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1.  Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China 
BMJ Open  2014;4(12):e006451.
Objectives
Studies from western countries show that dentists are vulnerable to work-related musculoskeletal disorders (WMSDs) of the neck and upper extremities, but little is known about their epidemiology among members of this rapidly growing profession in China. This study aims to investigate the prevalence of WMSDs and identify potential risk factors associated with their occurrence in the dental profession in China.
Setting and participants
A cross-sectional survey was carried out in 52 different hospitals in a large metropolitan city in China. A total of 304 questionnaires were distributed to respondents identified via stratified random sampling and 272 dentists (121 females and 151 males) completed the survey. The response rate was 89.5%.
Outcomes
Visual analogue score was used to record neck and upper limb musculoskeletal symptoms on a body chart. Work-related risk factors, including physical and psychosocial factors, were accounted for in the regression analysis.
Results
88% of the dentists reported at least one musculoskeletal disorder and 83.8% suffered from neck pain. In the multivariate analyses, working hours per day were associated with neck pain (OR=1.43; 95% CI 1.03 to 1.98). Inability to select the appropriate size of dental instrument was associated with shoulder (OR=2.07; 95% CI 1.00 to 4.32) and wrist/hand (OR=2.47; 95% CI 1.15 to 5.32) pain. As for psychosocial factors, high job demand was associated with symptoms in the shoulder (OR=1.09; 95% CI 1.00 to 1.18), elbow (OR=1.11; 95% CI 1.03 to 1.19) and wrist/hand (OR=1.09; 95% CI 1.02 to 1.17). Regular physical exercise was associated with decreased neck pain (OR=0.37; 95% CI 0.14 to 1.00).
Conclusions
The prevalence of WMSDs among Chinese dentists is high. Specifically, long working hours, inability to select the appropriate size of dental instrument and high job demand are the most significant risk factors.
doi:10.1136/bmjopen-2014-006451
PMCID: PMC4275663  PMID: 25526795
OCCUPATIONAL & INDUSTRIAL MEDICINE
2.  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
3.  A nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996–2006 
BMJ Open  2011;1(2):e000180.
Background
Return to work is an important outcome factor for working-age patients poststroke. Previous epidemiological studies on this topic have been small (on average 125 patients per study). Their estimated effects are therefore associated with a tremendous statistical uncertainty. The present study estimates the effect of various predictors on the odds of returning to work after stroke in the total population of 20–57-year-old previously employed hospital treated patients with stroke in Denmark 1996–2006 (N=19 985).
Methods and results
The patients were followed through national registers; 62% were gainfully occupied 2 years after stroke. The odds of returning to work were higher among people with intracerebral infarction, OR 1.0 (the reference group), than they were among people with subarachnoid haemorrhage, OR 0.79 (95% CI 0.71 to 0.88), and intracerebral haemorrhage, OR 0.39 (0.35 to 0.43). The odds of returning to work were lower among workers in elementary occupations OR 1.0 (reference group) than they were among workers in occupations that require skills at a basic level, OR 1.50 (1.38 to 1.64), technicians and associate professionals, OR 2.33 (2.05 to 2.65) and professionals, OR 3.04 (2.70 to 3.43). Patients in municipalities with a brain-injury rehabilitation centre did not have a better prognosis than patients in other municipalities, OR 0.91 (0.78 to 1.06). Being a woman, OR 0.79 (0.74 to 0.84), self-employed, OR 0.87 (0.78 to 0.96), or ≥50 years, OR 0.61 (0.57 to 0.65), was associated with an adverse prognosis.
Conclusion
Further research is needed to explain the gender inequality, which suggests either a potential to improve return-to-work rates among the females or a tendency among the males to return too early.
Article summary
Article focus
The present study estimates ORs for return to gainful occupation ca. 2 years after stroke.
It focuses on clinical, demographic and occupational factors which are potentially useful in predicting return to work.
The study includes the total population of 20–57-year-old previously employed hospital treated patients with stroke in Denmark 1996–2006.
Key messages
62% of the studied patients were gainfully occupied during the second calendar year after the stroke.
The odds of returning to work depend on age, gender, occupation, self-employment and type of stroke.
Women had a much lower chance of returning to work than men, and to our knowledge there are no known physiological factors which can justify this difference.
Patients in municipalities with a brain-injury rehabilitation centre did not have a better prognosis than patients in other municipalities.
Strengths and limitations of this study
The follow-up was carried out through registers and all people in the target population were included. Hence, the study is free from sampling bias, recall bias and non-response bias.
The statistical model was completely defined, and a detailed study protocol was published before we looked at any relation between the concerned exposure and response variables in our data material. Since we adhered to the protocol, the study is free from hindsight bias.
The study is further strengthened by its size.
The major weakness of the study is that it does not contain any stroke-severity measures.
doi:10.1136/bmjopen-2011-000180
PMCID: PMC3211051  PMID: 22021879

Results 1-3 (3)