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  • 1.
    Arumugam, Ashokan
    et al.
    University of Sharjah, UAE.
    Björklund, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Umeå universitet.
    Mikko, Sanna
    Umeå universitet.
    Häger, Charlotte K
    Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 5, article id e049226Article, review/survey (Refereed)
    Abstract [en]

    Objective To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury.Design Systematic Review.

    Data sources PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020.

    Eligibility criteria Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included.

    Data extraction and synthesis Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.Results Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by ≤2°, TTDPM by ≤1.5° and QFC by ≤6 Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low.

    Conclusions The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS/TTDPM/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking.

    PROSPERO registration number CRD42018107349.

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  • 2.
    Bjurling‐Sjöberg, Petronella
    et al.
    Uppsala University, Sweden;Region Sörmland, Sweden.
    Göras, Camilla
    Region Dalarna, Sweden;Dalarna University, Sweden.
    Lohela-Karlsson, Malin
    Uppsala University, Sweden;Region Västmanland, Sweden.
    Nordgren, Lena
    Uppsala University, Sweden;Region Sörmland, Sweden.
    Källberg, Ann-Sofie
    Dalarna University, Sweden;Region Dalarna, Sweden.
    Castegren, Markus
    Uppsala University, Sweden;Region Sörmland, Sweden;Karolinska Institutet, Sweden.
    Condén Mellgren, Emelie
    Uppsala University, Sweden;Region Västmanland, Sweden.
    Holmberg, Mats
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Ekstedt, Mirjam
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    Resilient performance in healthcare during the COVID-19 pandemic (ResCOV): study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 12, article id e051928Article in journal (Refereed)
    Abstract [en]

    Introduction

    Since early 2020, the COVID-19 pandemic has challenged societies and revealed the built-in fragility and dependencies in complex adaptive systems, such as healthcare. The pandemic has placed healthcare providers and systems under unprecedented amounts of strain with potential consequences that have not yet been fully elucidated. This multilevel project aims to explore resilient performance with the purpose of improving the understanding of how healthcare has adapted during the pandemic’s rampage, the processes involved and the consequences on working conditions, ethics and patient safety.

    Methods

    An emerging explorative multilevel design based on grounded theory methodology is applied. Open and theoretical sampling is performed. Empirical data are gathered over time from written narratives and qualitative interviews with staff with different positions in healthcare organisations in two Swedish regions. The participants’ first-person stories are complemented with data from the healthcare organisations’ internal documents and national and international official documents.

    Analysis

    Experiences and expressions of resilient performance at different system levels and times, existing influencing risk and success factors at the microlevels, mesolevels and macrolevels and inter-relationships and consequences in different healthcare contexts, are explored using constant comparative analysis. Finally, the data are complemented with the current literature to develop a substantive theory of resilient performance during the pandemic.

    Ethics and dissemination

    This project is ethically approved and recognises the ongoing strain on the healthcare system when gathering data. The ongoing pandemic provides unique possibilities to study system-wide adaptive capacity across different system levels and times, which can create an important basis for designing interventions focusing on preparedness to manage current and future challenges in healthcare. Feedback is provided to the settings to enable pressing improvements. The findings will also be disseminated through scientific journals and conferences.

  • 3.
    Bohman, Tony
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Bottai, Matteo
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Björklund, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain: a longitudinal cohort study2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 4, article id e024557Article in journal (Refereed)
    Abstract [en]

    Objectives To develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy. Design Longitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy. Participants and settings Eighty-nine women aged 31-65 years with non-specific chronic disabling neck pain from Gavle, Sweden. Measures The outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with cross-validation using the bootstrap resampling technique. Results Factors included in the final PGICS model were neck disability and age, and in the NDI model, neck disability, depression and catastrophising. In both models, the odds for short-term and long-term improvement increased with higher baseline neck disability, while the odds decreased with increasing age (PGICS model), and with increasing level of depression (NDI model). In the NDI model, higher baseline levels of catastrophising indicated increased odds for short-term improvement and decreased odds for long-term improvement. Both models showed acceptable predictive validity with an AUC of 0.64 (95% CI 0.55 to 0.73) and 0.67 (95% CI 0.59 to 0.75), respectively. Conclusion Age, neck disability and psychological factors seem to be important predictors of improvement, and may inform clinical decisions about physiotherapy in women with chronic neck pain. Before using the developed predictive models in clinical practice, however, they should be validated in other populations and tested in clinical settings.

  • 4.
    Chowdhury, Mohammad Rocky Khan
    et al.
    First Capital University of Bangladesh.
    Khan, Hafiz T A
    University of West London.
    Rashid, Mamunur
    University of Gävle, Faculty of Health and Occupational Studies, Department of Public Health and Sport Science, Public Health Science.
    Kabir, Russell
    Anglia Ruskin University, UK.
    Islam, Sazin
    First Capital University of Bangladesh.
    Islam, Md Shariful
    First Capital University of Bangladesh.
    Kader, Manzur
    Karolinska institutet.
    Differences in risk factors associated with single and multiple concurrent forms of undernutrition (stunting, wasting, or underweight) among children under 5 in Bangladesh: A nationally representative cross-sectional study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, article id e052814Article in journal (Refereed)
    Abstract [en]

    Objectives: The current study aims at differentiating the risk factors of cooccurrence and the single dimension of undernutrition among under-5 children in Bangladesh. 

    Design: A nationally representative cross-sectional study. 

    Setting: Bangladesh.

    Participants: Children age under 5 years of age. 

    Outcome measure: A child is considered to have cooccurrence of undernutrition if he/she has either coexistence of stunting and underweight; wasting and underweight at the same time or the coexistence of stunting, wasting, and underweight. Also, a child with a single dimension of undernutrition includes having stunting, wasting, and being underweight independently.

    Methods: A Chi-square test was used to assess the prevalence of undernutrition. Odds ratio (OR) and confidence interval (CI) of potential risk factors were quantified using logistic regression analysis. 

    Results: Two out of five under-5 children are suffering undernutrition in Bangladesh. The prevalence of cooccurrence and the single dimension of child undernutrition in Bangladesh was 19.3% (95% CI: 18.2, 20.5) and 18.9 (95% CI:17.9, 19.7) respectively. The key risk factors of cooccurrence of undernutrition were children born with small birth weight [AOR-3.40, 95% CI-2.52, 5.57], socio-economically poorest households [AOR-2.29, 95% CI-1.74, 3.01] and children age group 48-59 months [AOR-2.18, 95% CI-1.80, 2.63], on the other hand, children age group 12-23 months [AOR-161, 95% CI-1.35, 1.92], socio-economically poorer households [AOR-1.41, 95% CI-1.09, 1.82] and paternal illiteracy [AOR-1.19, 95% CI-1.01, 1.42] was significantly associated with single dimension of undernutrition. 

    Conclusion: One-fifth of the children are suffering cooccurrence of undernutrition and that is similar as measured by the single dimension of undernutrition. Parental education, mother’s undernutrition status, father’s employment status, children’s age, birth order, and small birth are the main differentiating risk factors of cooccurrence and the single dimension of undernutrition among under-5 children in Bangladesh which should be taken into consideration to formulate an evidence-based strategy to reduce undernutrition among under-5 children. 

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  • 5.
    Dantoft, Thomas M.
    et al.
    Danish Research Centre for Chemical Sensitivities, Copenhagen University Hospital, Gentofte, Denmark; Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark; Research Centre for Prevention and Health, Copenhagen, Denmark.
    Skovbjerg, Sine
    Research Centre for Prevention and Health, Copenhagen, Denmark.
    Andersson, Linus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Department of Psychology, Umeå University, Umeå, Sweden.
    Claeson, Anna-Sara
    Department of Psychology, Umeå University, Umeå, Sweden.
    Engkilde, Kaare
    Department of Dermato-Allergology, National Allergy Research Center, Copenhagen University Hospital Gentofte, Denmark.
    Lind, Nina
    Department of Psychology, Umeå University, Umeå, Sweden; Department of Economics, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Nordin, Steven
    Department of Psychology, Umeå University, Umeå, Sweden.
    Hellgren, Lars I.
    Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark.
    Gene expression profiling in persons with multiple chemical sensitivity before and after a controlled n-butanol exposure session2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 2, article id e013879Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the pathophysiological pathways leading to symptoms elicitation in multiple chemical sensitivity (MCS) by comparing gene expression in MCS participants and healthy controls before and after a chemical exposure optimised to cause symptoms among MCS participants.The first hypothesis was that unexposed and symptom-free MCS participants have similar gene expression patterns to controls and a second hypothesis that MCS participants can be separated from controls based on differential gene expression upon a controlled n-butanol exposure.

    DESIGN: Participants were exposed to 3.7 ppm n-butanol while seated in a windowed exposure chamber for 60 min. A total of 26 genes involved in biochemical pathways found in the literature have been proposed to play a role in the pathogenesis of MCS and other functional somatic syndromes were selected. Expression levels were compared between MCS and controls before, within 15 min after being exposed to and 4 hours after the exposure.

    SETTINGS: Participants suffering from MCS and healthy controls were recruited through advertisement at public places and in a local newspaper.

    PARTICIPANTS: 36 participants who considered themselves sensitive were prescreened for eligibility. 18 sensitive persons fulfilling the criteria for MCS were enrolled together with 18 healthy controls.

    OUTCOME MEASURES: 17 genes showed sufficient transcriptional level for analysis. Group comparisons were conducted for each gene at the 3 times points and for the computed area under the curve (AUC) expression levels.

    RESULTS: MCS participants and controls displayed similar gene expression levels both at baseline and after the exposure and the computed AUC values were likewise comparable between the 2 groups. The intragroup variation in expression levels among MCS participants was noticeably greater than the controls.

    CONCLUSIONS: MCS participants and controls have similar gene expression levels at baseline and it was not possible to separate MCS participants from controls based on gene expression measured after the exposure.

  • 6.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Holmström, Inger
    Mälardalens Högskola, Uppsala universitet.
    A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case–control study2014In: BMJ Open, E-ISSN 2044-6055, Vol. 4, no 10, p. e005961-Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

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  • 7.
    Göras, Camilla
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Maria, Unbeck
    Department of Orthopedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ehrenberg, Anna
    Örebro universitet, Institutionen för hälsovetenskaper.
    Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey2017In: BMJ Open, E-ISSN 2044-6055, BMJ Open, E-ISSN 2044-6055, Vol. 7, no 9, article id e015607Article, review/survey (Refereed)
    Abstract [en]

    Background: A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors’ estimations of their staffs’ attitudes to patient safety.

    Methods: A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate.

    Results: Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors’ estimations of their staffs’ ratings of the safety climate cohered fairly well.

    Conclusions: This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR.

  • 8.
    Göras, Camilla
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Olin, Karolina
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Development Centre, Turku University Hospital, Turku, Finland.
    Unbeck, Maria
    Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Pukk-Härenstam, Karin
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden.
    Ehrenberg, Anna
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Tessma, Mesfin Kassaye
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Ulrica
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
    Ekstedt, Mirjam
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; School of Health and Caring Sciences, Linneuniversitet, Kalmar, Sweden.
    Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 5, article id e026410Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

    DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

    SETTING: An OR department at a county hospital in Sweden.

    PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

    RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

    CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

    TRIAL REGISTRATION NUMBER: 2016/264.

  • 9.
    Hallman, David
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Gupta, Nidhi
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Korshøj, Mette
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Is prolonged sitting at work associated with the time course of neck-shoulder pain?: A prospective study in Danish blue-collar workers2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 11, article id e012689Article in journal (Refereed)
    Abstract [en]

    Objectives

    This study aimed to determine the extent to which objectively measured sitting time at work is associated with the course of neck-shoulder pain across one year in blue-collar workers.

    Methods

    Data was analyzed from 625 blue-collar workers in the Danish DPHACTO cohort study (2012-2013). Objective data on sitting time were collected at baseline using accelerometry. Self-reported pain intensity (numeric rating scale 0-10) in the neck-shoulder region was registered for one year using repeated text messages (14 in total). Linear Mixed Models were used to determine the relationship between percent time in sitting at work and trajectories of neck-shoulder pain, with and without adjustment for demographic, occupational and lifestyle factors, and baseline pain intensity.

    Results

    More sitting time at work was associated with a faster decline in pain intensity over 12-months, as indicated by a statistically significant effect of sitting on pain trajectories in the crude (p=0.020) and fully adjusted models (p=0.027).

    Conclusion                             

    In blue-collar workers, more sitting time at work was associated with a favorable development of pain intensity over time. The relationship between sitting at work and pain needs further investigation before explicit recommendations and guidelines on sedentary behavior among blue-collar workers can be developed.

  • 10.
    Hallman, David
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Dencker-Larsen, Sofie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Birk Jorgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nørregaard Rasmussen, Charlotte
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Are trajectories of neck-shoulder pain associated with sick leave and work ability in workers? A 1-year prospective study2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, article id e022006Article in journal (Refereed)
    Abstract [en]

    ObjectivesThe study aimed to determine the extent to which latent trajectories of neck–shoulder pain (NSP) are associated with self-reported sick leave and work ability based on frequent repeated measures over 1 year in an occupational population.

    MethodsThis longitudinal study included 748 Danish workers (blue-collar, n=620; white collar, n=128). A questionnaire was administered to collect data on personal and occupational factors at baseline. Text messages were used for repeated measurements of NSP intensity (scale 0–10) over 1 year (14 waves in total). Simultaneously, selfreported sick leave (days/month) due to pain was assessed at 4-week intervals, while work ability (scale 0–10) was assessed using a single item (work ability index) at 12-week intervals over the year. Trajectories of NSP, distinguished by latent class growth analysis, were usedas predictors of sick leave and work ability in generalised estimation equations with multiple adjustments.

    ResultsSick leave increased and work ability decreased across all NSP trajectory classes (low, moderate, strong fluctuating and severe persistent pain intensity). In the adjusted model, the estimated number of days on sickleave was 1.5 days/month for severe persistent NSP compared with 0.1 days/month for low NSP (relativ risk=13.8, 95% CI 6.7 to 28.5). Similarly, work ability decreased markedly for severe persistent NSP (OR=12.9,95% CI 8.5 to 19.7; median 7.1) compared with low NSP (median 9.5).

    ConclusionSevere persistent NSP was associatedwith sick leave and poor work ability over 1 year amongworkers. Preventive strategies aiming at reducing severepersistent NSP among working populations are needed.

  • 11.
    Jackson, Jennie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Sund, Marianne
    Elis Textil Service AB.
    Barlari Lobos, Griztko
    Elis Textil Service AB.
    Melin, Lars
    Elis Textil Service AB.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Assessing the efficacy of a job rotation for improving occupational physical and psychosocial work environment, musculoskeletal health, social equality, production quality, and resilience at a commercial laundromat: Protocol for a longitudinal case study2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 5, article id e067633Article in journal (Refereed)
    Abstract [en]

    Introduction: Job rotation is a work organization strategy used to reduce work‐related exposures and musculoskeletal complaints, yet evidence for the efficacy of the approach is weak. Mismatch between job rotation and company needs, lack of full implementation, lack of exposure variation in included tasks, and failure to assess variation may underlie inconclusive research findings to date. The study aims to develop a job rotation with company stakeholders, perform a process evaluation of the implementation, and determine the extent to which the intervention improves the physical and psychosocial work environment, indicators of health, gender and social equality among workers, and production quality and resilience.

    Methods and analysis: Approximately 60 production workers at a Swedish commercial laundromat will be recruited. Physical and psychosocial work environment conditions, health, productivity and gender and social equality will be assessed pre‐ and post‐ intervention using surveys, accelerometers, heart rate, electromyography and focus groups. A task‐based exposure matrix will be constructed, and exposure variation estimated at the level of the individual worker pre‐ and post‐ intervention. An implementation process evaluation will be conducted. Job rotation efficacy will be assessed in terms of improvement in work environment conditions, health, gender and social inequality, and production quality and resilience. This study will provide novel information on the effects of the job rotation on physical and psychosocial work environment conditions, production quality and rate, health, and gender and social inequality among blue‐collar workers in a highly multicultural workplace.

    Ethics and dissemination: The study received approval from the Swedish Ethical Review Authority. Results of the project will be shared directly with the employees, managers and union representatives from the participating company, other relevant labour market stakeholders, and with researchers at national and international conferences and via scientific publication.

    Trial registration: The study is pre‐registered with the Open Science Framework (https://osf.io/zmdc8/).

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  • 12.
    Kaltenbrunner, Monica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bengtsson, Lars
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Associations between lean maturity in primary care and musculoskeletal complaints among staff. A longitudinal study2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, article id e067753Article in journal (Refereed)
    Abstract [en]

    Objective. We had two aims: 1) to determine the prevalence of musculoskeletal complaints among staff in primary care 2) to determine to what extent Lean maturity of the primary care unit can predict musculoskeletal complaints one year later. 

    Design. Descriptive, correlational, and longitudinal design.

    Setting. Primary care units in mid-Sweden.

    Participants. In 2015, staff members responded to a web survey addressing Lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016. 

    Outcome measures. Associations with musculoskeletal complaints were determined both for Lean maturity in total, and for four Lean domains entered separately in a multivariate model, i.e., Philosophy, Processes, People and partners, and Problem-solving.     

    Results. The shoulders (12-month prevalence 58%), neck (54%), and low back (50%) were the most common sites of 12-months retrospective musculoskeletal complaints at baseline. Shoulders, neck, and low back also showed the most complaints for the preceding 7 days (37%, 33%, and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor one year later, for shoulders (one-year β: -0.002, 95% CI -.03 to .02), neck (β: 0.006, 95% CI -.01 to .03), low back (β: 0.004, 95% CI -.02 to .03) and upper back (β: 0.002, 95% CI -.02; .02). 

    Conclusion. The prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of Lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a one-year predictive analysis

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  • 13.
    Magnusson, Peter
    et al.
    Karolinska institutet; Region Gävleborg.
    Mattsson, Gustav
    Region Gävleborg.
    Wallhagen, Marita
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Building Engineering, Energy Systems and Sustainability Science, Environmental Science.
    Karlsson, Jan
    Örebro universitet.
    Health-related quality of life in patients with implantable cardioverter defibrillators in Sweden: a cross-sectional observational trial2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e047053Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Decisions regarding implantable cardioverter defibrillators (ICDs) must consider information about presumed health-related quality of life (HRQL). The purpose of the study was to assess HRQL in patients with ICD and compare it to a Swedish age-matched and sex-matched population.

    DESIGN: Cross-sectional observational trial.

    SETTING: Swedish ICD cohort.

    INTERVENTIONS: Short form 36 (SF-36) questionnaires from ICD recipients implanted 2007-2017 (response rate 77.2%) were analysed using Mann-Whitney U test and effect size (ES).

    RESULTS: In total, 223 patients (mean age 71.1±9.7 years, 82.1% men) were included. In most SF-36 domains (physical functioning (PF), role physical, general health (GH), vitality, social functioning and mental health), the score for patients with ICD was significantly lower (ES range 0.23-0.41, ie, small difference) than norms, except for bodily pain and role emotional. Both the physical component summary (PCS) and the mental component summary (MCS) scores had ES=0.31. Men and women had similar scores. Primary and secondary prevention patients scored similarly, except for worse GH in primary prevention (p=0.016, ES=0.35). Atrial fibrillation was associated with worse PF (ES=0.41) and PCS (ES=0.38). Appropriate therapy, inappropriate shock or complications requiring surgery were not associated with lower scores in any domain. In primary prevention due to ischaemic versus non-ischaemic cardiomyopathy, no domain was significantly different. PCS decreased with higher age strata (p=0.002) in contrast to MCS (p=0.986).

    CONCLUSIONS: Patients with ICDs have lower physical and mental HRQL than age-matched and sex-matched norms; however, the ESs are small. HRQL is similar regardless of sex, primary/secondary prevention indication, appropriate therapy, inappropriate shock or complications, but decreases with advancing age.

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  • 14.
    Mathiassen, Svend Erik
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Bolin, Malin
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden.
    Olofsdotter, Gunilla
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden.
    Johansson, Elin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Equal health at work? Protocol for an observational study of work organisation, workload and musculoskeletal complaints among women and men in grocery retail2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 1, article id e032409Article in journal (Refereed)
    Abstract [en]

    Introduction Women generally report more work-related musculoskeletal complaints than men and have higher rates of sickness absence, even within occupations. One likely reason is that work tasks within the occupation are gendered, i.e. women and men have different tasks, even when sharing the same job title. Retail is an appealing sector for studying working conditions and work environment in a gender context. The prevalence of work-related complaints is high, physical loads may differ considerably between tasks, and the distribution of tasks is likely gendered. The overall aim of this study in retail is to examine factors at the organisational and individual level that may, in a gender perspective, explain working conditions, work tasks, workloads, and musculoskeletal health.

    Methods and analyses Data will be collected in two grocery stores, each with 50-70 workers, at two occasions interspersed by about one year. In each of these four waves, data collection will include a web-based questionnaire to all workers addressing, e.g. work tasks, psychosocial factors, fatigue and pain; semi-structured interviews with managers and around 10 workers addressing, e.g. competences and decision levels; and technical measurements of postures, movements and heart rate in about 30 workers. The study is novel in combining an organisational gender perspective addressed through qualitative methods with a quantitative analysis of tasks, workload and health. The design allows an examination of both how genders may differ, and why they may differ, as well as analyses of the extent to which gendered working conditions change over time in the two participating stores.

    Ethics and dissemination Approval of the study by the Swedish Ethical Review Authority (reference number 2017/404) has been obtained. This work will be disseminated by publication of peer-reviewed papers in scientific journals, presentations at scientific conferences, and in meetings with representatives from Swedish retail, including unions and employers’ organisations.

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  • 15.
    Monnier, Andreas
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Swedish Armed Forces, Regional Medical Service Mälardalen, Berga.
    Larsson, Helena
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Swedish Armed Forces, HR Centre, Stockholm.
    Djupsjöbacka, Mats
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Brodin, Lars-Åke
    Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Huddinge.
    Äng, Björn O
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Stockholm ; Centre for Clinical Research Dalarna, Falun ; Karolinska University Hospital, Stockholm.
    Musculoskeletal pain and limitations in work ability in Swedish marines: a cross-sectional survey of prevalence and associated factors2015In: BMJ Open, E-ISSN 2044-6055, Vol. 5, no 10, article id e007943Article in journal (Refereed)
    Abstract [en]

    Objectives To estimate the prevalence of self-rated musculoskeletal pain and pain limiting work ability in Swedish Armed Forces (SAF) marines, and to study factors potentially associated with pain limiting work ability for the most prevalent pain regions reported.

    Design Population-based, cross-sectional survey.

    Participants There were 272 SAF marines from the main marine battalion in Sweden included in the study.

    Outcomes Self-assessed musculoskeletal pain and pain limiting the marines' work ability within a 6-month period, as obtained from structured questionnaires. The association of individual, health and work-related factors with musculoskeletal pain limiting work ability was systematically regressed with multiple logistic models, estimating OR and 95% CI.

    Results Musculoskeletal pain and pain limiting work ability were most common in the back, at 46% and 20%, and lower extremities at 51% and 29%, respectively. Physical training ≤1 day/week (OR 5.3, 95% CI 1.7 to 16.8); body height ≤1.80 m (OR 5.0, 95% CI 1.6 to 15.1) and ≥1.86 m (OR 4.4, 95% CI 1.4 to 14.1); computer work 1/4 of the working day (OR 3.2, 95% CI 1.0 to 10.0) and ≥1/2 (OR 3.3, 95% CI 1.1 to 10.1) of the working day were independently associated with back pain limiting work ability. None of the studied variables emerged significantly associated with such pain for the lower extremities.

    Conclusions Our findings show that musculoskeletal pain and resultant limitations in work ability are common in SAF marines. Low frequency of physical training emerged independently associated with back pain limiting work ability. This suggests that marines performing physical training 1 day per week or less are suitable candidates for further medical evaluation and secondary preventive actions. While also associated, body height and computer work need further exploration as underlying mechanisms for back pain limiting work ability. Further prospective studies are necessary to clarify the direction of causality.

  • 16.
    Monnier, Andreas
    et al.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Swedish Armed Forces, Military Academy Karlberg, Stockholm, Sweden.
    Larsson, Helena
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Swedish Armed Forces, Headquarters, Medical Services, Stockholm, Sweden.
    Nero, Håkan
    Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.
    Djupsjöbacka, Mats
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Äng, Björn O.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Center for Clinical Research, Uppsala University, Falun, Sweden.
    A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 5, article id e025150Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course.

    DESIGN: Prospective observational cohort study with weekly follow-ups.

    PARTICIPANTS: Fifty-three SwAF marines entering the training course.

    OUTCOMES: Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports.

    RESULTS: During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time.

    CONCLUSIONS: Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.

  • 17.
    Nilsson, Ulrica
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Sjukhuset, Perioperat Med & Intens Care, Stockholm, Sweden..
    Jaensson, Maria
    Örebro Univ, Sch Hlth Sci, Fac Hlth & Med Sci, Örebro, Sweden..
    Hugelius, Karin
    Örebro Univ, Sch Hlth Sci, Fac Hlth & Med Sci, Örebro, Sweden..
    Arakelian, Erebouni
    Uppsala universitet, Anestesiologi och intensivvård.
    Dahlberg, Karuna
    Örebro Univ, Sch Hlth Sci, Fac Hlth & Med Sci, Örebro, Sweden..
    A journey to a new stable state-further development of the postoperative recovery concept from day surgical perspective: a qualitative study2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 9, article id e037755Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to further develop the concept analysis by Allvinet alin 2007 and Lundmarket alin 2016 from the perspective of day-surgery patients. Also, to describe how patients experience postoperative recovery in relation to the identified dimensions and subdimensions and to interpret the findings in order to get a deeper understanding of the concept postoperative recovery.

    Design: Descriptive qualitative design with a theoretical thematic analysis.

    Setting: Six day-surgery departments in Sweden.

    Participants: Thirty-eight adult participants who had undergone day surgery in Sweden. Participants were purposively selected.

    Results: Four dimensions-physical, psychological, social and habitual-were confirmed. A total of eight subdimensions were also confirmed, two from Allvinet al's study and six from Lundmarket al's study. Recovery included physical symptoms and challenges coping with and regaining control over symptoms and bodily functions. Both positive and negative emotions were present, and strategies on how to handle emotions and achieve well-being were established. Patients became dependent on others. They coped with and adapted to the recovery process and gradually stabilised, reaching a new stable state.

    Conclusion: Postoperative recovery was described as a process with a clear starting point, and as a dynamic and individual process leading to an experience of a new stable state. The recovery process included physical symptoms, emotions and social and habitual consequences that challenges them. To follow-up and measure all four dimensions of postoperative recovery in order to support and understand the process of postoperative recovery is, therefore, recommended.

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  • 18.
    Olin, Karolina
    et al.
    Karolinska Institutet, Stockholm, Sweden; Tyks and Hospital District of Southwest Finland, Turku, Finland.
    Göras, Camilla
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Nilsson, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Unbeck, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Pukk-Härenstam, Karin
    Karolinska Institutet, Stockholm, Sweden; Karolinska Universitetssjukhuset, Stockholm, Sweden.
    Ekstedt, Mirjam
    Karolinska Institute, Stockholm, Sweden .
    Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 1, article id e052283Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care.

    OBJECTIVE: To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process.

    METHODS: Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool.

    RESULTS: High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia.

    CONCLUSION: The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.

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  • 19.
    Patomella, Ann-Helen
    et al.
    Karolinska institutet.
    Guidetti, Susanne
    Karolinska institutet.
    Mälstam, Emelie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Public Health and Sport Science, Public Health Science. Karolinska institutet.
    Eriksson, Christina
    Karolinska institutet.
    Bergström, Aileen
    Karolinska institutet.
    Åkesson, Elisabet
    Karolinska institutet.
    Kottorp, Anders
    Karolinska institutet; Malmö högskola.
    Asaba, Eric
    Karolinska institutet.
    Primary prevention of stroke: randomised controlled pilot trial protocol on engaging everyday activities promoting health2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 11, article id e031984Article in journal (Refereed)
    Abstract [en]

    Introduction

    Stroke is a globally common disease that has detrimental effects on the individual and, more broadly, on society. Lifestyle change can contribute to reducing risk factors for stroke. Although a healthy lifestyle has direct benefits, sustaining and incorporating healthy activities into everyday life is a challenge. Engaging everyday activities have the potential to support lifestyle change and to promote sustainable activity patterns. Current healthcare is failing to reduce modifiable risk factors in people at risk, and in addition to current practice, there is a need for systematic and efficient non-pharmacological and non-surgical stroke-prevention strategies. The aim of the pilot study was to increase knowledge about the effects of a prevention programme and its feasibility to promote sustainable and healthy activity patterns among persons at risk of stroke.

    Methods and analysis

    The proposed pilot study will be a two-armed randomised, assessor-blinded, parallel pilot trial. The study will include feasibility data, investigating acceptability and delivery of the intervention. Persons at risk of stroke (n=60) will be included in a mobile phone-supported prevention programme. The 10-week programme will be conducted at primary healthcare clinics, combining group meetings and online resources to support self-management of lifestyle change. Main outcomes are stroke risk, lifestyle habits and healthy activity patterns. Assessments will be performed at baseline and at follow-up (immediately following the end of the programme and at 6 and 12 months). Effects of the programme will be analysed using inferential statistics. Feasibility will be analysed using both qualitative and quantitative methods.

    Ethics and dissemination

    The study has been approved by the Regional Ethical Review Board in Stockholm, Sweden, being granted reference numbers 2015/834-31, 2016/2203-32 and 2019/01444. Study results will be disseminated through peer-review journals and presentations to mixed audiences at regional and international conferences. Trial registration number NCT03730701.

  • 20.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, China .
    Leo Swenne, Christine
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 8, article id e015038Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES To investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.

    DESIGN A focus group interview study with a descriptive design using qualitative content analysis of transcripts.

    SETTING One anaesthetic clinic at two hospitals in Sweden.

    PARTICIPANTS Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).

    RESULTS Patterns and five categories emerged: 1) Having different temporal foci during handover, 2) Insecurity when information is transferred from one team to another, 3) Striving to ensure quality of the handover, 4) Weighing the advantages and disadvantages of the bedside handover, and 5) Having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information, and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient, but also that it could threaten the patient’s privacy and that frequent interruptions could be disturbing.

    CONCLUSIONS The present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimize the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision-makers need to pay attention to the environment and infrastructure in postanaesthesia care.

  • 21.
    Randmaa, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    Leo Swenne, Christine
    Uppsala University, Uppsala, Sweden, and Department of Anaesthesia, County Council of Gävleborg, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala University, Uppsala, Sweden.
    SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study2014In: BMJ Open, E-ISSN 2044-6055, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors.

    Design: A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation.

    Setting: Anaesthetic clinics at two hospitals in Sweden.

    Participants: All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and post anaesthesia care units at anaesthetic clinics in two hospitals were invited to participate.

    Intervention: Implementation of SBAR in an anaesthetic clinic.

    Primary and secondary outcomes: The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication.

    Results: In the intervention group, there were statistically significant improvements in the factors “Between-group communication accuracy” (p=0.039) and “Safety climate” (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%.

    Conclusions: Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors.

  • 22.
    Rashid, Mamunur
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University, Uppsala, Sweden.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University, Uppsala, Sweden.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Factors associated with return-to-work among people on work absence due to long-term neck or back pain: a narrative systematic review2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 6, article id e014939Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE:

    The purpose of this narrative systematic review was to summarise prognostic factors for return to work (RTW) among people with long-term neck/shoulder or back pain.

    METHODS:

    A systematic literature search was performed through three databases (Medline, CINAHL and PsycINFO) for studies published until February 2016. Only observational studies of people on work absence (≥2 weeks) due to neck/shoulder or back pain were included. The methodological quality of the included studies was assessed using guidelines for assessing quality in prognostic studies on the basis of Framework of Potential Biases. Factors found in the included studies were grouped into categories based on similarities and then labelled according to the aspects covered by the factors in the category.

    RESULTS:

    Nine longitudinal prospective cohort studies and one retrospective study fulfilled the inclusion criteria. From these, five categories of factors were extracted. Our findings indicate that recovery beliefs, health-related factors and work capacity are important for RTW among people with long-term neck or back pain. We did not find support for workplace factors and behaviour being predictive of RTW.

    CONCLUSIONS:

    Our findings suggest that recovery beliefs, perceived health and work capacity may be important targets of intervention for people with long-term neck or back pain. However, more high-quality prospective studies are needed to confirm the results and improve our understanding of what is needed to facilitate RTW in this population.

  • 23.
    Robinson, Yohan
    et al.
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Olerud, Claes
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Willander, Johan
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Psychology.
    Do biological disease-modifying antirheumatic drugs reduce the spinal fracture risk related to ankylosing spondylitis?: A longitudinal multiregistry matched cohort study2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 12, article id e016548Article in journal (Refereed)
    Abstract [en]

    Objectives: Ankylosing spondylitis (AS) is associated with an increased spinal fracture risk due to the loss of elasticity in spinal motion segments. With the introduction of biological disease-modifying antirheumatic drug (bDMARD) treatment for AS, the individual course of the disease has been ameliorated. This study aims to examine the association of bDMARD treatment and risk of spinal fracture.

    Design: Longitudinal population-based multiregistry observational matched cohort study.

    Setting: Swedish Patient Registry 1987-2014 and Swedish Prescribed Drugs Registry 2005-2014.

    Participants: Included were patients ≥18 years of age receiving treatment at a healthcare facility for the primary diagnosis of AS. About 1352 patients received more than one prescription of bDMARD from 2005 to 2014. An untreated control group was created by propensity score matching for age, sex, comorbidity, antirheumatic prescriptions and years with AS (n=1352).

    Main Outcome Measures: Spinal fracture-free survival.

    Results: No bDMARD treatment-related effect on spinal fracture-free survival was observed in the matched cohorts. Male gender (HR=2.54, 95% CI 1.48 to 4.36) and Charlson Comorbidity Index score (HR=3.02, 95% CI 1.59 to 5.75) contributed significantly to spinal fracture risk.

    Conclusion: bDMARD had no medium-term effect on the spinal fracture-free survival in patients with AS.

    Trial Registration Number: NCT02840695

  • 24.
    Svensson, Sven
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Hallman, David
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Mathiassen, Svend Erik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Fagerström, Arne
    University of Gävle, Faculty of Education and Business Studies, Department of Business and Economic Studies, Business administration.
    Mutiganda, Jean Claude
    University of Gävle, Faculty of Education and Business Studies, Department of Business and Economic Studies, Business administration.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Flexible work: Opportunity and Challenge (FLOC) for individual, social and economic sustainability. Protocol for a prospective cohort study of non-standard employment and flexible work arrangements in Sweden2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 7, article id e057409Article in journal (Refereed)
    Abstract [en]

    Introduction

    Flexibility in working life, including non-standard employment (NSE) and flexible work arrangements (FWAs), offers the organisation a better ability to adapt to changing conditions while also posing considerable challenges for organisations as well as workers. The aim of the Flexible Work: Opportunity and Challenge (FLOC) study is to investigate associations between NSE and FWA on the one hand, and individual, social and economic sustainability on the other.

    Methods and analysis This prospective open cohort study targets approximately 8000 workers 18–65 years old in 8–10 public and private organisations in Sweden. We will use a comprehensive battery of measurement methods addressing financial performance, physical and psychosocial exposures, and physical and mental health, both at the organisational and the individual level. Methods include valid survey questionnaires and register data, and, in subpopulations, technical measurements, interviews and diaries. Main exposures are type of employment and type of work arrangement. Main outcomes are indicators of social and economic sustainability and, at the individual level, health and well-being. Data, collected over 54 months at approximately 18-month intervals, will be analysed using multivariate methods considering main effects as well as potential effect modifiers. The analyses will take into account that respondents are nested in organisations, divisions and/or have specific managers.

    Ethics and dissemination: FLOC is approved by the Swedish Ethical Review Authority (decision numbers 2019–06220, 2020–06094 and 2021–02725). Data will be published in peer-reviewed journals and presented at international conferences, and researchers will assist the organisations in improving policies and routines for employment and organisation of work.

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  • 25.
    Welmer, Anna-Karin
    et al.
    Karolinska institutet.
    Sandberg, Linda
    Karolinska institutet.
    Sandlund, Christina
    Karolinska institutet; Region Stockholm.
    Björck, Caroline
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet; Region Gävleborg.
    Hagströmer, Maria
    Karolinska institutet; Region Stockholm.
    Hamilton, Julia
    Department of Geriatric Medicine, Sabbatsberg Hospital, Stockholm, Sweden.
    Helgstrand, Gunilla
    Karolinska institutet; Department of Geriatric Medicine, Sabbatsberg Hospital, Stockholm, Sweden.
    Lindgren, Charlotte
    Department of Geriatric Medicine, Dalengeriatriken Aleris Närsjukvård AB, Stockholm, Sweden.
    Nordstrand, Linda
    Karolinska institutet.
    Sandstedt, Petter
    Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
    Kivipelto, Miia
    Karolinska institutet.
    Boström, Anne-Marie
    Karolinska institutet.
    Study protocol for the ‘preventing functional decline in acutely hospitalised older patients (PREV_FUNC)’ study: effects of two multicomponent exercise programmes on physical function – a three-armed randomised controlled trial2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 8, article id e070885Article in journal (Refereed)
    Abstract [en]

    Introduction

    Acutely hospitalised older patients often live with frailty and have an increased risk of impaired physical function. Previous studies suggest that exercise might mitigate the risk of physical impairment; however, further research is needed to compare the effect of different types of exercise interventions. In this paper, we report a protocol for a trial that aims to examine (1) if multicomponent exercise interventions (interventions that include both mobility and strengthening exercises) have effects on physical function compared with usual care in older adults and (2) if a comprehensive multicomponent exercise programme is more effective than a simple multicomponent exercise programme that only include walking and sit-to-stand exercises.

    Methods and analysis

    This is a three-armed randomised controlled trial, with two intervention groups (comprehensive and simple exercise programme) and a control group receiving usual care. We will include 320 participants aged ≥75 years from geriatric medical departments of four hospitals in Stockholm, Sweden. Assessments will be conducted at hospital admission, discharge and 3 months thereafter concerning physical function (primary outcome), activities of daily living, health-related quality of life, sarcopenia and falls. The number of readmissions will be registered up to 1 year after discharge. Data will be analysed with linear mixed effects models, according to the intention-to-treat approach.

    Ethics and dissemination

    Ethical approval for this trial has been granted by the Swedish Ethical Review Authority (approval number 2022-03032-01). Data collection will consider the information requirement, the requirement of consent, confidentiality obligations and the utilisation requirement. Trial findings will be disseminated through multiple channels, including scientific publications and conferences, and workshops with healthcare professionals and the public.

    Trial registration number NCT05366075

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  • 26.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Rissén, Dag
    Region Gävleborg.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.
    Psychometric testing of a short form questionnaire for measurement of health experiences among people with musculoskeletal disorders undergoing multimodal rehabilitation2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 5, article id e025103Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of present study was to assess if a previously suggested short-form questionnaire tested among women with non-specific neck-shoulder pain is suitable also for use among men and women with non-specific musculoskeletal disorders in any part of the body, by testing its construct validity by a confirmatory factor analysis. If not, the secondary aim was to investigate the evolving factor structure when performing an explorative factor analysis of data in the expanded sample.

    Methods

    Questionnaire data was collected in three different contexts, in primary care via eight different multimodal rehabilitation teams, in specialised care via two different specialist care centres. The sample consisted of 116 participants, male (n=29) and female (n=87) with non-specific musculoskeletal disorders.

    Data was analysed using confirmatory and exploratory factor analysis and a visual comparison between the result of the Principal Component Analysis in present study, and the results attained in a previous study with a similar aim and design.

    Results

    The confirmatory factor analyses did not end up in a model with acceptable measures for validity. Three models were tested, none of them met the criterion for an acceptable model and the goodness-of-fit statistics were not fully acceptable. The exploratory factor analysis had an only partly comparable result, compared to previous study.

    Conclusion

    The results of present study did not prove the suggested short form questionnaire to be suitable for evaluation of symptoms among men and women with non-specific musculoskeletal disorders in any part of the body. Further studies including larger samples are recommended.

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