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Andrea LC, Svendsen SW, Frost P, Smidt K, Gelineck J, Christiansen DH, Deutch SR, Hansen TB, Haahr JP, Dalbøge A. Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability. Skeletal Radiol 2024:10.1007/s00256-024-04675-7. [PMID: 38652296 DOI: 10.1007/s00256-024-04675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. MATERIALS AND METHODS This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland-Altman plots, or intraclass coefficients. RESULTS A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). CONCLUSION Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.
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Affiliation(s)
- Linda Christie Andrea
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark.
| | - Susanne Wulff Svendsen
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kate Smidt
- Department of Orthopedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - John Gelineck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark
| | - Jens Peder Haahr
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
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Worm MS, Kruse M, Valentin JB, Svendsen SW, Nielsen JF, Thomsen JF, Johnsen SP. Acquired Brain Injury Among Adolescents and Young Adults: A Nationwide Study of Labor Market Attachment. J Occup Rehabil 2023; 33:592-601. [PMID: 36795230 DOI: 10.1007/s10926-023-10097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Purpose Young patients represent a particularly vulnerable group regarding vocational prognosis after an acquired brain injury (ABI). We aimed to investigate how sequelae and rehabilitation needs are associated with vocational prognosis up to 3 years after an ABI in 15-30-year-old patients. Methods An incidence cohort of 285 patients with ABI completed a questionnaire on sequelae and rehabilitation interventions and needs 3 months after the index hospital contact. They were followed-up for up to 3 years with respect to the primary outcome "stable return to education/work (sRTW)", which was defined using a national register of public transfer payments. Data were analyzed using cumulative incidence curves and cause-specific hazard ratios. Results Young individuals reported a high frequency of mainly pain-related (52%) and cognitive sequelae (46%) at 3 months. Motor problems were less frequent (18%), but negatively associated with sRTW within 3 years (adjusted HR 0.57, 95% CI 0.39-0.84). Rehabilitation interventions were received by 28% while 21% reported unmet rehabilitation needs, and both factors were negatively associated with sRTW (adjusted HR 0.66, 95% CI 0.48-0.91 and adjusted HR 0.72, 95% CI 0.51-1.01). Conclusions Young patients frequently experienced sequelae and rehabilitation needs 3 months post ABI, which was negatively associated with long-term labor market attachment. The low rate of sRTW among patients with sequelae and unmet rehabilitation needs indicates an untapped potential for ameliorated vocational and rehabilitating initiatives targeted at young patients.
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Affiliation(s)
- M S Worm
- Department of Neurology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - M Kruse
- Danish Centre for Health Economics, DaCHE, University of Southern Denmark, Odense, Denmark
| | - J B Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - S W Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
- Danish Ramazzini Centre, Department of Occupational Medicine - University Research Clinic, Herning Hospital, Herning, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - J F Thomsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S P Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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Trøstrup J, Frost P, Dalbøge A, Mikkelsen LR, Høybye MT, Jørgensen LB, Casper SD, Klebe TM, Svendsen SW. Reducing Shoulder Complaints in Employees with High Occupational Shoulder Exposures: A Cluster-Randomised Controlled Study (The Shoulder-Café Study). J Occup Rehabil 2023; 33:473-485. [PMID: 36512271 DOI: 10.1007/s10926-022-10086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To evaluate if a group-based Shoulder-Café intervention could reduce shoulder complaints more effectively than an individual-based control intervention in employees with shoulder complaints and high occupational shoulder exposures. METHODS A cluster-randomised controlled study of 109 participants from 60 companies in Central Denmark Region. Companies were randomised and allocated to either Shoulder-Café or control intervention. Participants in both interventions received a pamphlet on home-based shoulder exercises and a pamphlet with general information on reducing occupational shoulder exposures. They also had their occupational shoulder exposures assessed. Shoulder-Café participants additionally received three café-meetings with casual discussion, clinical shoulder evaluation, education about shoulder anatomy and occupational shoulder exposures, supervised exercises, workplace-oriented counselling, and an optional workplace visit. The primary outcome measure was the Oxford Shoulder Score (OSS) at 6-month follow-up. Secondary outcome measures were the OSS at 12 months, Fear-Avoidance Beliefs Questionnaire - Physical Activity at 6 and 12 months, and Patients' Global Impression of Change at 6 months. The study also included seven supplementary outcome measures. RESULTS Both groups improved from baseline to 6 months with respect to the primary outcome (P < 0.01). No group differences were found for the primary outcome (mean difference (MD) [95% confidence interval]: 0.3 [- 1.6; 2.2]) or secondary outcomes. The supplementary outcomes "felt informed about handling shoulder complaints" and "felt informed about reducing occupational exposures" at 6 months, and "Patients' Global Impression of Change" and "overall satisfaction" at 12 months favoured the Shoulder-Café intervention. CONCLUSION The Shoulder-Café intervention did not reduce shoulder complaints more effectively than the control intervention. TRIAL REGISTRATION The trial was registered at Clinicaltrials.gov on 19 May 2017 (ID: NCT03159910).
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Affiliation(s)
- J Trøstrup
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.
| | - P Frost
- Centre for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - A Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L R Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M T Høybye
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L B Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Knowledge Centre for Neurorehabilitation of Western Denmark, Regional Hospital Central Jutland, Hammel, Denmark
| | | | - T M Klebe
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
| | - S W Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Gødstrup Hospital - University Research Clinic, Herning, Denmark
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Kirkeby L, Svendsen SW, Hansen TB, Frost P. Return to Work After Surgery For Trapeziometacarpal Joint Osteoarthritis in Relation to Occupational Hand Force Requirements. J Hand Surg Am 2023; 48:361-369. [PMID: 36774322 DOI: 10.1016/j.jhsa.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 12/04/2022] [Accepted: 12/20/2022] [Indexed: 02/13/2023]
Abstract
PURPOSE This study evaluated the hypothesis that higher occupational hand force requirements are related to slower return to work (RTW) after surgery for trapeziometacarpal joint osteoarthritis. METHODS Patients treated surgically for trapeziometacarpal joint osteoarthritis from 2001 to 2017 were identified in the Danish National Patient Register. Sustainable RTW (sRTW) was defined as the first period of 4 consecutive weeks without health-related public transfer payments, according to the Danish National Register on Public Transfer Payments. Occupational codes from the Danish Employment Classification Module were linked to a hand-arm job exposure matrix to obtain occupational hand force requirements for each patient. Cox regression models were used to analyze time until sRTW in relation to hand force requirements with adjustment for age, sex, type of surgery, preoperative sick leave, and calendar year of surgery. RESULTS The study included 2,090 patients. Within 104 weeks, 91% sustainably returned to work. The percentage of individuals in the subgroups that did not RTW was 8% of low-force- and medium-force-exposed patients and 14% of high-force-exposed patients. Medium and high occupational hand force requirements were associated with slower sRTW. The adjusted hazard ratio for sRTW was 0.84 (95% confidence interval, 0.74-0.95) for medium and 0.59 (95% confidence interval, 0.50-0.68) for high compared with low hand force requirements. Among patients who returned to work, patients with medium and high hand force requirements had median periods until sRTW of 16 and 18 weeks, respectively, compared with 10 weeks among patients with low hand force requirements. CONCLUSIONS The prognosis regarding RTW after surgery for trapeziometacarpal joint osteoarthritis is generally good, but patients with higher occupational hand force requirements can expect slower RTW. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Lone Kirkeby
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedic Surgery, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, Aarhus, Denmark.
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Gødstrup Hospital - University Research Clinic, Herning, Denmark
| | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedic Surgery, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, Aarhus, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
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Worm MS, Valentin JB, Johnsen SP, Nielsen JF, Svendsen SW. Vocational/educational prognosis in adolescents and young adults with acquired brain injury: a nationwide cohort study. Brain Inj 2022; 37:1-8. [PMID: 36576114 DOI: 10.1080/02699052.2022.2158221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 07/04/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine prognostic factors for work ability and employment/educational status among young patients referred to outpatient neurorehabilitation clinics after an acquired brain injury. METHODS A nationwide cohort study of 471 15-30-year-old patients who attended an interdisciplinary clinical assessment and provided questionnaire data at baseline and after one year. The outcomes were the Work Ability Score (WAS, 0-10 (best)) and employment/educational status after one year. Prognostic performance was analyzed using univariable regression and multivariable Ridge regression in a five-fold cross-validated procedure. RESULTS Preinjury, 86% of the patients were employed, while the percentage had decreased to 55% at baseline and 52% at follow-up. The model, which included clinical measures of function, showed moderate prognostic performance with respect to WAS (R2=0.29) and employment/educational status (area under the curve (AUC)=0.77). Glasgow Outcome Scale Extended (R2=0.15, AUC=0.68) and the cognitive subscale of the Functional Independence Measure (R2=0.09, AUC=0.64), along with fatigue measured with the Multidimensional Fatigue Inventory (R2=0.15, AUC=0.60) were the single predictors with the highest predictive performance. CONCLUSION Despite generally high scores in motor and cognitive tests, only about half of the patients were employed at baseline and this proportion remained stable. Global disability, cognitive sequelae and fatigue had the highest prognostic performance.
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Affiliation(s)
- M S Worm
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J B Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - S P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - S W Svendsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
- Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark
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Korshøj M, Svendsen SW, Hendriksen PF, Gupta N, Holtermann A, Andersen JH, Dalbøge A, Frost P. Agreement between an expert-rated mini job exposure matrix of occupational biomechanical exposures to the lower body and technical measurements or observation: a method comparison study. BMJ Open 2022; 12:e064035. [PMID: 36576183 PMCID: PMC9723893 DOI: 10.1136/bmjopen-2022-064035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Investigating the agreement between an expert-rated mini job exposure matrix (JEM) of lower body exposures and technical measurements of worktime spent standing/walking and observation-based estimates of time spent kneeling/squatting and total load lifted per workday. METHODS We chose 16 job titles from the 121 job groups in the lower body JEM and included them in the mini JEM. New expert ratings for the mini JEM were performed by the same five occupational physicians who performed the ratings for the lower body JEM. For each job title and type of exposure, the exposure estimates were a mean of the five independent ratings. Technical measurements of standing/walking for all 16 job titles, and for 8 job titles workplace observations were performed of kneeling/squatting and total load lifted per workday. Data were collected from September to December 2015 and supplemented by data from the NOMAD and DPhacto studies collected between 2011 and 2013. All data were collected in Denmark. Agreement between expert-based and measured/observed lower body exposures by job titles was evaluated using Spearman's rank correlation, Bland-Altman plots evaluated systematic deviations and limits of agreement (LoA). RESULTS Standing/walking showed a rank correlation of 0.55, kneeling/squatting 0.83 and total load lifted per workday 0.71. The mini JEM estimates did not systematically deviate from the technical measurements/observations for time spent standing/walking (mean difference 0.20 hours/workday, LoA -1.63, 2.03 hours/workday) and kneeling/squatting (mean difference -0.35 hours/workday, LoA -1.21, 0.51 hours/workday). For total load lifted per workday, the mini JEM systematically overestimated the exposures compared with the observations (mean difference -909 kg/workday, LoA -3000, 1147 kg/workday). CONCLUSIONS There was moderate to very high agreement between an expert-rated mini JEM of standing/walking, kneeling/squatting, and lifting exposures and corresponding technical measurements/observations. This method comparison study supports the use of the expert-based lower body JEM in large-scale occupational epidemiological studies.
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Affiliation(s)
- Mette Korshøj
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbæk Hospital, a part of Copenhagen University Hospital, Holbæk, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Gødstrup Hospital, University Research Clinic, Gødstrup, Denmark
| | | | - Nidhi Gupta
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Johan Hviid Andersen
- Danish Ramazzini Centre, Department of Occupational Medicine, Gødstrup Hospital, University Research Clinic, Gødstrup, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Dalbøge A, Frost P, Andersen JH, Svendsen SW. Associations between single and combined occupational mechanical exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study. Scand J Work Environ Health 2022; 48:490-497. [PMID: 35532098 PMCID: PMC9888441 DOI: 10.5271/sjweh.4032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate whether the risk of surgery for subacromial impingement syndrome (SIS) increases with the number of combined occupational mechanical exposures compared with single exposure. METHODS We reanalyzed data from a register-based cohort study of the entire Danish working population (N=2 374 403) with 14 118 events of surgery for SIS (2003-2008). Exposure information in 10-year windows was obtained by combining occupational codes with a job exposure matrix. For single and combined mechanical exposures, we created three exposure variables of the number of years with specific exposure intensities with or without co-existing mechanical exposures. We used logistic regression as survival analysis. RESULTS We found exposure-response relations for duration and intensity of each single mechanical exposure except for repetition. The single effect of arm elevation >90º reached a maximum adjusted odds ratio (ORadj) of 1.7 [95% confidence interval (CI) 1.5-2.0], which increased to 1.8 (95% CI 1.5-2.0), 2.0 (95% CI 1.9-2.2), and 2.2 (95% CI 2.0-2.5) when combined with repetition, force, and both. When combining repetition with arm elevation >90º, force, and both, ORadj increased from 1.5 (95% CI 1.3-1.8) to 2.1 (95% CI 1.8-2.4), 2.5 (95% CI 2.4-2.9), and 2.7 (95% CI 2.4-3.0). For force, ORadj increased from 2.5 (95% CI 2.1-2.9) to 2.6 (95% CI 2.3-2.8), 2.8 (95% CI 2.4-3.2), and 3.0 (95% CI 2.6-3.4). CONCLUSION We found an increased risk of surgery for SIS with the number of combined exposures; the risk was especially pronounced when the combined exposures included force.
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Affiliation(s)
- Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark,Danish Ramazzini Centre, Department of Occupational Medicine - University Research Clinic, Gødstrup Hospital, Denmark,
Correspondence to: Annett Dalbøge, Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. [E-mail: ]
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Hviid Andersen
- Danish Ramazzini Centre, Department of Occupational Medicine - University Research Clinic, Gødstrup Hospital, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine - University Research Clinic, Gødstrup Hospital, Denmark
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Kothari SF, Eggertsen PP, Frederiksen OV, Thastum MM, Svendsen SW, Tuborgh A, Næss-Schmidt ET, Rask CU, Schröder A, Kasch H, Nielsen JF. Characterization of persistent post-traumatic headache and management strategies in adolescents and young adults following mild traumatic brain injury. Sci Rep 2022; 12:2209. [PMID: 35140235 PMCID: PMC8828894 DOI: 10.1038/s41598-022-05187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
Characteristics of persistent post-traumatic headache (PTH) in young individuals are poorly known leading to diagnostic problems and diverse management. We aimed to describe headache phenotypes and self-reported management strategies in young individuals with PTH following mild traumatic brain injury (mTBI). A comprehensive structured questionnaire was used to evaluate headache phenotypes/characteristics and management strategies to relieve headache in 107, 15–30-year-old individuals with PTH. Around 4 months post-injury, migraine-like headache in combination with tension-type like headache (40%) was the most commonly encountered headache phenotype followed by migraine-like headache (36%). Around 50% reported aura-like symptoms before/during the headache attack. Medication-overuse headache was diagnosed in 10%. Stress, sleep disturbances, and bright lights were the most common trigger factors. More than 80% reported that their headache was worsened by work-related activity and alleviated by rest/lying down. Simple analgesics were commonly used (88%) whereas prophylactic drugs were rarely used (5%). Bedrest and physiotherapy were also commonly used as management strategies by 56% and 34% of the participants, respectively. In conclusion, most young individuals with PTH after mTBI presented with combined migraine-like and tension-type-like headache followed by migraine-like headache, only. Preventive headache medication was rarely used, while simple analgesics and bedrest were commonly used for short-term headache relief.
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Affiliation(s)
- Simple Futarmal Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark. .,Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark. .,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
| | | | | | | | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | | | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Helge Kasch
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Thastum MM, Schroeder A, Evald L, Naess-Schmidt E, Tuborgh A, Jensen JS, Svendsen SW, Nielsen JF, Rask CU. Self-Rated Executive Function and Health-Related Quality of Life in Young Adults With Persistent Post-Concussion Symptoms: A Cross-Sectional Study. Arch Clin Neuropsychol 2021; 37:762-774. [PMID: 34849526 DOI: 10.1093/arclin/acab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess self-reported executive dysfunction in young adult patients with persistent post-concussion symptoms (PCS) 2-6 months post-injury, and the association with self-reported Health-Related Quality of Life (HRQoL). METHOD This cross-sectional study carried out in a hospital setting was a secondary analysis of data from a separate randomized trial testing the effect of a novel intervention, "Get going After concussIoN " (GAIN), for persistent PCS. Patients (18-30 years) were recruited from a clinical cohort of patients with a hospital diagnosis of concussion or referred by primary care physicians. Main measures were The Behaviour Rating Inventory of Executive Function-Adult Version providing two index scores, that is, the Metacognitive Index (MI) and the Behavioural Regulation Index (BRI), and the Quality of Life after Brain Injury-Overall Scale. RESULTS Compared with normative data, patients had elevated scores (i.e., worse functioning) on both the MI and the BRI. In linear regression analysis, the MI score, but not the BRI score, was negatively associated with self-reported HRQoL (MI: slope = -.27, 95% confidence interval, CI [-.53, -.02], p = .03; BRI: slope = -.19, 95% CI [-.49, .13], p = .24), suggesting a positive association of subjective executive dysfunction and lower HRQoL. However, the association was attenuated after adjustment for self-reported psychological distress (MI: slope = -.09, 95% CI [-.34, .17], p = .51). CONCLUSION Self-reported executive dysfunction is common in young adult patients with persistent PCS, but not strongly associated with decreased HRQoL after adjusting for concurrent psychological distress.
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Affiliation(s)
- Mille Moeller Thastum
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.,Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Andreas Schroeder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Erhard Naess-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Astrid Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Jens Sondergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
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10
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Tuborgh A, Svendsen SW, Elklit A, Hunter J, Jensen JS, Schröder A, Nielsen JF, Thastum MM, Næss-Schmidt ET, Rask CU. Attachment and symptom reporting in adolescents and young adults after a concussion. J Psychosom Res 2021; 150:110603. [PMID: 34509710 DOI: 10.1016/j.jpsychores.2021.110603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of hospital-treated concussion is 100-300/100,000 person years. Reporting of long-lasting post-concussion symptoms (PCS) is estimated at 5-15%. Attachment insecurity is a potential vulnerability factor for physical illness and poorer disease outcomes in general. This study aimed to explore associations between attachment insecurity and PCS in young people sustaining a concussion. METHODS This cross-sectional study was embedded in a cohort of 15-30-year-old patients (n = 3080) 3 months after sustaining a concussion. Data were obtained from a database and questionnaires. PCS were measured by the Rivermead Post-Concussion Symptoms Questionnaire and attachment dimensions (anxiety and avoidance) by the Experiences in Close Relationships-Relationship Structures Questionnaire. Multiple linear regression models were performed to investigate the association between the attachment dimensions and PCS with adjustment for demographic, injury-related and psychological factors and with additional testing for interaction between the attachment dimensions. RESULTS In the final study sample, comprising 973 patients (31.6%), we found an interaction between the attachment dimensions. Hence, the effect of attachment anxiety on PCS was statistically insignificant at low avoidance (25th percentile) but significant at high avoidance (75th percentile, β = 0.64 (95%CI: 0.02; 1.26)), whereas the effect of attachment avoidance was significant regardless of level of attachment anxiety (25th percentile, β = 1.09 (95%CI: 0.18; 2.01); 75th percentile, β = 2.71 (95%CI: 1.80; 3.61)). CONCLUSION Attachment insecurity, especially characterised by high avoidance in combination with high anxiety, also called fearful attachment, is associated with PCS. Considering the attachment perspective can potentially improve health care for this patient group.
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Affiliation(s)
- A Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - S W Svendsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Department of Public Health, Section of Environmental Health, University of Copenhagen, Denmark
| | - A Elklit
- Department of Psychology, National Centre of Psycho-traumatology, University of Southern Denmark, Denmark
| | - J Hunter
- Department of Psychiatry, Sinai Health System, University of Toronto, Canada
| | - J S Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - A Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - M M Thastum
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - E T Næss-Schmidt
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - C U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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11
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Worm MS, Valentin JB, Johnsen SP, Nielsen JF, Forchhammer HB, Svendsen SW. Predictors of disability in adolescents and young adults with acquired brain injury after the acute phase. Brain Inj 2021; 35:893-901. [PMID: 34057869 DOI: 10.1080/02699052.2021.1927183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To develop and validate a prediction model for disability among young patients with acquired brain injury (ABI) after the acute phase. METHODS Within a nationwide cohort of 446 15-30-year-old ABI-patients, we predicted disability in terms of Glasgow Outcome Scale - Extended (GOS-E) <7 12 months after baseline assessment in outpatient neurorehabilitation clinics. We studied 22 potential predictors covering demographic and medical factors, clinical tests, and self-reported fatigue and alcohol/drug consumption. The model was developed using multivariable logistic regression analysis and validated by 5-fold cross-validation and geographical validation. The model's performance was assessed by receiver operating characteristic curves and calibration plots. RESULTS Baseline assessment took place a median of 12 months post-ABI. Low GOS-E (range 1-8 (best)) and Functional Independence Measure (range 18-126 (best)) along with high mental fatigue (range 4-20 (worst)) predicted disability. The model showed high validity and performance with an area under the curve of 0.82 (95% confidence interval (CI) 0.77, 0.87) in the cross-validation and 0.81 (95% CI 0.73, 0.88) in the geographical validation. CONCLUSION We developed and validated a parsimonious model which effectively predicted disability. The model may be useful to guide decision-making in outpatient neurorehabilitation clinics treating young patients with ABI.
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Affiliation(s)
- M S Worm
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J B Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - S P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - H B Forchhammer
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S W Svendsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark.,Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark
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12
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Trillingsgaard Naess-Schmidt E, Udby Blicher J, Møller Thastum M, Ulrikka Rask C, Wulff Svendsen S, Schröder A, Høgh Tuborgh A, Østergaard L, Sangill R, Lund T, Nørhøj Jespersen S, Roer Pedersen A, Hansen B, Fristed Eskildsen S, Feldbaek Nielsen J. Microstructural changes in the brain after long-term post-concussion symptoms: A randomized trial. J Neurosci Res 2020; 99:872-886. [PMID: 33319932 DOI: 10.1002/jnr.24773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 01/17/2023]
Abstract
A recent randomized controlled trial in young patients with long-term post-concussion symptoms showed that a novel behavioral intervention "Get going After concussIoN" is superior to enhanced usual care in terms of symptom reduction. It is unknown whether these interventional effects are associated with microstructural brain changes. The aim of this study was to examine whether diffusion-weighted MRI indices, which are sensitive to the interactions between cellular structures and water molecules' Brownian motion, respond differently to the interventions of the above-mentioned trial and whether such differences correlate with the improvement of post-concussion symptoms. Twenty-three patients from the intervention group (mean age 22.8, 18 females) and 19 patients from the control group (enhanced usual care) (mean age 23.9, 14 females) were enrolled. The primary outcome measure was the mean kurtosis tensor, which is sensitive to the microscopic complexity of brain tissue. The mean kurtosis tensor was significantly increased in the intervention group (p = 0.003) in the corpus callosum but not in the thalamus (p = 0.78) and the hippocampus (p = 0.34). An increase in mean kurtosis tensor in the corpus callosum tended to be associated with a reduction in symptoms, but this association did not reach significance (p = 0.059). Changes in diffusion tensor imaging metrics did not differ between intervention groups and were not associated with symptoms. The current study found different diffusion-weighted MRI responses from the microscopic cellular structures of the corpus callosum between patients receiving a novel behavioral intervention and patients receiving enhanced usual care. Correlations with improvement of post-concussion symptoms were not evident.
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Affiliation(s)
- Erhard Trillingsgaard Naess-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
| | - Jakob Udby Blicher
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Mille Møller Thastum
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Wulff Svendsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Høgh Tuborgh
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Leif Østergaard
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ryan Sangill
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Torben Lund
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Sune Nørhøj Jespersen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - Asger Roer Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
| | - Brian Hansen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Simon Fristed Eskildsen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
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13
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Kirkeby L, Svendsen SW, Hansen TB, Frost P. Surgery for trapeziometacarpal osteoarthritis in relation to cumulative occupational hand force requirements: a Danish nationwide cohort study. Occup Environ Med 2020; 78:92-97. [PMID: 32895317 DOI: 10.1136/oemed-2020-106654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate if higher cumulative occupational hand force requirements are associated with higher risks of surgery for trapeziometacarpal osteoarthritis and with surgery earlier in life. METHODS The study was based on Danish national registers. Among all persons born in Denmark 1931 to 1990, we included those who had been employed for at least 5 years since 1991 by the end of 2000, or later when this employment criterion was reached, up until the end of 2016. Cumulative exposure estimates for 10-year time windows (force-years) were assessed by combining individual year-by-year information on occupational codes with an expert based hand-arm job exposure matrix. First-time events of surgery for trapeziometacarpal osteoarthritis 2001 to 2017 constituted the outcome. Surgery rates were analysed by a logistic regression technique equivalent to discrete survival analysis using a 1-year lag. We also calculated rate advancement periods. RESULTS A total of 2 860 448 persons contributed with around 48 million person-years of follow-up, during which 3977 cases appeared (821 among men and 3156 among women). Compared with <5 force-years, the adjusted OR (ORadj) for ≥5 to <10 force-years was 1.39 (95% CI 1.14 to 1.68) and for ≥10 to 30 force-years 1.47 (95% CI 1.26 to 1.71) among men and 1.64 (95% CI 1.50 to 1.78) and 1.29 (95% CI 1.16 to 1.43) among women. The sex combined ORadj were 1.59 (95% CI 1.47 to 1.72) and 1.36 (95% CI 1.25 to 1.48). Among the exposed, surgery was advanced by 3 to 7 years. CONCLUSION Medium/high cumulative hand force requirements were associated with elevated hazard rates of surgery for trapeziometacarpal osteoarthritis and advanced the time of surgery by several years.
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Affiliation(s)
- Lone Kirkeby
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro, Denmark .,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Susanne Wulff Svendsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark.,Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Poul Frost
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
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14
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Bonde JPE, Flachs EM, Madsen IE, Petersen SB, Andersen JH, Hansen J, Jørgensen EB, Kolstad H, Holtermann A, Schlünssen V, Svendsen SW. Acute myocardial infarction in relation to physical activities at work: a nationwide follow-up study based on job-exposure matrices. Scand J Work Environ Health 2020; 46:268-277. [PMID: 31725896 DOI: 10.5271/sjweh.3863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective This study aimed to evaluate sex-specific risks of acute myocardial infarction (AMI) according to lifting and standing/walking at work. Methods The study population included 1.15 million Danish wage earners. Annual job codes from 1976 onwards were linked to specific exposures using job-exposure matrices (JEM). Cases of AMI during follow-up 1996-2016 were retrieved from national registers. Incidence rate ratios (IRR) were computed by Poisson regression adjusting for demographic and JEM-assessed lifestyle factors. Models addressed physical activities at work the previous 0-2 years (short-term risk) and cumulative physical activities (long-term risk). Results During 21.4 million person-years of follow-up, 22 037 AMI occurred in men and 6942 in women. Exposure-response relationships between recent physical activities at work and AMI were not evident. In men, the fully adjusted long-term IRR for the highest of five exposure categories compared to the lowest were 1.09 [95% confidence interval (CI) 1.03-1.15] for lifting and 1.01 (95% CI 0.96-1.07) for standing/walking. In women, the corresponding figures were 1.27 (95% CI 1.15-1.40) and 1.18 (95% CI 1.07-1.30). The latter risk estimate was strongly attenuated, and the trend became insignificant when adjusted for lifting. Findings were only partially supported by sensitivity analyses. Conclusion The study provides limited support to the hypothesis that long-term lifting and standing/walking at work is related to increased risk of AMI. Possible effects of acute physical exertion are not addressed and bias towards the null because of crude exposure assignment cannot be ruled out.
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Affiliation(s)
- Jens Peter Ellekilde Bonde
- Bispebjerg Frederiksberg Hospitals, Department of Occupational and Environmental Medicine, Bispebjerg Bakke 23, DK-Copenhagen 2400 NV, Denmark.
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15
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Flachs EM, Petersen SEB, Kolstad HA, Schlünssen V, Svendsen SW, Hansen J, Budtz-Jørgensen E, Andersen JH, Madsen IEH, Bonde JPE. Cohort Profile: DOC*X: a nationwide Danish occupational cohort with eXposure data - an open research resource. Int J Epidemiol 2020; 48:1413-1413k. [PMID: 31730707 DOI: 10.1093/ije/dyz110] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Johnni Hansen
- The Danish Cancer Society, Research Center, Copenhagen, Denmark
| | - Esben Budtz-Jørgensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Johan Hviid Andersen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | | | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.,Institute of, Public, Health, University of Copenhagen, Copenhagen, Denmark
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16
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Thastum MM, Rask CU, Næss-Schmidt ET, Tuborgh A, Jensen JS, Svendsen SW, Nielsen JF, Schröder A. Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2-6 months post-injury: A randomised trial. EClinicalMedicine 2019; 17:100214. [PMID: 31891145 PMCID: PMC6933237 DOI: 10.1016/j.eclinm.2019.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/11/2019] [Accepted: 11/12/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Evidence for effective interventions to prevent long-term sequelae after concussion is sparse. This study aimed to test the efficacy of Get going After concussIoN (GAIN), an interdisciplinary, individually-tailored intervention of 8 weeks duration based on gradual return to activities and principles from cognitive behavioural therapy. METHODS We conducted an open-label, parallel-group randomised trial in a hospital setting in Central Denmark Region. Participants were 15-30-year-old patients with high levels of post-concussion symptoms (PCS) 2-6 months post-concussion (i.e., a score ≥20 on the Rivermead Post-concussion Symptoms Questionnaire (RPQ)). They were randomly assigned (1:1) to either enhanced usual care (EUC) or GAIN+EUC. Masking of participants and therapists was not possible. The primary outcome was change in RPQ-score from baseline to 3-month FU. All analyses were done on an intention-to-treat basis using linear mixed-effects models. This trial is registered with ClinicalTrials.gov, number NCT02337101. FINDINGS Between March 1, 2015, and September 1, 2017, we included 112 patients. Patients allocated to GAIN+EUC (n=57) reported a significantly larger reduction of PCS than patients allocated to EUC (n=55) with a mean adjusted difference in improvement of 7·6 points (95% confidence interval (CI) 2·0-13·1, p=0·008), Cohen's d=0·5 (95% CI 0·1-0·9). Number needed to treat for prevention of one additional patient with RPQ ≥20 at 3-month FU was 3·6 (95% CI 2·2-11·3). No adverse events were observed. INTERPRETATION Compared with EUC, GAIN+EUC was associated with a larger reduction of post-concussion symptoms at 3-month FU. FUNDING Central Denmark Region and the foundation "Public Health in Central Denmark Region - a collaboration between municipalities and the region".
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Affiliation(s)
- Mille Moeller Thastum
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark
- Corresponding author.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark
| | | | - Astrid Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark
| | - Jens Sondergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark
| | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark
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17
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Trøstrup J, Mikkelsen LR, Frost P, Dalbøge A, Høybye MT, Casper SD, Jørgensen LB, Klebe TM, Svendsen SW. Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study). Trials 2019; 20:627. [PMID: 31718683 PMCID: PMC6852773 DOI: 10.1186/s13063-019-3703-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 09/05/2019] [Indexed: 11/27/2022] Open
Abstract
Background In Denmark, exercise therapy in combination with work modification is the first-choice treatment for persons with shoulder complaints and high occupational shoulder exposures. To obtain this treatment they must visit several healthcare providers, which makes usual care fragmented and uncoordinated. Therefore, we developed a new intervention which unifies the expertise that is needed. The main hypotheses are that a group-based Shoulder-Café intervention will more effectively reduce (1) shoulder complaints and (2) occupational shoulder exposures than an individual-based Shoulder-Guidance intervention (active control – enhanced usual care). Methods A cluster-randomised trial is conducted including 120 employees with high occupational shoulder exposures. Companies (clusters) are randomised to either Shoulder-Café or Shoulder-Guidance with a 1:1 allocation ratio. Participants are 18–65 years old and have an Oxford Shoulder Score (OSS) ≤ 40. Both interventions include a home-based shoulder-exercise programme, assessment of shoulder exposures by technical measurements and self-report, and general information on how to reduce shoulder exposures. The Shoulder-Café course also includes three café meetings with physiotherapist-supervised exercises, clinical shoulder evaluation, education on shoulder anatomy, workplace-orientated counselling, and an opportunity for a workplace visit by a health and safety consultant. The primary outcomes are the OSS at 6-month follow-up (hypothesis I), and the mean number of min/day with the arm elevated > 60° shortly after the end of the intervention (hypothesis II). We will use a mixed-model analysis that allows for company clustering, and data will be analysed according to the intention-to-treat principle. Discussion Persons with shoulder complaints and high occupational shoulder exposures are an obvious target group for secondary prevention efforts. We developed the Shoulder-Café to reduce shoulder complaints and shoulder exposures while unifying the expertise that is needed to evaluate and treat shoulder complaints. If the intervention is effective, it would warrant widespread implementation. Trial registration Clinicaltrials.gov, ID: NCT03159910. Registered on 18 May 2017
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Affiliation(s)
- Jeanette Trøstrup
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark. .,Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark.
| | - Lone Ramer Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark.,Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Terp Høybye
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lene Bastrup Jørgensen
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Martin Klebe
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
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18
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Petersen SB, Flachs EM, Svendsen SW, Marott JL, Budtz-Jørgensen E, Hansen J, Stokholm ZA, Schlünssen V, Andersen JH, Bonde JP. Influence of errors in job codes on job exposure matrix-based exposure assessment in the register-based occupational cohort DOC*X. Scand J Work Environ Health 2019; 46:259-267. [PMID: 31642934 DOI: 10.5271/sjweh.3857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective Job-exposure matrices (JEM) may be efficient for exposure assessment in occupational epidemiological studies, but they rely on valid job information. We evaluated the agreement between JEM-based exposure estimates according to self-reported job titles converted to DISCO-88 codes and according to register-based DISCO-88 codes in the Danish Occupational Cohort with eXposure data (DOC*X). Furthermore, we evaluated the agreement between these two sets of DISCO-88 codes. Methods We used JEM regarding wood dust, lifting, standing/walking, arm elevation >90°, and noise from DOC*X. Participants from previous questionnaire studies were assigned JEM-based exposure estimates using (i) self-reported job titles converted to DISCO-88 codes and (ii) DISCO-88 codes registered in DOC*X, in four time periods (1976-78: N=7707; 1981-83: N=2193; 1991-94: N=2664; 2004: N=11 782). Agreement between the exposure estimates and between the DISCO-88 codes (four-digit levels, 1-4) was evaluated by kappa (κ) statistics. Sensitivities were calculated using the self-reported observation as the gold standard. Results We found substantial agreement (κ>0.60) between exposure estimates for all types of job-exposures and all time periods except for one κ. Low sensitivity (30-65%) was found for the period 1981-83, but for the other time periods the sensitivities varied between 60-91%. For individual 4-digit DISCO-88 codes, the sensitivities varied substantially and overall the sensitivities increased by lower digit level of DISCO-88. Conclusion The validity of the DISCO-88 codes in DOC*X was generally high. Substantial agreement was found for the JEM-based exposure estimates and the DISCO-88 codes per se, although the DISCO-88 code-specific agreement varied across digit levels and time periods.
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Affiliation(s)
- Sesilje Bondo Petersen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
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Vad MV, Frost P, Rosenberg J, Svendsen SW. Persistent postoperative pain after inguinal hernia repair in relation to occupational lifting and standing/walking: a 6-month follow-up study. Occup Environ Med 2019; 76:712-717. [PMID: 31484681 DOI: 10.1136/oemed-2019-105919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/29/2019] [Accepted: 08/23/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aims to evaluate the risk of persistent postoperative pain after inguinal hernia repair in relation to occupational lifting and standing/walking. METHODS We conducted a 6-month follow-up study that included all men with an inguinal hernia repair registered in the Danish Hernia Database from 1 January 2015 to 31 October 2016, who were born from 1 October 1949 to 1 October 1998, and who were alive, living in Denmark, and active in the labour market in the week before surgery. Members of the cohort received a questionnaire 6 months after surgery. Exposure estimates were allocated by combining self reported job titles with a job exposure matrix. Prevalence ratios of persistent postoperative pain during activity ≥2 on a numerical rating scale (range 0-10) according to occupational lifting and standing/walking were estimated using Poisson regression. RESULTS Of 4817 eligible patients, 2609 (54%) returned the questionnaire and 2508 contributed to the analyses. A total of 473 men (18.9%) reported persistent postoperative pain. In the group lifting >1000 to 6125 kg/day, the prevalence was 26.8% compared with 17.5% in the minimally exposed group; adjusted prevalence ratio: 1.44 (95% CI 1.16 to 1.79). For standing/walking >6 hours/day, the prevalence was 23.6% compared with 17.0% in the group standing <4 hours/day; adjusted prevalence ratio: 1.18 (95% CI 0.92 to 1.50). CONCLUSIONS The risk of persistent postoperative pain after inguinal hernia repair was elevated among men with occupational lifting exposures >1000 kg/day. This finding suggests a preventive potential.
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Affiliation(s)
- Marie Vestergaard Vad
- Occupational Medicine, Herning Hospital, Denmark and Occupational Medicine, Aarhus University Hospital, Danish Ramazzini Centre, Aarhus, Denmark
| | - Poul Frost
- Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Rosenberg
- Department of Surgical Gastroenterology D, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Thastum MM, Rask CU, Naess-Schmidt ET, Jensen JS, Frederiksen OV, Tuborgh A, Svendsen SW, Nielsen JF, Schröder A. Design of an early intervention for persistent post-concussion symptoms in adolescents and young adults: A feasibility study. NeuroRehabilitation 2018; 43:155-167. [PMID: 30040756 DOI: 10.3233/nre-172391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND About 5-15 % of patients with concussion experience persistent post-concussion symptoms (PCS) longer than 3 months post-injury. OBJECTIVE To explore the feasibility of a new intervention for young patients with persistent PCS and long-term changes after intervention. METHODS Thirty-two consecutive patients (15-30 years) with persistent PCS 2-4 months post-injury were recruited from a cohort study or referred to a non-randomized feasibility study of an individually tailored, 8-week, multidisciplinary intervention. Assessment was performed at baseline, end of intervention (EOI), and at 3- and 12-month follow-up (FU). Main measures were The Experience of Service Questionnaire (ESQ), Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and The Quality of Life after Brain Injury - Overall Scale (QOLIBRI-OS). RESULTS Twenty-three (72%) patients completed the intervention. The ESQ demonstrated high patient satisfaction. There was a decrease of PCS and an increase in quality of life from baseline to EOI: RPQ score -8.9 points, 95% CI 4.5 to 13.3, p < 0.001; QOLIBRI-OS score +10.5 points, 95% CI 2.5 to 18.5, p = 0.010. Improvement was maintained at 3- and 12-month FU. CONCLUSION The new early intervention is feasible and may prevent chronification of PCS. An RCT is currently performed to evaluate the effect of the intervention.
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Affiliation(s)
- Mille Moeller Thastum
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark.,Child and Adolescent Psychiatric Center, Risskov, Aarhus University Hospital, Denmark
| | | | | | - Oana-Veronica Frederiksen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Astrid Tuborgh
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark.,Child and Adolescent Psychiatric Center, Risskov, Aarhus University Hospital, Denmark
| | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Joergen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
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21
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Rasmussen CDN, Hendriksen PR, Svendsen MJ, Ekner D, Hansen K, Sørensen OH, Svendsen SW, van der Beek AJ, Holtermann A. Improving work for the body - a participatory ergonomic intervention aiming at reducing physical exertion and musculoskeletal pain among childcare workers (the TOY-project): study protocol for a wait-list cluster-randomized controlled trial. Trials 2018; 19:411. [PMID: 30064464 PMCID: PMC6069746 DOI: 10.1186/s13063-018-2788-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 07/05/2018] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of musculoskeletal pain (MSP) is persistently high throughout the world. Work-related factors such as high physical workload (lifting, bending and twisting of the back) are considered to be among the main causes of MSP. Work in childcare includes the need to lift, carry, and support children in a range of activities, requiring several demanding postures and movements, such as bending forward and twisting of the back and sitting on the floor. Participatory ergonomics may represent a solution for decreasing the physical workload to reduce MSP. We present the protocol of a study aiming to evaluate the effect and process of a participatory ergonomics intervention designed to reduce physical exertion during work and MSP (including MSP interfering with work) among childcare workers. Methods/design This study will use a two-arm cluster-randomized design employing a wait-list control, with childcare institutions forming the clusters. Three workshops will be conducted during the 4-month intervention period. Participants will identify risk factors for strenuous work and MSP, develop solutions for reducing the identified risk factors, and implement them in their team. An ergonomic consultant will guide the process. The data collection will consist of questionnaires and objective measures of heart rate and physical activity, observations of physical workload, and information on sickness absence based on company records. Primary outcomes are physical exertion during work and MSP (including pain-related work interference) measured at 4 months. Secondary outcomes measured at 4 months are sickness absence due to MSP; objectively measured occupational physical activity and heart rate; and self-reported self-efficacy, employee involvement, and need for recovery. Alongside the trial, a process evaluation and an economic evaluation will be conducted. Discussion The study will evaluate the effect and process of a participatory ergonomics intervention to reduce physical exertion at work and MSP among childcare workers. By performing a cluster-randomized controlled trial with an effect evaluation based on both objective and self-reported measures with the addition of a process evaluation and economic evaluation, this study will contribute to the evidence for prevention of MSP among a less studied occupational group. Results are expected in 2018–2019. Trial registration ISRCTN, ISRCTN10928313. Registered on 11 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2788-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Peter Rasmus Hendriksen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Malene Jagd Svendsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Dorte Ekner
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Klaus Hansen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Ole Henning Sørensen
- Center for Industrial Production, Aalborg University Copenhagen, A. C. Meyers Vænge 15, 2450, Copenhagen, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Kirkeby L, Frost P, Hansen TB, Svendsen SW. Disability and return to work after MRI on suspicion of scaphoid fracture: Influence of MRI pathology and occupational mechanical exposures. PLoS One 2018; 13:e0197978. [PMID: 29864121 PMCID: PMC5986122 DOI: 10.1371/journal.pone.0197978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/12/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives We aimed to determine the prognosis after early MRI on clinical suspicion of scaphoid fracture, hypothesising that MRI pathology is associated with more disability and that MRI pathology and high occupational mechanical hand-arm exposures are associated with slower return to work (RTW). Methods We conducted a follow-up study of a cohort of 469 patients, who were scanned in the period 2006 to 2010. The respondents constituted our cohort for disability analysis and the subset that was in the labour market at the time of the trauma constituted our sub-cohort for RTW analysis. Questionnaires included disability scores, job title, and lifestyle factors. Job titles were linked with a job exposure matrix to estimate occupational exposures. Register information was obtained on time until RTW. We used logistic regression analysis of disability and Cox regression analysis of time until RTW. Results The proportion that responded was 53% (249/469) for the disability analysis and 59% (125/212) for the RTW analysis. The mean age at follow up was 43.5 years, the mean time since trauma was 4.8 years, 53% had injury of the dominant hand, and 54% had MRI pathology. Men constituted 43% of the cohort and 56% of the sub-cohort. MRI pathology was not associated with more disability [e.g., for a 'Disabilities of the Arm Shoulder and Hand'-score ≥20 the odds ratio was 0.58 (95% confidence interval 0.26–1.17)]. Patients without MRI pathology and with low occupational exposures were off work for an average of four weeks. Patients with MRI pathology or high occupational exposures were off work for twice as long time. Conclusion MRI pathology was not associated with more disability. For patients, who were in the labour market at the time of the trauma, MRI pathology and high occupational mechanical hand-arm exposures were associated with slower RTW.
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Affiliation(s)
- Lone Kirkeby
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Holstebro, Denmark
- * E-mail:
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Holstebro, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland–University Research Clinic, Herning, Denmark
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Hansen GM, Svendsen SW, Brunner I, Nielsen JF. Predicting shoulder function after constraint-induced movement therapy: a retrospective cohort study. Top Stroke Rehabil 2018; 25:281-287. [PMID: 29473446 DOI: 10.1080/10749357.2018.1440508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Several predictors have been associated with upper extremity (UE) recovery after stroke, but characteristics that predict shoulder function after constraint-induced movement therapy (CIMT) have not yet been identified. Objectives To identify predictors associated with satisfactory shoulder function in patients with reduced shoulder function at admission to CIMT. Methods One hundred and seventy five patients were treated using CIMT while in a specialized inpatient hospital. Satisfactory shoulder function was defined according to the functional ability scale of the Wolf Motor Function test. Predictors of satisfactory shoulder function after CIMT were identified using multivariable logistic regression. Results Better distal arm function and good proximal shoulder function on admission to CIMT were strong predictors of satisfactory shoulder function, while age and time of admission to CIMT since stroke were not. Seventeen percent of all CIMT-participants with reduced shoulder function pre-CIMT reached a level of satisfactory shoulder function after CIMT. Discussion A substantial part of patients with reduced shoulder function reached a level of satisfactory shoulder function after CIMT. Intensive CIMT training, comprising tasks that require both distal and proximal UE function, may increase shoulder function in patients with a potential functional reserve.
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Affiliation(s)
- Gunhild Mo Hansen
- a Hammel Neurorehabilitation Center and University Clinic , Aarhus University , Aarhus , Denmark
| | - Susanne Wulff Svendsen
- a Hammel Neurorehabilitation Center and University Clinic , Aarhus University , Aarhus , Denmark.,b Occupational Medicine , Herning Regional Hospital and University Clinic, Aarhus University , Aarhus , Denmark
| | - Iris Brunner
- a Hammel Neurorehabilitation Center and University Clinic , Aarhus University , Aarhus , Denmark
| | - Jørgen Feldbæk Nielsen
- a Hammel Neurorehabilitation Center and University Clinic , Aarhus University , Aarhus , Denmark
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Næss-Schmidt ET, Blicher JU, Tietze A, Rask CU, Svendsen SW, Schröder A, Thastum MM, Tuborgh AH, Frederiksen OV, Østergaard L, Eskildsen SF, Hansen B, Jespersen S, Nielsen JF. Diffusion MRI findings in patients with extensive and minimal post-concussion symptoms after mTBI and healthy controls: a cross sectional study. Brain Inj 2017; 32:91-98. [PMID: 29095055 DOI: 10.1080/02699052.2017.1377352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PRIMARY OBJECTIVES We hypothesized that the microstructure of the corpus callosum, thalamus and hippocampus, as measured with diffusion and Mean of the Kurtosis Tensor (MKT) MRI, differs between healthy subjects and patients with extensive and minimal post-concussion symptoms (PCS) and that MKT measures correlate with PCS severity and self-reported cognitive symptoms. RESEARCH DESIGN A cross-sectional study comparing patients with extensive PCS and patients with minimal PCS 2-5 months after mild traumatic brain injury (mTBI) with each other and with an external healthy control group. METHODS AND PROCEDURES Diffusion MRI was obtained in 25 patients with extensive PCS and in 25 patients with minimal PCS as measured by the Rivermead Post-concussion Symptoms Questionnaire. The patients were matched on age, sex and time since accident. Data from an external healthy control group (n = 27) was included. MAIN OUTCOME AND RESULTS There was no difference in MKT between the two groups with mTBI and no correlation between MKT and PCS. There was no difference between the three groups in other diffusion measures. CONCLUSIONS Our results did not point to microstructural changes in the corpus callosum, thalamus and hippocampus in relation to PCS after mTBI.
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Affiliation(s)
| | - Jakob Udby Blicher
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Anna Tietze
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,c Dept of Neuroradiology , Aarhus University Hospital , Aarhus , Denmark
| | - Charlotte Ulrikka Rask
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark.,e Regional Centre for Child and Adolescent Psychiatry, Risskov , Aarhus University Hospital , Aarhus , Denmark
| | - Susanne Wulff Svendsen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
| | - Andreas Schröder
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Mille Møller Thastum
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Astrid Høeg Tuborgh
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Oana-Veronica Frederiksen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
| | - Leif Østergaard
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,c Dept of Neuroradiology , Aarhus University Hospital , Aarhus , Denmark
| | - Simon Fristed Eskildsen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Brian Hansen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Sune Jespersen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,f Dept of Physics and Astronomy , Aarhus University , Aarhus , Denmark
| | - Jørgen Feldbæk Nielsen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
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Norup A, Svendsen SW, Doser K, Ryttersgaard TO, Frandsen N, Gade L, Forchhammer HB. Prevalence and severity of fatigue in adolescents and young adults with acquired brain injury: A nationwide study. Neuropsychol Rehabil 2017; 29:1113-1128. [PMID: 28895796 DOI: 10.1080/09602011.2017.1371045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: To investigate the prevalence and severity of fatigue in adolescents and young adults with acquired brain injury (ABI) compared with healthy controls (HCs) and to examine associations between fatigue and gender, age and level of education. Methods: This cross-sectional study included 15-30 year old patients with ABI and a convenience sample of 15-30 year old HCs. All participants completed the 20-item Multidimensional Fatigue Inventory (MFI-20). Pathological fatigue was defined as "General Fatigue" ≥12. Adjusted mean differences between groups were calculated using multivariate analysis of covariance (MANCOVA). The adjusted prevalence proportion ratio (PPRadj) of pathological fatigue was calculated using Poisson regression. Results: The patients (n = 334) had higher scores than the HCs (n = 168) on all MFI-20 subscales with adjusted mean differences ranging from 1.7 to 4.7 and a higher prevalence of pathological fatigue (73% versus 29%), PPRadj 2.7 (95% confidence interval 2.1-3.5). Female patients experienced more fatigue than males on the "General Fatigue" and "Reduced Activity" subscales, while no gender differences were found in the HC group. Patients and HCs with elementary education had elevated scores on the "Reduced Activity" and "Mental Fatigue" subscales. Age was not associated with any of the subscale scores. Conclusion: Young patients with ABI had markedly higher prevalence and severity of fatigue than HCs. Age (15-30 years) was not associated with fatigue. No clear patterns of associations were evident with gender and level of education. Abbreviations: ABI: acquired brain injury; CI: confidence interval; GF: general fatigue; GOSE: Glasgow Outcome Scale Extended; HC: healthy control; MANCOVA: multivariate analysis of covariance; MF: mental fatigue; MFI-20: Multidimensional Fatigue Inventory-20; PF: physical fatigue; RA: reduced activity; RM: reduced motivation; TBI: traumatic brain injury.
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Affiliation(s)
- Anne Norup
- a National study of young brain injury survivors, Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Susanne Wulff Svendsen
- b National study of young brain injury survivors, Hammel Neurorehabilitation Centre and University Research Clinic , Aarhus University , Hammel , Denmark
| | - Karoline Doser
- c Survivorship Unit , Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Trine Okkerstrøm Ryttersgaard
- d National study of young brain injury survivors, Department of Neurology , Aalborg University Hospital , Aalborg , Denmark
| | - Nicole Frandsen
- e National study of young brain injury survivors, Department of Neurology , Odense University Hospital , Odense , Denmark
| | - Louise Gade
- f National study of young brain injury survivors, Department of Neurology , Slagelse Hospital , Slagelse , Denmark
| | - Hysse Birgitte Forchhammer
- a National study of young brain injury survivors, Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
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Dalbøge A, Frost P, Andersen JH, Svendsen SW. Surgery for subacromial impingement syndrome in relation to intensities of occupational mechanical exposures across 10-year exposure time windows. Occup Environ Med 2017; 75:176-182. [DOI: 10.1136/oemed-2017-104511] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/17/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
Abstract
ObjectivesWe aimed to identify intensities of occupational mechanical exposures (force, arm elevation and repetition) that do not entail an increased risk of surgery for subacromial impingement syndrome (SIS) even after prolonged durations of exposure. Additionally, we wanted to evaluate if exposure to hand-arm vibration (HAV) is an independent risk factor.MethodsWe used data from a register-based cohort study of the entire Danish working population (n=2 374 403). During follow-up (2003–2008), 14 118 first-time events of surgery for SIS occurred. For each person, we linked register-based occupational codes (1993–2007) to a general population job exposure matrix to obtain year-by-year exposure intensities on measurement scales for force, upper arm elevation >90° and repetition and expert rated intensities of exposure to HAV. For 10-year exposure time windows, we calculated the duration of exposure at specific intensities above minimal (low, medium and high). We used a logistic regression technique equivalent to discrete survival analysis adjusting for cumulative effects of other mechanical exposures.ResultsWe found indications of safe exposure intensities for repetition (median angular velocity <45°/s), while force exertion ≥10% of maximal voluntary electrical activity and upper arm elevation >90° >2 min/day implied an increased risk reaching ORs of 1.7 and 1.5 after 10 years at low intensities. No associations were found for HAV.ConclusionsWe found indications of safe exposure intensities for repetition. Any intensities of force and upper arm elevation >90° above minimal implied an increased risk across 10-year exposure time windows. No independent associations were found for HAV.
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Vad MV, Frost P, Rosenberg J, Andersen JH, Svendsen SW. Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors: a longitudinal study. Occup Environ Med 2017; 74:769-775. [PMID: 28546321 DOI: 10.1136/oemed-2016-104160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/07/2017] [Accepted: 04/21/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate exposure-response relationships between occupational mechanical exposures and first-time lateral and medial inguinal hernia repair and effects of lifestyle factors. To estimate if occupational mechanical exposures advance the repairs. METHODS This longitudinal study was based on a cohort of men aged 18-65 years with questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. We estimated occupational mechanical exposures using a job exposure matrix. First-time inguinal hernia repairs from 1998 to 2014 were identified in the Danish Hernia Database. We used Cox regression analyses and calculated excess fractions among the exposed and rate advancement periods (RAPs). RESULTS Among 17 967 men, we identified 382 lateral and 314 medial repairs. The risk of lateral repairs increased with time spent standing/walking with an HR of 1.45 (95% CI 1.12 to 1.88) for ≥6 hours/day versus <4 hours/day, corresponding to an excess fraction of cases of 31% in the group with ≥6 hours/day. This group had a RAP of 6.7 (95% CI 2.6 to 10.8) years. Medial repairs were not associated with occupational mechanical exposures. A body mass index ≥30 kg/m2 showed lower HRs for both repair types. Leisure-time physical activity and smoking status were not related to any of the outcomes. CONCLUSIONS Assuming a causal relationship, the results suggest that around 30% of all first-time lateral inguinal hernia repairs in the highest exposure category would be preventable if the time spent standing/walking could be reduced from ≥6 to <4 hours/day. The repairs might even be postponed by 6-7 years.
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Affiliation(s)
- Marie Vestergaard Vad
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark.,Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Rosenberg
- Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Johan Hviid Andersen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark
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Dalbøge A, Frost P, Andersen JH, Svendsen SW. Surgery for subacromial impingement syndrome in relation to occupational exposures, lifestyle factors and diabetes mellitus: a nationwide nested case–control study. Occup Environ Med 2017; 74:728-736. [DOI: 10.1136/oemed-2016-104272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/04/2022]
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Tabatabaeifar S, Svendsen SW, Johnsen B, Hansson GÅ, Fuglsang-Frederiksen A, Frost P. Reversible median nerve impairment after three weeks of repetitive work. Scand J Work Environ Health 2017; 43:163-170. [PMID: 28060387 DOI: 10.5271/sjweh.3619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The aim of this study was to evaluate the development of impaired median nerve function in relation to hand-intensive seasonal work. We hypothesized that at end-season, median nerve conduction would be impaired and then recover within weeks. Methods Using nerve conduction studies (NCS), we examined median nerve conduction before, during, and after engaging in 22 days of mink skinning. For a subgroup, we used goniometry and surface electromyography to characterize occupational mechanical exposures. Questionnaire information on symptoms, disability, and lifestyle factors was obtained. Results The study comprised 11 male mink skinners with normal median nerve conduction at pre-season (mean age 35.7 years, mean number of seasons with skinning 8.9 years). Mink skinning was characterized by a median angle of wrist flexion/extension of 16º extension, a median velocity of wrist flexion/extension of 22 °/s, and force exertions of 11% of maximal voluntary electrical activity. At end-season, mean distal motor latency (DML) had increased 0.41 ms (P<0.001), mean sensory nerve conduction velocity (SNCV) digit 2 had decreased 6.3 m/s (P=0.004), and mean SNCV digit 3 had decreased 6.2 m/s (P=0.01); 9 mink skinners had decreases in nerve conduction, 5 fulfilled electrodiagnostic criteria and 4 fulfilled electrodiagnostic and clinical criteria (a positive Katz hand diagram) for carpal tunnel syndrome (CTS). Three to six weeks post-season, the changes had reverted to normal. Symptom and disability scores showed corresponding changes. Conclusions In this natural experiment, impaired median nerve conduction developed during 22 days of repetitive industrial work with moderate wrist postures and limited force exertion. Recovery occurred within 3-6 weeks post-season.
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Affiliation(s)
- Sorosh Tabatabaeifar
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 2C, DK-8000 Aarhus C, Denmark.
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Sommer TG, Svendsen SW, Frost P. Sickness absence and permanent work disability in relation to upper- and lower-body pain and
occupational mechanical and psychosocial exposures. Scand J Work Environ Health 2016; 42:481-489. [DOI: 10.5271/sjweh.3600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Dalbøge A, Hansson GÅ, Frost P, Andersen JH, Heilskov-Hansen T, Svendsen SW. Upper arm elevation and repetitive shoulder movements: a general population job exposure matrix based on expert ratings and technical measurements. Occup Environ Med 2016; 73:553-60. [DOI: 10.1136/oemed-2015-103415] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/26/2016] [Indexed: 01/23/2023]
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Heilskov-Hansen T, Mikkelsen S, Svendsen SW, Thygesen LC, Hansson GÅ, Thomsen JF. Exposure-response relationships between movements and postures of the wrist and carpal tunnel syndrome among male and female house painters: a retrospective cohort study. Occup Environ Med 2016; 73:401-8. [PMID: 27030204 DOI: 10.1136/oemed-2015-103298] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate exposure-response relationships between measured movements and postures of the wrist and the incidence of carpal tunnel syndrome (CTS), and any modifications by sex. METHODS In 2011, we established a historical cohort of 9364 members of the Painters' Union in Denmark. Self-reported task distributions were obtained by questionnaire (53% responded) and combined with sex-specific task exposure matrices to get individual estimates of exposure intensity, that is, velocity of wrist flexion/extension, mean power frequency (MPF) and non-neutral wrist postures. Exposure duration was assessed from yearly working proportions. Registered first-time hospital discharge CTS diagnoses and CTS surgery were collected as outcomes. The cohort was followed from 1994 to 2010. Log-linear Poisson regression was used. RESULTS For CTS diagnoses, the adjusted incidence rate ratios (IRRs) increased with increasing wrist velocity (IRR=1.37 (95% CI 1.10 to 1.71) per °/s) and MPF (IRR=1.53 (95% CI 1.21 to 1.91) per 0.01 Hz). For CTS surgery, the results were similar. The outcomes were not related to non-neutral postures or exposure duration. The adjusted IRRs for women were higher than those for men. There were no multiplicative interaction effects between exposure intensity, exposure duration and sex. However, the absolute incidence rates (IRs) increased at a steeper rate for women than for men, indicating an additive interaction. CONCLUSIONS The incidence of CTS increased with increasing velocity of wrist flexion/extension and MPF of wrist movements. The relative increase in incidence rates was the same for women and men, but the absolute incidence rates increased at a steeper rate for women than for men.
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Affiliation(s)
- Thomas Heilskov-Hansen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Sigurd Mikkelsen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susanne Wulff Svendsen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Gert-Åke Hansson
- Occupational and Environmental Medicine, Lund University, and University and Regional Laboratories Region Scania, Lund, Sweden
| | - Jane Frølund Thomsen
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Christiansen DH, Frost P, Frich LH, Falla D, Svendsen SW. The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome: Impact of Sex, Socio-Demographic and Clinical Factors. PLoS One 2016; 11:e0151077. [PMID: 26954692 PMCID: PMC4783058 DOI: 10.1371/journal.pone.0151077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS). Objective We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy. Methods Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1–75.9, 1 July 2007 to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event. Results Within 52 weeks after first contact, 43% of the patients had physiotherapy and 30% underwent surgery. Within 26 weeks after surgery, 80% had a record of physiotherapy. After first contact and after surgery, exercise was part of physiotherapy in 65% and 84% of the patients, respectively. A public hospital contact, physiotherapy before hospital contact, administrative region, female sex, a diagnosis of other or unspecified disorders (M75.8-M75.9), and surgical procedure predicted higher use of physiotherapy. Low education level predicted slightly lower use of physiotherapy after first contact, but not after surgery. Conclusion In patients with SIS in Danish hospital settings, physiotherapy was more often used after surgery than as part of initial non-surgical treatment. The use of physiotherapy was less common among men than women, whereas unequal use of physiotherapy in relation to education level was not noticeable. The use of physiotherapy with exercises in initial non-surgical treatment was relatively limited.
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Affiliation(s)
- David Høyrup Christiansen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland—University Research Clinic, Herning, Denmark
- * E-mail:
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark
| | | | - Deborah Falla
- Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
- Institute for Neurorehabilitation Systems, Bernstein Focus Neurotechnology (BFNT) Göttingen Bernstein Center for Computational Neuroscience (BCCN), University Medical Center Göttingen Georg-August University, Göttingen, Germany
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland—University Research Clinic, Herning, Denmark
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Christiansen DH, Falla D, Frost P, Frich LH, Svendsen SW. Physiotherapy after subacromial decompression surgery: development of a standardised exercise intervention. Physiotherapy 2015; 101:327-39. [DOI: 10.1016/j.physio.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
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Sejersen MHJ, Frost P, Hansen TB, Deutch SR, Svendsen SW. Proteomics perspectives in rotator cuff research: a systematic review of gene expression and protein composition in human tendinopathy. PLoS One 2015; 10:e0119974. [PMID: 25879758 PMCID: PMC4400011 DOI: 10.1371/journal.pone.0119974] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/03/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other tendinopathies, and to evaluate perspectives of proteomics--the comprehensive study of protein composition--in tendon research. MATERIALS AND METHODS We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue. RESULTS We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy. Most of the included studies quantified prespecified mRNA molecules and proteins using polymerase chain reactions and immunoassays, respectively. There was a tendency towards an increase of collagen I (11 of 15 studies) and III (13 of 14), metalloproteinase (MMP)-1 (6 of 12), -9 (7 of 7), -13 (4 of 7), tissue inhibitor of metalloproteinase (TIMP)-1 (4 of 7), and vascular endothelial growth factor (4 of 7), and a decrease in MMP-3 (10 of 12). Fourteen proteomics studies of tendon tissues/cells failed inclusion, mostly because they were conducted in animals or in vitro. CONCLUSIONS Based on methods, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although proteomics technologies may be a way to identify protein profiles (including non-prespecified proteins) that characterise specific tendon disorders or stages of tendinopathy. Thus, our results suggested an untapped potential for proteomics in tendon research.
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Affiliation(s)
- Maria Hee Jung Sejersen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland—University Research Clinic, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Bæk Hansen
- Research Unit for Orthopaedics, Holstebro Regional Hospital, Holstebro, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | | | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland—University Research Clinic, Herning, Denmark
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Sommer TG, Frost P, Svendsen SW. Combined musculoskeletal pain in the upper and lower body: associations with occupational mechanical and psychosocial exposures. Int Arch Occup Environ Health 2015. [PMID: 25731853 DOI: 10.1007/s00420–015–1036-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Pain in more than one site is common in working populations. We aimed to characterise combined pain (pain in the upper and lower body) and to evaluate whether the prevalence of combined pain is positively related to combined occupational mechanical exposures to the upper and lower body and to high psychosocial job strain. METHODS This cross-sectional study was based on questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. The study included 14,081 men and 20,173 women. Occupational exposures were assessed by job exposure matrices. We analysed the prevalence of pain limited to the upper body, pain limited to the lower body, and combined pain in relation to occupational exposures using Poisson regression. RESULTS During the last year, 23.2 % of the men and 33.9 % of the women reported combined pain, which was characterised by somatisation, illness worrying, and low SF-36 scores. For men, the adjusted prevalence ratio for combined pain was 1.51 [95 % confidence interval (95 % CI) 1.40-1.64] in relation to exposures limited to the upper body and 2.24 (95 % CI 2.11-2.39) in relation to combined exposures. For women, the corresponding adjusted prevalence ratios were 1.56 (95 % CI 1.50-1.63) and 1.55 (95 % CI 1.50-1.61). High job strain was related to pain among men, only. CONCLUSION Combined pain may in part be explained by local effects of occupational mechanical exposures acting at more than one site.
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Affiliation(s)
- Tine Gjedde Sommer
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Nørrebrogade 44, building 2C, 8000, Aarhus C, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.
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Sommer TG, Frost P, Svendsen SW. Combined musculoskeletal pain in the upper and lower body: associations with occupational mechanical and psychosocial exposures. Int Arch Occup Environ Health 2015; 88:1099-110. [DOI: 10.1007/s00420-015-1036-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
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Tabatabaeifar S, Frost P, Andersen JH, Jensen LD, Thomsen JF, Svendsen SW. Varicose veins in the lower extremities in relation to occupational mechanical exposures: a longitudinal study. Occup Environ Med 2015; 72:330-7. [DOI: 10.1136/oemed-2014-102495] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/26/2014] [Indexed: 01/08/2023]
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Vad MV, Frost P, Svendsen SW. Occupational mechanical exposures and reoperation after first-time inguinal hernia repair: a prognosis study in a male cohort. Hernia 2014; 19:893-900. [PMID: 25537572 DOI: 10.1007/s10029-014-1339-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 12/11/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate exposure-response relationships between occupational mechanical exposures and risk of reoperation after inguinal hernia repair. METHODS Using register information, we identified all men born in Denmark 1938-1988, who had their first inguinal hernia repair 1998-2008, and who were 18-65 years old and active in the labour market at the time of surgery. The Danish Hernia Database provided information on repairs and reoperations. We used registered occupational codes and a job exposure matrix based on experts' ratings to estimate total load lifted per day, frequency of heavy lifting, and number of hours per day spent standing/walking. We also obtained register information on sickness absence. Multivariable Cox regression analysis was used. RESULTS The cohort comprised 34,822 patients. We did not reveal exposure-response relationships between occupational mechanical exposures and the hazard ratio (HR) of reoperation. The percentage of patients with >2 weeks of sickness absence within 8 weeks after surgery increased with total load lifted per day from 15 to 53%. Longer sickness absence was associated with an increased HR of reoperation, but within strata of sickness absence, we found no increase in the HR of reoperation with increasing exposures. CONCLUSION We did not find indications that the HR of reoperation was related to occupational mechanical exposures, even after accounting for a potential protective effect of sickness absence. Hence, the exposure-related prolonged duration of sickness absence could not be explained by exposure-related complications that led to reoperation.
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Affiliation(s)
- M V Vad
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark.
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
| | - P Frost
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - S W Svendsen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark
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Dalbøge A, Frost P, Andersen JH, Svendsen SW. Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study. Occup Environ Med 2014; 71:750-6. [DOI: 10.1136/oemed-2014-102161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rubak TS, Svendsen SW, Andersen JH, Haahr JPL, Kryger A, Jensen LD, Frost P. An expert-based job exposure matrix for large scale epidemiologic studies of primary hip and knee osteoarthritis: the Lower Body JEM. BMC Musculoskelet Disord 2014; 15:204. [PMID: 24927760 PMCID: PMC4067499 DOI: 10.1186/1471-2474-15-204] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When conducting large scale epidemiologic studies, it is a challenge to obtain quantitative exposure estimates, which do not rely on self-report where estimates may be influenced by symptoms and knowledge of disease status. In this study we developed a job exposure matrix (JEM) for use in population studies of the work-relatedness of hip and knee osteoarthritis. METHODS Based on all 2227 occupational titles in the Danish version of the International Standard Classification of Occupations (D-ISCO 88), we constructed 121 job groups comprising occupational titles with expected homogeneous exposure patterns in addition to a minimally exposed job group, which was not included in the JEM. The job groups were allocated the mean value of five experts' ratings of daily duration (hours/day) of standing/walking, kneeling/squatting, and whole-body vibration as well as total load lifted (kg/day), and frequency of lifting loads weighing ≥20 kg (times/day). Weighted kappa statistics were used to evaluate inter-rater agreement on rankings of the job groups for four of these exposures (whole-body vibration could not be evaluated due to few exposed job groups). Two external experts checked the face validity of the rankings of the mean values. RESULTS A JEM was constructed and English ISCO codes were provided where possible. The experts' ratings showed fair to moderate agreement with respect to rankings of the job groups (mean weighted kappa values between 0.36 and 0.49). The external experts agreed on 586 of the 605 rankings. CONCLUSION The Lower Body JEM based on experts' ratings was established. Experts agreed on rankings of the job groups, and rankings based on mean values were in accordance with the opinion of external experts.
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Affiliation(s)
- Tine Steen Rubak
- Department of Occupational Medicine, Slagelse Hospital, Ingemannsvej 18, 4200 Slagelse, Denmark.
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Meyland J, Heilskov-Hansen T, Alkjær T, Koblauch H, Mikkelsen S, Svendsen SW, Thomsen JF, Hansson GÅ, Simonsen EB. Sex differences in muscular load among house painters performing identical work tasks. Eur J Appl Physiol 2014; 114:1901-11. [DOI: 10.1007/s00421-014-2918-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
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Frost P, Johnsen B, Fuglsang-Frederiksen A, Svendsen SW. Reply: Lifestyle risk factors for ulnar neuropathy and ulnar neuropathy-like symptoms. Muscle Nerve 2014; 49:618-9. [DOI: 10.1002/mus.24137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 11/14/2013] [Accepted: 11/27/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Poul Frost
- Danish Ramazzini Centre; Department of Occupational Medicine; Aarhus Hospital, Aarhus University Hospital; Aarhus Denmark
| | - Birger Johnsen
- Department of Neurophysiology; Aarhus Hospital, Aarhus University Hospital; Aarhus Denmark
| | | | - Susanne Wulff Svendsen
- Danish Ramazzini Centre; University Department of Occupational Medicine; Herning, Regional Hospital; Herning Denmark
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Juhl M, Larsen PS, Andersen PK, Svendsen SW, Bonde JP, Nybo Andersen AM, Strandberg-Larsen K. Occupational lifting during pregnancy and child’s birth size in a large cohort study. Scand J Work Environ Health 2014; 40:411-9. [DOI: 10.5271/sjweh.3422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Mocevic E, Svendsen SW, Jørgensen KT, Frost P, Bonde JP. Occupational lifting, fetal death and preterm birth: findings from the Danish National Birth Cohort using a job exposure matrix. PLoS One 2014; 9:e90550. [PMID: 24614129 PMCID: PMC3948676 DOI: 10.1371/journal.pone.0090550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/01/2014] [Indexed: 11/24/2022] Open
Abstract
Objective We examined the association between occupational lifting during pregnancy and risk of fetal death and preterm birth using a job exposure matrix (JEM). Methods For 68,086 occupationally active women in the Danish National Birth Cohort, interview information on occupational lifting was collected around gestational week 16. We established a JEM based on information from women, who were still pregnant when interviewed. The JEM provided mean total loads lifted per day within homogeneous exposure groups as informed by job and industry codes. All women were assigned an exposure estimate from the JEM. We used Cox regression models with gestational age as underlying time variable and adjustment for covariates. Results We observed 2,717 fetal deaths and 3,128 preterm births within the study cohort. No exposure-response relation was observed for fetal death, but for women with a prior fetal death, we found a hazard ratio (HR) of 2.87 (95% CI 1.37, 6.01) for stillbirth (fetal death ≥22 completed gestational weeks) among those who lifted >200 kg/day. For preterm birth, we found an exposure-response relation for primigravid women, reaching a HR of 1.43 (95% CI 1.13, 1.80) for total loads >200 kg per day. These findings correspond to an excess fraction of 11% for stillbirth and 10% for preterm birth. Conclusion We found an increased risk of stillbirth among women with a prior fetal death, who lifted >200 kg/day, and an exposure-response relationship between occupational lifting and preterm birth among primigravid women. The study adds to a large body of prospective studies on occupational lifting and adverse pregnancy outcomes by refined exposure assessment.
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Affiliation(s)
- Emina Mocevic
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copehagen, Denmark
- * E-mail:
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, University Department of Occupational Medicine, Herning Regional Hospital, Herning, Denmark
| | - Kristian Tore Jørgensen
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copehagen, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copehagen, Denmark
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Runge SB, Pedersen JK, Svendsen SW, Juhl M, Bonde JP, Nybo Andersen AM. Occupational lifting of heavy loads and preterm birth: a study within the Danish National Birth Cohort. Occup Environ Med 2013; 70:782-8. [PMID: 23839660 DOI: 10.1136/oemed-2012-101173] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the association between occupational lifting during pregnancy and preterm birth. The risk of preterm birth was estimated for total burden lifted per day and number of medium and heavy loads lifted per day. METHODS In a study population of 62 803 pregnant women enrolled to the Danish National Birth Cohort from 1996 to 2002, the association between self-reported occupational lifting in the first part of pregnancy and preterm birth was analysed using logistic regression models with adjustment for age, parity, cervical cone biopsy, assisted reproduction and smoking. Associations between lifting and extremely (before 28 weeks), very (28-32 weeks) and moderately (33-37 weeks) preterm birth were analysed using Cox regression models. RESULTS We found a dose-response relation between total daily burden lifted and preterm birth with an OR of 1.50 (95% CI 1.03 to 2.19) with loads over 1000 kg/day. No threshold value was found. The associations were strongest for extremely and very preterm birth with HRs (95% CIs) of 4.3 (1.4 to 13.8) and 1.7 (0.7 to 4.0), respectively. Lifting heavy loads (>20 kg) more than10 times/day was associated with preterm birth up to an OR of 2.03 (95% CI 1.14 to 3.62). CONCLUSION In a society with social welfare and a highly regulated working environment, occupational lifting was associated with an increased risk of preterm birth.
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Affiliation(s)
- Stine Bjerrum Runge
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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47
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Frost P, Andersen JH, Thomsen JF, Svendsen SW. Commentary. Scand J Work Environ Health 2013; 39:420. [DOI: 10.5271/sjweh.3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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48
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Svendsen SW, Dalbøge A, Andersen JH, Thomsen JF, Frost P. Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures: a longitudinal study. Scand J Work Environ Health 2013; 39:568-77. [DOI: 10.5271/sjweh.3374] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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49
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Rubak TS, Svendsen SW, Søballe K, Frost P. Risk and rate advancement periods of total hip replacement due to primary osteoarthritis in relation to cumulative physical workload. Scand J Work Environ Health 2013; 39:486-94. [DOI: 10.5271/sjweh.3365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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50
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Ban I, Troelsen A, Christiansen DH, Svendsen SW, Kristensen MT. Standardised test protocol (Constant Score) for evaluation of functionality in patients with shoulder disorders. Dan Med J 2013; 60:A4608. [PMID: 23651718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The Constant Score (CS), developed as a scoring system to evaluate overall functionality of patients with shoulder disorders, is widely used but has been criticised for relying on an imprecise terminology and for lack of a standardised methodology. A modified guideline was therefore published in 2008 with several new recommendations, but a standardised test protocol was not included. Also, this new version has not been translated into Danish. The aims of the present study were to develop a standardised English test protocol for the newly modified CS, and to translate and cross-culturally adapt this version into Danish. MATERIAL AND METHODS An English test protocol was developed and translated into Danish at two independent centres according to international recommendations. Consensus on a preliminary version was achieved. The subjective part was tested on six patients, while two physiotherapists gave feedback on the objective part. Relevant items were culturally adapted and rephrased, and a simple standardised test protocol was developed. RESULTS Only minor inconsistencies in the translations were found. A few questions and words had to be rephrased due to cultural and linguistic differences. One of the authors of the modified CS approved both the English and the Danish test protocol. CONCLUSION A simple test protocol of the modified CS was developed in both English and Danish. With precise terminology and definitions, the test protocol is the first of its kind. We suggest its use internationally for standardised assessment of the CS. Testing of validity, reliability and responsiveness of both versions needs to be done in future research. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Ilija Ban
- Ortopædkirurgisk Afdeling, Hvidovre Hospital, 2750 Hvidovre, Denmark.
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