers. Approximately 5–10% of the exposed population displayed abnormal results on monofilament tests. The vibrotactile testing showed significantly increased VPTs for 125 Hz in dig II bilaterally (right hand, p = 0.01; left hand, p = 0.024) in the vibration exposed group.
A multiple regression analysis (VPT - dependent variable; age, height, examiner and five different vibration dose calculations – predictor variables) in dig II bilaterally showed rather low R2-values. None of the explanatory variables including five separately calculated vibration doses were included in the models, neither for the total vibration exposed group, nor for the highest exposed quartile.
A logistic multiple regression analysis (result of monofilament testing - dependent variable; age, height, examiner and five vibration dose calculations – predictor variables) of the results of monofilament testing in dig II bilaterally gave a similar outcome. None of the independent variables including five calculated vibration doses were included in the models neither for the total exposed group nor for the highest exposed quartile.
Conclusion
In spite of the fairly short vibration exposure, a tendency to raised VPTs as well as pathologic monofilament test results was observed. Thus, early neurophysiologic symptoms and signs of vibration exposure may appear after short-term exposure also in young workers.
doi:10.1186/1745-6673-8-8
PMCID: PMC3621786  PMID: 23536994
Vibration exposure; Neurophysiologic effects; Vibrotactile thresholds; Monofilament test
2.  Physical capacity and psychological mood in association with self-reported work ability in vibration-exposed patients with hand symptoms 
Background
The aim of this study was to investigate whether self-reports of work ability correlated to the results of quantitative tests measuring physical capacity and a questionnaire assessing psychological mood in vibration-exposed patients with hand symptoms.
Methods
The participants comprised 47 patients (36 men and eleven women) with exposure to hand vibration and vascular and/or neurological symptoms in the hands. They performed several quantitative tests (manual dexterity, hand grip strength, finger strength) and completed the Work Ability Index (WAI) and Hospital Anxiety and Depression Scale (HADS) questionnaires.
Results
Correlation analysis revealed statistically significant associations between the WAI results, the HADS indices, hand grip and finger strength, and manual dexterity measured using the Purdue Pegboard®. Multiple regression analysis revealed age and HADS indices as the strongest predictors of work ability.
Conclusions
The patient’s age and psychological mood may be stronger predictors of work ability compared with results from tests measuring physical capacity of the hands in vibration-exposed patients with hand symptoms. When using the WAI as an instrument for assessing work ability in these patients, health care providers need to be more aware of the impact of the psychological mood.
doi:10.1186/1745-6673-7-22
PMCID: PMC3514171  PMID: 23136907
Quantitative test; Work Ability Index; WAI; Mental condition; HADS; Vibration; Hand symptoms; Grip strength; Manual dexterity
3.  Simple neck pain questions used in surveys, evaluated in relation to health outcomes: a cohort study 
BMC Research Notes  2012;5:587.
Background
The high prevalence of pain reported in many epidemiological studies, and the degree to which this prevalence reflects severe pain is under discussion in the literature. The aim of the present study was to evaluate use of the simple neck pain questions commonly included in large epidemiological survey studies with respect to aspects of health. We investigated if and how an increase in number of days with pain is associated with reduction in health outcomes.
Methods
A cohort of university students (baseline age 19–25 years) were recruited in 2002 and followed annually for 4 years. The baseline response rate was 69% which resulted in 1200 respondents (627 women, 573 men). Participants were asked about present and past pain and perceptions of their general health, sleep disturbance, stress and energy levels, and general performance. The data were analyzed using a mixed model for repeated measurements and a random intercept logistic model.
Results
When reporting present pain, participants also reported lower prevalence of very good health, higher stress and sleep disturbance scores and lower energy score. Among those with current neck pain, additional questions characterizing the pain such as duration (categorized), additional pain sites and decreased general performance were associated with lower probability of very good health and higher amounts of sleep disturbance. Knowing about the presence or not of pain explains more of the variation in health between individuals, than within individuals.
Conclusion
This study of young university students has demonstrated that simple neck pain survey questions capture features of pain that affect aspects of health such as perceived general health, sleep disturbance, mood in terms of stress and energy. Simple pain questions are more useful for group descriptions than for describing or following pain in an individual.
doi:10.1186/1756-0500-5-587
PMCID: PMC3538694  PMID: 23102060
Musculoskeletal; Neck pain; Validity; Health; Performance; Epidemiological study
4.  Computer use and stress, sleep disturbances, and symptoms of depression among young adults – a prospective cohort study 
BMC Psychiatry  2012;12:176.
Background
We have previously studied prospective associations between computer use and mental health symptoms in a selected young adult population. The purpose of this study was to investigate if high computer use is a prospective risk factor for developing mental health symptoms in a population-based sample of young adults.
Methods
The study group was a cohort of young adults (n = 4163), 20–24 years old, who responded to a questionnaire at baseline and 1-year follow-up. Exposure variables included time spent on computer use (CU) in general, email/chat use, computer gaming, CU without breaks, and CU at night causing lost sleep. Mental health outcomes included perceived stress, sleep disturbances, symptoms of depression, and reduced performance due to stress, depressed mood, or tiredness. Prevalence ratios (PRs) were calculated for prospective associations between exposure variables at baseline and mental health outcomes (new cases) at 1-year follow-up for the men and women separately.
Results
Both high and medium computer use compared to low computer use at baseline were associated with sleep disturbances in the men at follow-up. High email/chat use was negatively associated with perceived stress, but positively associated with reported sleep disturbances for the men. For the women, high email/chat use was (positively) associated with several mental health outcomes, while medium computer gaming was associated with symptoms of depression, and CU without breaks with most mental health outcomes. CU causing lost sleep was associated with mental health outcomes for both men and women.
Conclusions
Time spent on general computer use was prospectively associated with sleep disturbances and reduced performance for the men. For the women, using the computer without breaks was a risk factor for several mental health outcomes. Some associations were enhanced in interaction with mobile phone use. Using the computer at night and consequently losing sleep was associated with most mental health outcomes for both men and women. Further studies should focus on mechanisms relating information and communication technology (ICT) use to sleep disturbances.
doi:10.1186/1471-244X-12-176
PMCID: PMC3528646  PMID: 23088719
5.  Workplace Rehabilitation and Supportive Conditions at Work: A Prospective Study 
Purpose To investigate the impact of rehabilitation measures on work ability and return to work (RTW), specifically the association between workplace rehabilitation/supportive conditions at work and work ability and RTW over time, among women on long-term sick leave. Methods Questionnaire data were collected (baseline, 6 and 12 months) from a cohort of women (n = 324). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability index (WAI), work ability score and working degree. These analyses were performed with different models; the explanatory variables for each model were workplace rehabilitation, supportive conditions at work and time. Results The individuals provided with workplace rehabilitation and supportive conditions (e.g. influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community and work satisfaction) had significantly increased WAI and work ability score over time. These individuals scored higher work ability compared to those individuals having workplace rehabilitation without supportive conditions, or neither. Additionally, among the individuals provided with workplace rehabilitation and supportive conditions, working degree increased significantly more over time compared to those individuals with no workplace rehabilitation and no supportive conditions. Conclusion The results highlight the importance of integrating workplace rehabilitation with supportive conditions at work in order to increase work ability and improve the RTW process for women on long-term sick leave.
doi:10.1007/s10926-012-9391-z
PMCID: PMC3666126  PMID: 23065193
Sickness absence; Back to work; Female; Rehabilitation activity; Self-reported; Working degree; Occupational health
6.  Changes in work situation and work ability in young female and male workers. A prospective cohort study 
BMC Public Health  2012;12:694.
Background
Good work ability is very important in young workers, but knowledge of work situations that influence work ability in this group is poor. The aim of this study was to assess whether changes in self-reported work factors are associated with self-reported work ability among young female and male workers.
Methods
A sample of 1,311 (718 women and 593 men) was selected from a Swedish cohort of workers aged 21–25 years. At baseline and at 1-year follow-up, participants completed a self-administrated questionnaire including ratings of physical and psychosocial work factors and current work ability. Prevalence ratios were calculated to assess univariate and multivariate associations between changes in work factors and changes in work ability.
Results
Decreased job control (PR 1.7, 95% CI 1.49–2.12) and increased negative influence of job demands on private life (PR 1.5, 95% CI 1.25–1.69) were associated with reduced work ability for both female and male workers in the multivariate analyses. Among female workers, an association was found between improved work ability and increased social support at work (PR 2.4, CI 1.43–3.95). For male workers, increased job control (PR 2.3, 95% CI 1.21–4.54) and decreased negative influence of job demands on private life (PR 2.1, 95% CI 1.10–3.87) were associated with improved work ability in the multivariate analyses.
Conclusions
Decreased job control and increased negative influence of job demands on private life over time seem to be the most important work factors associated with reduced work ability among young workers of both sexes. Increased social support at work, increased job control, and decreased negative influence of job demands on private life were also found to be the main work factors associated with improved work ability, although with possible gender differences.
doi:10.1186/1471-2458-12-694
PMCID: PMC3508794  PMID: 22920936
Work ability score; Work exposure; Epidemiology; Risk factors
7.  Prevention of musculoskeletal disorders in workers: classification and health surveillance – statements of the Scientific Committee on Musculoskeletal Disorders of the International Commission on Occupational Health 
The underlying purpose of this commentary and position paper is to achieve evidence-based recommendations on prevention of work-related musculoskeletal disorders (MSDs). Such prevention can take different forms (primary, secondary and tertiary), occur at different levels (i.e. in a clinical setting, at the workplace, at national level) and involve several types of activities. Members of the Scientific Committee (SC) on MSDs of the International Commission on Occupational Health (ICOH) and other interested scientists and members of the public recently discussed the scientific and clinical future of prevention of (work-related) MSDs during five round-table sessions at two ICOH conferences (in Cape Town, South Africa, in 2009, and in Angers, France, in 2010). Approximately 50 researchers participated in each of the sessions. More specifically, the sessions aimed to discuss new developments since 1996 in measures and classification systems used both in research and in practice, and agree on future needs in the field.
The discussion focused on three questions: At what degree of severity does musculoskeletal ill health, and do health problems related to MSDs, in an individual worker or in a group of workers justify preventive action in occupational health? What reliable and valid instruments do we have in research to distinguish ‘normal musculoskeletal symptoms’ from ‘serious musculoskeletal symptoms’ in workers? What measures or classification system of musculoskeletal health will we need in the near future to address musculoskeletal health and related work ability?
Four new, agreed-upon statements were extrapolated from the discussions: 1. Musculoskeletal discomfort that is at risk of worsening with work activities, and that affects work ability or quality of life, needs to be identified. 2. We need to know our options of actions before identifying workers at risk (providing evidence-based medicine and applying the principle of best practice). 3. Classification systems and measures must include aspects such as the severity, frequency, and intensity of pain, as well as measures of impairment of functioning, which can help in prevention, treatment and prognosis. 4. We need to be aware of economic and/or socio-cultural consequences of classification systems and measures.
doi:10.1186/1471-2474-13-109
PMCID: PMC3437218  PMID: 22721454
Occupation; Epidemiology; Prevention; Aetiology; Expert opinion; Occupational health; Public health; Rheumatology; Rehabilitation; Orthopaedics
8.  Perceived exertion, comfort and working technique in professional computer users and associations with the incidence of neck and upper extremity symptoms 
Background
The aim of this study was to investigate whether perceived exertion, perceived comfort and working technique is associated with the incidence of neck and upper extremity symptoms among professional computer users.
Methods
At baseline a self-administered questionnaire was distributed to 853 participants from 46 different work sites (382 men and 471 women) who, at baseline, had been free from neck and upper extremity symptoms during the preceding month. Work-related exposures, individual factors, and symptoms from the neck and upper extremities were assessed. Observations of working technique were performed by ergonomists using an ergonomic checklist. Incidence data were collected by means of 10 monthly questionnaires, asking for information on the occurrence of neck, shoulder and arm/hand symptoms. Perceived exertion was rated on a modified Borg RPE scale ranging from 0 (very, very light) to 14 (very, very strenuous). Perceived comfort was rated on a 9-point scale ranging from -4 (very, very poor) to +4 (very, very good) in relation to the chair, computer screen, keyboard, and computer mouse.
Results
The median follow up time was 10.3 months. The incidence of symptoms from the neck, shoulders and arm/hands were 50, 24 and 34 cases per 100 person years, respectively.
Higher perceived exertion in the neck, shoulder or arm/hands was associated with an increased risk of developing symptoms in the corresponding body region. Moreover, a dose-response relationship between the level of exertion and the risk of developing symptoms was recorded for all three regions. There was an association between low comfort and an increased risk for neck symptoms, but not for shoulder and arm/hand symptoms, although a trend towards such an association (not statistically significant) could be seen. Working technique was, in this study, not associated with the risk of developing symptoms in any of the investigated body regions.
Conclusion
There was a strong association between high perceived exertion and the development of neck, shoulder, and arm/hand symptoms. Moreover, there was an association between poor perceived comfort and neck pain. Surveillance of computer users may include perceived exertion and comfort to target individuals at risk for neck and upper extremity symptoms.
doi:10.1186/1471-2474-13-38
PMCID: PMC3362766  PMID: 22436251
Computer work; Perceived exertion; Perceived comfort; Working technique; neck and upper extremity disorders
9.  Balancing extensive ambition and a context overflowing with opportunities and demands: A grounded theory on stress and recovery among highly educated working young women entering male-dominated occupational areas 
Several factors underline the issue of stress-related health among young highly educated women. Major societal changes might provide more new challenges with considerably changed and expanded roles than were expected by earlier generations, especially among women. The quantity of young women with higher education has also increased threefold in Sweden in less than two decades and there are a growing number of young women that hereby break with traditional gender positions and enter new occupational areas traditionally dominated by men. The research questions in the present study were: “What is the main concern, regarding stress and recovery, among young highly educated working women breaking with traditional gender positions and entering male-dominated occupational areas?” and “How do they handle this concern?” We conducted open-ended interviews with 20 informants, aged 23-29 years. The results showed that the synergy between highly ambitious individuals and a context overflowing with opportunities and demands ended up in the informants’ constantly striving to find a balance in daily life (main concern). This concern refers to the respondents experiencing a constant overload of ambiguity and that they easily became entangled in a loop of stress and dysfunctional coping behavior, threatening the balance between stress and sufficient recovery. In order to handle this concern, the respondents used different strategies in balancing extensive ambition and a context overflowing with opportunities and demands (core category). This preliminary theoretical model deepens our understanding of how the increasing numbers of highly educated young women face complex living conditions endangering their possibility of maintaining health and work ability.
doi:10.3402/qhw.v6i3.5904
PMCID: PMC3168367  PMID: 21909337
stress; recovery; young women; individualization; gender; grounded theory
10.  A case report of vibration-induced hand comorbidities in a postwoman 
Background
Prolonged exposure to hand-transmitted vibration is associated with an increased occurrence of symptoms and signs of disorders in the vascular, neurological and osteoarticular systems of the upper limbs. However, the available epidemiological evidence is derived from studies on high vibration levels caused by vibratory tools, whereas little is known about possible upper limb disorders caused by chronic exposure to low vibration levels emitted by fixed sources.
Case presentation
We present the case of a postwoman who delivered mail for 15 years using a low-powered motorcycle. The woman was in good health until 2002, when she was diagnosed with bilateral Raynaud's phenomenon. In March 2003 a bilateral carpal tunnel syndrome was electromyographically diagnosed; surgical treatment was ineffective. Further examinations in 2005 highlighted the presence of chronic tendonitis (right middle finger flexor).
Risk assessment
From 1987, for 15 years, our patient rode her motorcycle for 4 h/day, carrying a load of 20-30 kg. For about a quarter of the time she drove over country roads. Using the information collected about the tasks carried out every day by the postwoman and some measurements performed on both handles of the motorcycle, as well as on both iron parts of the handlebars, we reconstructed the woman's previous exposure to hand-arm vibration. 8-hour energy-equivalent frequency weighted acceleration was about 2.4 m/s2. The lifetime dose was 1.5 × 109(m2/s4)hd.
Conclusions
The particular set of comorbidities presented by our patient suggests a common pathophysiological basis for all the diseases. Considering the level of exposure to vibrations and the lack of specific knowledge on the effects of vibration in women, we hypothesize an association between the work exposure and the onset of the diseases.
doi:10.1186/1471-2474-12-47
PMCID: PMC3045397  PMID: 21320318
11.  Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults - a prospective cohort study 
BMC Public Health  2011;11:66.
Background
Because of the quick development and widespread use of mobile phones, and their vast effect on communication and interactions, it is important to study possible negative health effects of mobile phone exposure. The overall aim of this study was to investigate whether there are associations between psychosocial aspects of mobile phone use and mental health symptoms in a prospective cohort of young adults.
Methods
The study group consisted of young adults 20-24 years old (n = 4156), who responded to a questionnaire at baseline and 1-year follow-up. Mobile phone exposure variables included frequency of use, but also more qualitative variables: demands on availability, perceived stressfulness of accessibility, being awakened at night by the mobile phone, and personal overuse of the mobile phone. Mental health outcomes included current stress, sleep disorders, and symptoms of depression. Prevalence ratios (PRs) were calculated for cross-sectional and prospective associations between exposure variables and mental health outcomes for men and women separately.
Results
There were cross-sectional associations between high compared to low mobile phone use and stress, sleep disturbances, and symptoms of depression for the men and women. When excluding respondents reporting mental health symptoms at baseline, high mobile phone use was associated with sleep disturbances and symptoms of depression for the men and symptoms of depression for the women at 1-year follow-up. All qualitative variables had cross-sectional associations with mental health outcomes. In prospective analysis, overuse was associated with stress and sleep disturbances for women, and high accessibility stress was associated with stress, sleep disturbances, and symptoms of depression for both men and women.
Conclusions
High frequency of mobile phone use at baseline was a risk factor for mental health outcomes at 1-year follow-up among the young adults. The risk for reporting mental health symptoms at follow-up was greatest among those who had perceived accessibility via mobile phones to be stressful. Public health prevention strategies focusing on attitudes could include information and advice, helping young adults to set limits for their own and others' accessibility.
doi:10.1186/1471-2458-11-66
PMCID: PMC3042390  PMID: 21281471
12.  Myofeedback training and intensive muscular strength training to decrease pain and improve work ability among female workers on long-term sick leave with neck pain: a randomized controlled trial 
Abstract
The theoretical framework is that muscle tension in the neck is related to insufficient muscular rest and is a risk factor for chronic pain and reduced work ability. Promoting muscle strength and muscle rest may increase work ability and reduce neck pain.
Objectives
To test whether myofeedback training or intensive strength training leads to decreased pain and increased work ability in women on long-term sick leave.
Methods
This is a randomized controlled trial of two 1-month interventions with myofeedback or muscular strength training in the home environment. Female human service organization workers (n = 60) on long-term (>60 days) sick leave and with chronic neck pain were followed with self-reported and laboratory-observed data of health, pain, muscular activation, and work ability, at baseline, immediately after the intervention and 3 months after baseline.
Results
For both intervention groups, pain was lowered over time compared with the control group. Decreased pain and muscular activity was associated with increased self-rated work ability and with laboratory-observed work ability at 3-month follow-up. Decreased pain was also associated with increased self-rated work ability at 1-month follow-up. Muscular strength training was associated with increased self-rated work ability and mental health. Myofeedback was associated with increased observed work ability and self- rated vitality.
Conclusions
The two interventions showed positive results, suggesting that they could be developed for use in health care practice to address pain and work ability. The intensive muscular strength training program, which is both easy to conduct at home and easy to coach, was associated with increased work ability.
doi:10.1007/s00420-010-0568-5
PMCID: PMC3037486  PMID: 20803028
Randomized controlled trial; Musculoskeletal disorder; Chronic pain; Biofeedback; Work ability; Sickness absence
13.  Nerve conduction in relation to vibration exposure - a non-positive cohort study 
Background
Peripheral neuropathy is one of the principal clinical disorders in workers with hand-arm vibration syndrome. Electrophysiological studies aimed at defining the nature of the injury have provided conflicting results. One reason for this lack of consistency might be the sparsity of published longitudinal etiological studies with both good assessment of exposure and a well-defined measure of disease. Against this background we measured conduction velocities in the hand after having assessed vibration exposure over 21 years in a cohort of manual workers.
Methods
The study group consisted of 155 male office and manual workers at an engineering plant that manufactured pulp and paper machinery. The study has a longitudinal design regarding exposure assessment and a cross-sectional design regarding the outcome of nerve conduction. Hand-arm vibration dose was calculated as the product of self-reported occupational exposure, collected by questionnaire and interviews, and the measured or estimated hand-arm vibration exposure in 1987, 1992, 1997, 2002, and 2008. Distal motor latencies in median and ulnar nerves and sensory nerve conduction over the carpal tunnel and the finger-palm segments in the median nerve were measured in 2008. Before the nerve conduction measurement, the subjects were systemically warmed by a bicycle ergometer test.
Results
There were no differences in distal latencies between subjects exposed to hand-arm vibration and unexposed subjects, neither in the sensory conduction latencies of the median nerve, nor in the motor conduction latencies of the median and ulnar nerves. Seven subjects (9%) in the exposed group and three subjects (12%) in the unexposed group had both pathological sensory nerve conduction at the wrist and symptoms suggestive of carpal tunnel syndrome.
Conclusion
Nerve conduction measurements of peripheral hand nerves revealed no exposure-response association between hand-arm vibration exposure and distal neuropathy of the large myelinated fibers in a cohort of male office and manual workers.
doi:10.1186/1745-6673-5-21
PMCID: PMC2923164  PMID: 20642848
14.  Perceived connections between information and communication technology use and mental symptoms among young adults - a qualitative study 
BMC Public Health  2010;10:66.
Background
Prospective associations have been found between high use of information and communication technology (ICT) and reported mental symptoms among young adult university students, but the causal mechanisms are unclear. Our aim was to explore possible explanations for associations between high ICT use and symptoms of depression, sleep disorders, and stress among young adults in order to propose a model of possible pathways to mental health effects that can be tested epidemiologically.
Methods
We conducted a qualitative interview study with 16 women and 16 men (21-28 years), recruited from a cohort of university students on the basis of reporting high computer (n = 28) or mobile phone (n = 20) use at baseline and reporting mental symptoms at the one-year follow-up. Semi-structured interviews were performed, with open-ended questions about possible connections between the use of computers and mobile phones, and stress, depression, and sleep disturbances. The interview data were analyzed with qualitative content analysis and summarized in a model.
Results
Central factors appearing to explain high quantitative ICT use were personal dependency, and demands for achievement and availability originating from the domains of work, study, social life, and individual aspirations. Consequences included mental overload, neglect of other activities and personal needs, time pressure, role conflicts, guilt feelings, social isolation, physical symptoms, worry about electromagnetic radiation, and economic problems. Qualitative aspects (destructive communication and information) were also reported, with consequences including vulnerability, misunderstandings, altered values, and feelings of inadequacy. User problems were a source of frustration. Altered ICT use as an effect of mental symptoms was reported, as well as possible positive effects of ICT on mental health.
Conclusions
The concepts and ideas of the young adults with high ICT use and mental symptoms generated a model of possible paths for associations between ICT exposure and mental symptoms. Demands for achievement and availability as well as personal dependency were major causes of high ICT exposure but also direct sources of stress and mental symptoms. The proposed model shows that factors in different domains may have an impact and should be considered in epidemiological and intervention studies.
doi:10.1186/1471-2458-10-66
PMCID: PMC2836296  PMID: 20152023
15.  Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models: a cohort study 
Background
In the literature there are discussions on the choice of outcome and the need for more longitudinal studies of musculoskeletal disorders. The general aim of this longitudinal study was to analyze musculoskeletal neck pain, in a group of young adults. Specific aims were to determine whether psychosocial factors, computer use, high work/study demands, and lifestyle are long-term or short-term factors for musculoskeletal neck pain, and whether these factors are important for developing or ongoing musculoskeletal neck pain.
Methods
Three regression models were used to analyze the different outcomes. Pain at present was analyzed with a marginal logistic model, for number of years with pain a Poisson regression model was used and for developing and ongoing pain a logistic model was used. Presented results are odds ratios and proportion ratios (logistic models) and rate ratios (Poisson model). The material consisted of web-based questionnaires answered by 1204 Swedish university students from a prospective cohort recruited in 2002.
Results
Perceived stress was a risk factor for pain at present (PR = 1.6), for developing pain (PR = 1.7) and for number of years with pain (RR = 1.3). High work/study demands was associated with pain at present (PR = 1.6); and with number of years with pain when the demands negatively affect home life (RR = 1.3). Computer use pattern (number of times/week with a computer session ≥ 4 h, without break) was a risk factor for developing pain (PR = 1.7), but also associated with pain at present (PR = 1.4) and number of years with pain (RR = 1.2). Among life style factors smoking (PR = 1.8) was found to be associated to pain at present. The difference between men and women in prevalence of musculoskeletal pain was confirmed in this study. It was smallest for the outcome ongoing pain (PR = 1.4) compared to pain at present (PR = 2.4) and developing pain (PR = 2.5).
Conclusion
By using different regression models different aspects of neck pain pattern could be addressed and the risk factors impact on pain pattern was identified. Short-term risk factors were perceived stress, high work/study demands and computer use pattern (break pattern). Those were also long-term risk factors. For developing pain perceived stress and computer use pattern were risk factors.
doi:10.1186/1471-2474-10-73
PMCID: PMC2714495  PMID: 19545386
16.  Incidence of Raynaud's phenomenon in relation to hand-arm vibration exposure among male workers at an engineering plant a cohort study 
Background
The objective of this study was to assess the incidence of Raynaud's phenomenon in relation to hand-arm vibration exposure in a cohort consisting of male office and manual workers.
Methods
The baseline population consisted of 94 office and 147 manual workers at an engineering plant. Raynaud's phenomenon (RP) was assessed at baseline and at follow up (at 5, 10 and 15 years). A retrospective and a prospective cohort analysis of data were done. Hand-arm vibration exposure dose was defined as the product of exposure duration and the weighted hand-arm vibration exposure value according to ISO 5349-1.
Results
The retrospective/prospective incidence of Raynaud's phenomenon was 16/14 per 1000 exposure years among exposed and 2.4/5.0 per 1000 years among the not exposed. The retrospective dose response curve based on 4 dose classes showed that class 2, 3 and 4 had similar response and showed higher incidence than the not-exposed. The dose with RP response to hand-arm vibration corresponded to a 10 year A(8) value between 0.4–1.0 m/s2.
Conclusion
The results indicate that the EU directive on an action value for hand-arm vibration of 2.5 m/s2 is not too low. Rather, it suggests that employers should take on actions even at exposure values of 1 m/s2A(8).
doi:10.1186/1745-6673-3-13
PMCID: PMC2442108  PMID: 18558009
17.  Chronic pain has a small influence and mood has no influence on vibrotactile perception thresholds among working women 
Muscle & Nerve  2010;42(3):401-409.
In chronic diffuse upper limb pain physical abnormalities are usually absent. The aims of our study were to investigate: (1) the function of somatosensory pathways and (2) the influence of mood on vibration perception. Measurements were made of: (i) vibrotactile perception thresholds (VPTs) and nerve conduction in working women with (n = 35) and without (n = 65) chronic diffuse upper limb pain, and (ii) perceived stress and energy using a two-dimensional mood adjective checklist. The groups did not differ in any nerve conduction measurements. Women with chronic pain had raised VPTs in the radial and ulnar nerve areas, but not in the median nerve area. Neither perceived stress nor energy appeared to influence the VPT. Increases of VPTs in chronic diffuse upper limb pain may be due to peripheral nerve affliction, but our findings support the idea that they may also be secondary to pain and may be related to a central nervous mechanism. Muscle Nerve, 2010
doi:10.1002/mus.21697
PMCID: PMC2995312  PMID: 20564595
chronic pain; upper limb; vibrotactile perception threshold; mood; nerve conduction

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