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  • 101.
    Gupta, Nidhi
    et al.
    National Research Centre for the Working Environment, Copenhagen.
    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.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen.
    Prediction of objectively measured physical activity and sedentariness among blue-collar workers using survey questionnaires2016In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, no 3, p. 237-245Article in journal (Refereed)
    Abstract [en]

    Objectives We aimed at developing and evaluating statistical models predicting objectively measured occupational time spent sedentary or in physical activity from self-reported information available in large epidemiological studies and surveys.

    Methods Two-hundred-and-fourteen blue-collar workers responded to a questionnaire containing information about personal and work related variables, available in most large epidemiological studies and surveys. Workers also wore accelerometers for 1-4 days measuring time spent sedentary and in physical activity, defined as non-sedentary time.Least-squares linear regression models were developed, predicting objectively measured exposures from selected predictors in the questionnaire.

    Results A full prediction model based on age, gender, BMI, job group, self-reported occupational physical activity, and self-reported occupational sedentary time explained 63% (R2 adjusted) of the variance of both objectively measured occupational sedentary time and physical activity time since these two exposures were complementary. Single-predictor models based only on self-reported information about either occupational physical activity or occupational sedentary time explained21% and 38%, respectively, of the variance of the objectively measured exposures. Internal validation using bootstrapping suggested that the full and single-predictor models would show almost the same performance in new data sets as in that used for modelling.

    Conclusions Both full and single-predictor models based on self-reported information typically available in most large epidemiological studies and surveys were able to predict objectively measured occupational time spent sedentary or in physical activity, with explained variances ranging from 21% to 63%.

  • 102.
    Gupta, Nidhi
    et al.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    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.
    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.
    Hallman, David
    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.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    1National Research Centre for the Working Environment, Copenhagen, Denmark.
    Gender differences in time spent sedentary and in physical activity during leisure: A comparison of data analyzed using a traditional approach and compositional data analysis2017Conference paper (Refereed)
  • 103.
    Gupta, Nidhi
    et al.
    National Research Centre for the Working Environment, Copenhagen.
    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.
    Mateu-Figueras, Gloria
    Department of Computer Science, Applied Mathematics and Statistics, University of Girona.
    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.
    Hallman, David
    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.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen.
    A comparison of standard and compositional data analysis in studies addressing group differences in sedentary behavior and physical activity2018In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 15, no 1, article id 53Article in journal (Refereed)
    Abstract [en]

    Background. Data on time spent in physical activity, sedentary behavior and sleep during a day is compositional in nature, i.e. they add up to a constant value, typically 100% time. Compositional data have fundamentally different properties from unconstrained data in real space, and require other processing and analysis procedures, referred to as compositional data analysis (CoDA). Most physical activity and sedentary behavior studies, however, still apply analytical procedures adapted to data in real space, which can lead to misleading results. The present study describes a comparison of time spent sedentary and in physical activity between age groups and sexes, and investigates the extent to which results obtained by CoDA differ from those obtained using standard analytical procedures.

    Methods. Time spent sedentary, standing, and in physical activity (walking/running/stair climbing/cycling) during work and leisure was determined for 1-4 days among 677 blue-collar workers using accelerometry. Differences between sexes and age groups were tested using MANOVA, using both a standard approach and a CoDA approach based on isometric log-ratio transformed data.  

    Results. When determining differences between sexes in time used for different activities at work, the effect size using standard analysis (η2=0.045, p<0.001) was 15% smaller than that obtained with CoDA (η2=0.052, p<0.001), although both approaches suggested a statistically significant difference. When determining corresponding differences between age groups, CoDA resulted in a 60% larger, and significant, effect size (η2=0.012, p=0.02) than that obtained with the standard approach (η2=0.008, p=0.07). During leisure, results with standard (age; η2=0.007, p=0.09; sex; η2=0.052, p<0.001) and CoDA (age; η2=0.007, p=0.09; sex; η2=0.051, p<0.001) analyses were similar.

    Conclusion. Results and, hence, inferences concerning differences by age and sex in time spent sedentary and in physical activity at work differed between CoDA and standard analysis. We encourage researchers to use CoDA in similar studies, in order to adequately account for the compositional nature of data on physical activity and sedentary behavior

  • 104.
    Gupta, Nidhi
    et al.
    National Research Centre for Working Environment, Copenhagen Denmark.
    Storda Christiansen, Caroline
    National Research Centre for Working Environment, Copenhagen Denmark.
    Hallman, David
    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 Working Environment, Copenhagen Denmark.
    Gomes Carneiro, Isabella
    National Research Centre for Working Environment, Copenhagen Denmark.
    Holtermann, Andreas
    National Research Centre for Working Environment, Copenhagen Denmark.
    Is Objectively Measured Sitting Time Associated with Low Back Pain?: A Cross-Sectional Investigation in the NOMAD study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0121159Article in journal (Refereed)
    Abstract [en]

    Background: Studies on the association between sitting time and low back pain (LBP) have found contrasting results. This may be due to the lack of objectively measured sitting time or because socioeconomic confounders were not considered in the analysis.

    Objectives: To investigate the association between objectively measured sitting time (daily total, and occupational and leisure-time periods) and LBP among blue-collar workers.

    Methods: Two-hundred-and-one blue-collar workers wore two accelerometers (GT3X+ Actigraph) for up to four consecutive working days to obtain objective measures of sitting time, estimated via Acti4 software. Workers reported their LBP intensity the past month on a scale from 0 (no pain) to 9 (worst imaginable pain) and were categorized into either low (≤5) or high (>5) LBP intensity groups. In the multivariate-adjusted binary logistic regression analysis, total sitting time, occupational and leisure-time sitting were both modeled as continuous (hours/day) and categorical variables (i.e. low, moderate and high sitting time).

    Results: The multivariate logistic regression analysis showed a significant positive association between total sitting time (hours) and high LBP intensity (odds ratio; OR=1.43, 95%CI=1.15-1.77, P=0.01). Similar results were obtained for leisure-time sitting (OR=1.45, 95%CI= 1.10-1.91, P=0.01), and a similar but non-significant trend was obtained for occupational sitting time (OR=1.34, 95%CI 0.99-1.82, P=0.06). In the analysis on categorized sitting time, high sitting time was positively associated with high LBP for total (OR=3.31, 95%CI= 1.18-9.28, P=0.03), leisure (OR=5.31, 95%CI= 1.57-17.90, P=0.01), and occupational (OR=3.26, 95%CI= 0.89-11.98, P=0.08) sitting time, referencing those with low sitting time.

    Conclusion: Sitting time is positively associated with LBP intensity among blue-collar workers. Future studies using a prospective design with objective measures of occupational sitting time are recommended.

  • 105.
    Gustafsson, Patrik
    et al.
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Crenshaw, Albert G.
    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.
    Edmunsson, David
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Toolanen, Göran
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Crnalic, Sead
    Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden.
    Muscle oxygenation in Type 1 diabetic and non-diabetic patients with and without chronic compartment syndrome2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 10, article id e0186790Article in journal (Refereed)
    Abstract [en]

    Background. Type 1 diabetic patients and non-diabetic patients were referred for evaluation for chronic exertional compartment syndrome (CECS) based on clinical examination and complaints of activity-related leg pain in the region of the tibialis anterior muscle. Previous studies using near-infrared spectroscopy (NIRS) showed greater deoxygenation during exercise for CECS patients versus healthy controls; however, this comparison has not been done for diabetic CECS patients.

    Methods. We used NIRS to test for differences in oxygenation kinetics for Type 1 diabetic patients diagnosed with (CECS-diabetics, n = 9) versus diabetic patients without (CON-diabetics, n = 10) leg anterior chronic exertional compartment syndrome. Comparisons were also made between non-diabetic CECS patients (n = 11) and healthy controls (CON, n = 10). The experimental protocol consisted of thigh arterial cuff occlusion (AO, 1-minute duration), and treadmill running to reproduce symptoms. NIRS variables generated were resting StO2%, and oxygen recovery following AO. Also, during and following treadmill running the magnitude of deoxygenation and oxygen recovery, respectively, were determined.

    Results. There was no difference in resting StO2%between CECS-diabetics (78.2±12.6%) vs. CONdiabetics (69.1±20.8%), or between CECS (69.3±16.2) vs. CON (75.9±11.2%). However, oxygen recovery following AO was significantly slower for CECS (1.8±0.8%/sec) vs. CON (3.8±1.7%/sec) (P = 0.002); these data were not different between the diabetic groups. StO2%during exercise was lower (greater deoxygenation) for CECS-diabetics (6.3±8.6%) vs. CON-diabetics (40.4±22.0%), and for CECS (11.3±16.8%) vs. CON (34.1±21.2%) (P<0.05 for both). The rate of oxygen recovery post exercise was faster for CECS-diabetics (3.5±2.6%/sec) vs. CON-diabetics (1.4±0.8%/sec) (P = 0.04), and there was a tendency of difference for CECS (3.1±1.4%/sec) vs. CON (1.9±1.3%/sec) (P = 0.05).

    Conclusion. The greater deoxygenation during treadmill running for the CECS-diabetics group (vs. CON-diabetics) is in line with previous studies (and with the present study) that compared non-diabetic CECS patients with healthy controls. Our findings could suggest that NIRS may be useful as a diagnostic tool for assessing Type 1 diabetic patients suspected of CECS.

  • 106.
    Gustafsson, Susanne
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Anderzén, Ingrid
    Department of Public Health and Caring Sciences, Uppsala University.
    Lindberg, Per
    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.
    Managerial masculinity : an issue for wellbeing at work.: Reflections on the borderline between middle level management and fathering, using life-history method.2016In: Scientific Programme: Wellbeing at Work 2016, 2016Conference paper (Refereed)
    Abstract [en]

    Objectives

    In this paper we reflect on potential linkages within and between masculinity, management and wellbeing. The aim is to reveal the tensions in which technocratic managerial masculinity faces difficulties when combined with fathering and its consequences for wellbeing, both on individual- and family level.

    Methods

    Audio-recorded life-history interviews were conducted with employees, at three companies in Sweden during spring 2014. One of them was with a former manager, also a father, which is the subject of this paper. The tran-scribed interview formed the basis of an individual case study that was interpretive analyzed using a gender theoretic approach.

    Results

    Managerial masculinity is revealed as obstacles such as hegemonic expectations of not being good enough which is emerging in contradictive situations between hospital visits and office deadlines. To cope with hege-monic masculinity displaced in a contradictive cornerstone the embodiment of thoughts, ideas and experien-ces became transformed into a wish to quit the leadership assignment, a process in which support from colle-agues, relatives and friends were recognized as important. The decision to quit was immediately followed by a relief, but over time became mixed-up with sorrowful feelings of lack. Looking back at the event makes a shift in value-system prominent: The informant’s self-understanding has been transformed from prioritizing level of sa-lary and the value of money to instead emphasize broader values in life expressed in terms of family wellbeing.

    Conclusion

    Through the tensions that emerge from ‘changing faces of masculinity’ the capacity to navigate life is reshaped. As long as hegemonic masculinity is taken for granted it is difficult to challenge and question it. But when ideas, experiences and feelings are transformed from a personal- to a cultural level they become possible to share with others: a process of exchange through which alternative ways of doing are crystallized. Personal experi-ences are thus transformed into collective possessions and given new meanings. We interpret the exchange of thoughts and ideas as expression of supportive interaction, shown to prompt new kinds of enactment in personal lives – thus a potential for wellbeing at work

  • 107.
    Gustafsson, Susanne
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Lindberg, Per
    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.
    Rethinking potential connection between gender, work- and family life and how to link the emerging reasoning to well-being2015In: Proceedings 19th Triennial Congress of the IEA, Melbourne 9-14 August 2015, 2015Conference paper (Refereed)
    Abstract [en]

    How women and men negotiate roles and relationships is crucial for having the potential to combine paid work with other parts of their life. How women and men actually do this can be understood as constrained by what women and men are expected to do. Earlier research on organizational working patterns has revealed links between such constraints and gender relations (Acker, 1990). ”Processes of transformation” (Gustafsson, 2007) is a theoretical concept that will be used here in this paper to explore a potential connection between working life and family life, as varying and gendered. How these two spheres of life are situationally connected will have implications for well-being. It is this theoretical reasoning that will be illustrated in this paper, how it works in practice, through the use of empirical examples from an ongoing larger study on work and health.

    In mainstream literature, the term “work–life balance” is frequently used, often in very simplified ways, concealing underlying dynamism and complexity. “Women” as a group and “men” as a group are often seen as fixed, unproblematic gender categories, classifying bodies and therewith define gender. It is therefore not surprising that gender categoricalism can become the basis in occupational health. If categorical thinking on gender is parked on the top of biological difference, gender relations and “roles” correspond with natural differences and thus serve to mask how underlying gender relations, contradictive and ambivalent, produce and reproduce men’s privileged position simultaneously with women’s subordination (Connell, 1987). Using categorical thinking on gender risk to become contradictive, since expected change in health promotion programs at work may fail.

    To understand how a balance can be struck between work and family-life obligations, contradictions and ambivalences need to be made visible and gender variations as well as nuances have to be sought for. We herewith call for a re-thinking of how the connection between gender, work, family and well-being can be seen and practiced through occupational health policy. An analytical tool able to facilitate this re-thinking in occupational health practices will be suggested in this paper. We are convinced that it is this kind of concepts that are needed right now in order to mobilize an acceleration of ongoing gender transformation that would contribute to improve health and well-being, both in work and family spheres of life.

    This paper is part of a comprehensive intervention study on occupational health and well-being among blue- and white-collar workers, both women and men, in three companies in Sweden. In the baseline questionnaire, the employees mentioned that work–life balance is most significant for them as they strive to achieve well-being and health. This is the motivation for a study whose overall purpose is to contribute to a better understanding of potential linkages between gender, work and family, and well-being. The aim of this paper is threefold. First, it focuses on how employed women and men “do gender” when combining earning and caring activities and looks at the contributions or limitations or both. Second, it considers how the gender regime can be seen as providing a context for various gender-related limitations and opportunities, and differences and similarities between the employed women and men in three companies in Sweden. Third, it illuminates an alternative approach for combining gender, work, family and well-being.

  • 108.
    Gustafsson, Susanne
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Lindberg, Per
    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.
    Anderzen, Ingrid
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Using gender as analytical tool in an analysis of a manager's health: Reflection on life-history method2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no Suppl. 1, p. S64-S64, article id O197Article in journal (Refereed)
    Abstract [en]

    Introduction: It is a lack of research on the meanings of genderdynamism in relation to manager’s health in Sweden.The purpose of this paper was therefore to reflect on whether gender form, -content and/or, -arena, either contribute to reproduce or transform surrounding condition on the job and in the family and also its consequences for health, both on individual and family level.

    Methods: A semi-structured life-history interview was conducted with aformer manager on the basis of gender theory and written verbatim into a transcript. A life-history case was elaborated using gender as an analytical tool. By sorting and comparing already gendered life events, both on the job and in the family, the main findings evolved.

    Results: Paradoxically a turning point in Jan’s life became prominent with a personal crisis, and this was explained by how several minor shifts of genderedform,-content and -arena co-occurred.This resulted in that a gender neutral form of agency appeared possible to try out in practice. When this was done the conditions on the job and in the family were shaped in accordance with what is meant with good lives for all.

    Conclusion: In most gender research the force of gender is limited due to its cross-sectional focus through time. But with the life-history research gender relations become prominent in its multiplicity, illuminating minor shifts of ongoing processes of transformation, understood as patterns of agency.

  • 109.
    Haapakangas, Annu
    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. Turku University of Applied Sciences, Turku, Finland.
    Hallman, David
    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.
    Jahncke, Helena
    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.
    Self-rated productivity and employee well-being in activity-based offices: the role of environmental perceptions and workspace use2018In: Building and Environment, ISSN 0360-1323, E-ISSN 1873-684X, Vol. 145, p. 115-124Article in journal (Refereed)
    Abstract [en]

    Activity-based offices are increasingly popular. However, productivity and well-being in these work environments have been little researched. The aims of this study were to quantitatively determine perception and use of the activity-based office environment in relation to self-rated productivity and well-being at work, and to identify important predictors of these outcomes. Four activity-based offices in a large Swedish government agency were surveyed 12 months after implementation.Two hundred and thirty-nine respondents were included in the analyses. Linear regression models, adjusted for relevant covariates, were constructed separately for predictors measuring satisfaction with different aspect of the environment (physical environment, privacy, communication, personalization, personal storage, IT functions and cleaning) and office use (the number of daily workspace switches, different workspaces used and the time spent looking for a workspace). Satisfaction with the physical environment, privacy and communication had the strongest positive association with self-rated productivity and well-being at work. Increased workspace switching was associated with higher productivity, while an increase in self-reported time spent searching for a workspace was associated with lower productivity and well-being. However, predictors related to office use generally explained only a small proportion of variance in the two outcomes. The results suggest that office developers should focus particularly on privacy needs but also on communication, personalization, smooth workspace switching and minimization of work time spent looking for available workspaces.

  • 110.
    Hadrevi, Jenny
    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.
    New Aspects on Chronic Trapezius Myalgia: Contribution of Metabolomics and Proteomics2014In: Journal of Musculoskeletal Pain, ISSN 1058-2452, E-ISSN 1540-7012, Vol. 22, no 4, p. 382-388Article, review/survey (Refereed)
    Abstract [en]

    Several hypotheses regarding the underlying mechanisms and the maintenance behind chronic work-related musculoskeletal disorders have been presented. Chronic low load work and psychosocial stress is believed to be the underlying causes to these pain conditions. The recent application of comprehensive screening methods: omnics methods; to this field of research could contribute to current knowledge regarding the pathophysiology of these disorders. The pathophysiological mechanisms behind chronic trapezius myalgia are discussed in the context of new findings obtained with proteomic and metabolomic methods. Proteins and metabolites which differ in abundance between healthy muscle and muscle suffering from chronic trapezius myalgia are presented. Primarily, the pathways and effects of the proteins and metabolites found in three recently published papers are discussed. Proteomics and metabolomics are efficient screening methods enabling the presentation of potential biomarkers and pathophysiological mechanisms explaining the pathophysiology of chronic work-related trapezius myalgia. The previous findings detecting systematic differences of proteins and metabolites when comparing chronic myalgic muscle to healthy muscle, indicating a higher glycogen metabolism, increased muscle turnover and increased neuronal signalling in the myalgic muscle, are discussed in this review.

  • 111.
    Hadrevi, Jenny
    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.
    Ghafouri, Bijar
    Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University.
    Larsson, Britt
    Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University.
    Gerdle, Björn
    Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University and Pain and Rehabilitation Centre, County Council of Östergötland.
    Hellström, Fredrik
    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.
    Multivariate modeling of proteins related to trapezius myalgia, a comparative study of female cleaners with or without pain2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 9, p. e73285-Article in journal (Refereed)
    Abstract [en]

    The prevalence of chronic trapezius myalgia is high in women with high exposure to awkward working positions, repetitive movements and movements with high precision demands. The mechanisms behind chronic trapezius myalgia are not fully understood. The purpose of this study was to explore the differences in protein content between healthy and myalgic trapezius muscle using proteomics. Muscle biopsies from 12 female cleaners with work-related trapezius myalgia and 12 pain free female cleaners were obtained from the descending part of the trapezius. Proteins were separated with two-dimensional differential gel electrophoresis (2D-DIGE) and selected proteins were identified with mass spectrometry. In order to discriminate the two groups, quantified proteins were fitted to a multivariate analysis: partial least square discriminate analysis. The model separated 28 unique proteins which were related to glycolysis, the tricaboxylic acid cycle, to the contractile apparatus, the cytoskeleton and to acute response proteins. The results suggest altered metabolism, a higher abundance of proteins related to inflammation in myalgic cleaners compared to healthy, and a possible alteration of the contractile apparatus. This explorative proteomic screening of proteins related to chronic pain in the trapezius muscle provides new important aspects of the pathophysiology behind chronic trapezius myalgia.

  • 112.
    Hadrevi, Jenny
    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. Umeå University.
    Ghafouri, Bijar
    Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University .
    Sjörs, Anna
    Institute of Stress Medicine, Carl Skottsbergs gata 22B, SE 41319 Gothenburg, Sweden.
    Antti, Henrik
    Department of Chemistry, Faculty of Science and Technology, Umeå University.
    Larsson, Britt
    Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University .
    Crenshaw, Albert
    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.
    Gerdle, Björn
    Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University .
    Hellström, Fredrik
    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.
    Comparative metabolomics of muscle interstitium fluid in human trapezius myalgia: an in vivo microdialysis study2013In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 113, no 12, p. 2977-2989Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The mechanisms behind trapezius myalgia are unclear. Many hypotheses have been presented suggesting an altered metabolism in the muscle. Here, muscle microdialysate from healthy and myalgic muscle is analysed using metabolomics. Metabolomics analyse a vast number of metabolites, enabling a comprehensive explorative screening of the cellular processes in the muscle.

    METHODS:

    Microdialysate samples were obtained from the shoulder muscle of healthy and myalgic subjects that performed a work and stress test. Samples from the baseline period and from the recovery period were analysed using gas chromatography-mass spectrometry (GC-MS) together with multivariate analysis to detect differences in extracellular content of metabolites between groups. Systematic differences in metabolites between groups were identified using multivariate analysis and orthogonal partial least square discriminate analysis (OPLS-DA). A complementary Mann-Whitney U test of group difference in individual metabolites was also performed.

    RESULTS:

    A large number of metabolites were detected and identified in this screening study. At baseline, no systematic differences between groups were observed according to the OPLS-DA. However, two metabolites, L-leucine and pyroglutamic acid, were significantly more abundant in the myalgic muscle compared to the healthy muscle. In the recovery period, systematic difference in metabolites between the groups was observed according to the OPLS-DA. The groups differed in amino acids, fatty acids and carbohydrates. Myristic acid and putrescine were significantly more abundant and beta-D-glucopyranose was significantly less abundant in the myalgic muscle.

    CONCLUSION:

    This study provides important information regarding the metabolite content, thereby presenting new clues regarding the pathophysiology of the myalgic muscle.

  • 113.
    Hadrévi, Jenny
    et al.
    Department of Community Medicine and Rehabilitation, Sports Medicine Unit, Umeå University, Umeå, Sweden.
    Björklund, Martin
    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 Community Medicine and Rehabilitation, Sports Medicine Unit, Umeå University, Umeå, Sweden.
    Kosek, Eva
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hällgren, Solveig
    Department of Clinical Sciences, Professional Development, Umeå University, Sweden.
    Antti, Henrik
    Department of Chemistry, Faculty of Science and Technology, Umeå University, Umeå, Sweden.
    Fahlström, Martin
    Department of Clinical Sciences, Professional Development, Umeå University, Sweden.
    Hellström, Fredrik
    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.
    Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls2015In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, article id 15925Article in journal (Refereed)
    Abstract [en]

    Chronic musculoskeletal pain exists either as localised to a single region or as widespread to multiple sites in several quadrants of the body. Prospective studies indicate that widespread pain could act as a far end of a continuum of musculoskeletal pain that started with chronic localised pain. The mechanism by which the transition from localised pain to widespread occurs is not clear, although many studies suggest it to be an altered metabolism. In this study, systemic metabolic differences between women with chronic localised neck-shoulder pain (NP), women with chronic widespread pain (CWP) and women who were healthy (CON) were assessed. Blood samples were analysed taking a metabolomics approach using gas chromatography mass spectrometry (GC-MS) and orthogonal partial least square discriminant analysis (OPLS-DA). The metabolomics analysis showed a clear systematic difference in the metabolic profiles between the subjects with NP and the CON but only a weak systematic difference between the subjects with CWP and the CON. This most likely reflects a difference in the portion of the metabolome influenced by the two pain conditions. In the NP group, the overall metabolic profile suggests that processes related to energy utilisation and lipid metabolism could be central aspects of mechanisms maintaining disorder.

  • 114.
    Hadrévi, Jenny
    et al.
    Department of Community Medicine and Rehabilitation, Sports Medicine Unit, Umeå University, Umeå, Sweden.
    Turkina, Maria
    Department of clinical and experimental medicine, Linköping University.
    Carlsson, Andreas
    Division of community medicine, Department of medical and health sciences, Linköping University; Pain and rehabilitation center, anesthetics, operations and specialty surgery center, Region Östergötland.
    Gerdle, Björn
    Division of community medicine, Department of medical and health sciences, Linköping University; Pain and rehabilitation center, anesthetics, operations and specialty surgery center, Region Östergötland.
    Larsson, Britt
    Division of community medicine, Department of medical and health sciences, Linköping University; Pain and rehabilitation center, anesthetics, operations and specialty surgery center, Region Östergötland.
    Hellström, Fredrik
    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.
    Ghafouri, Bijar
    Division of community medicine, Department of medical and health sciences, Linköping University; Pain and rehabilitation center, anesthetics, operations and specialty surgery center, Region Östergötland.
    Myosin light chain and calcium regulating protein differences in chronic musculoskeletal neck and shoulder pain2016In: Journal of Integrated OMICS, ISSN 2182-0287, Vol. 6, no 1, p. 1-8, article id 191Article in journal (Refereed)
    Abstract [en]

    Proteomic screening analysis has detected myosin light chain (MLC) as a protein implied to be involved in chronic musculoskeletal neck and shoulder pain. Several analyses of MLC proteins have stated a difference in phosphorylation being the determining factor for protein activation hence altered contrability of the muscle in i.e. senescence. In continuation of a previous publication, this study is an attempt to analyze the different MLC isoforms by mass spectrometry and immune-analyses in myalgic and healthy trapezius muscle. In the present study no differences in phosphorylation level between the corresponding individual proteins were detected using LC-MSMS and immunoblotting; instead we assigned different isoforms of regulatory MLCs. To further elucidate the contrability: calcium (Ca2+) regulatory proteins, sarco(endo)plasmic reticulum Ca2+ ATPase 1 (SERCA-1) and calsequestrine (CSQ) were analyzed by western blot. The analysis revealed a significantly increased abundance of SERCA-1 protein in the myalgic muscle and a significantly increased abundance of CSQ in healthy muscle. Myalgic muscle contraction patterns have in previous studies shown to differ from healthy muscle which may be connected to the Ca2+ availability in the muscle. Here we present the proteomic characterization of differences in Ca2+ regulating proteins and particularly regulatory MLCs in trapezius muscle of women with chronic musculoskeletal neck and shoulder pain.

  • 115.
    Hagströmer, Maria
    et al.
    Karolinska Institutet.
    Kwak, Lydia
    Karolinska Institutet.
    Hallman, David
    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.
    Grooten, Wim
    Karolinska Institutet.
    Bergman, Patrick
    Linnéuniversitetet.
    A holistic approach in measuring occupational physical activity: challenges and potentials2015In: / [ed] University of Limerick, 2015, p. 11-Conference paper (Refereed)
    Abstract [en]

    Considering that adults spend a considerable proportion of their day at work, employment is a key determinant for daily PA. However, specifics of how and under what circumstances occupational PA (OPA) influences total PA, including other PA domains (e.g. leisure time PA, transport), are unclear. Little is also known about OPA patterns in different occupational groups and how OPA patterns can be changed, among for example those who have mostly sedentary occupations. One important issue concerns if working in a standing position and the use of dynamic chairs has any effect on OPA levels, for instance among office workers. This despite the fact that ergonomists advocate sedentary workers to work in a standing position or use an “active sitting” approach using “dynamic” chairs. To be able to give recommendations regarding PA to employees with different OPA, more insight is needed on how to optimally measure OPA. To move the field forward, knowledge should be combined from different disciplines involved in measuring OPA. Therefore, we want to initiate an interdisciplinary discussion on appropriate measurements of OPA. The aim of the symposium is to present a holistic approach to measuring OPA by combining our expertise in the field of PA and health, measurement of PA using objective measures and self-reported measures, ergonomics, occupational health and public health science.

  • 116.
    Halling, Bengt
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. 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.
    Lean Implementation: the significance of people and dualism2013Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Lean, with its origins at the Toyota Motor Company, is a concept that is known to increase effectiveness in manufacturing. The Lean concept is now argued to be relevant not only in manufacturing but in service and health-care delivery as well. The reported results of Lean implementation efforts are divided. There are reports that most of the Lean implementation efforts are not reaching the goal; on the other hand, there are reports of promising results. The divided results from Lean implementation efforts show how important it is to research and identify factors that are barriers to successful implementation of Lean. This thesis aims to contribute knowledge about barriers to Lean implementation by collecting empirical findings from manufacturing and health care and structuring the perceived barriers and difficulties to Lean implementation. My first study aimed to compare similarities and divergences in barriers to Lean described by key informants in manufacturing and health care. The data was collected via semi-structured interviews. Findings showed that the perceived difficulties and barriers are much the same in manufacturing and health care. The second study was a case study at a manufacturing firm, researching how the views on Lean of the managers implementing Lean influence its implementation. Data was collected via semi-structured interviews with 20 individuals and covered all hierarchical management levels in the company. Findings showed that managers' views on Lean influence the implementation but also that learning during the implementation process can alter managers' views of Lean. The third study aimed to research how management of Lean is described in the literature. This was done through a literature review. The findings showed that Lean management is a matter of dualism, consisting of two complementary systems of action, management and leadership, which are related to the two basic principles of Lean, continuous improvement and respect for the people.

  • 117.
    Halling, Bengt
    et al.
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. 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. Ergonomi, KTH.
    Bergman, Mikael
    Fagersta Stainless.
    Herdin, Gunnar
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production.
    Presentation av Human Lean Center2018In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö?   10-12 juni 2018 Gävle: Program och abstracts / [ed] Per Lindberg, Gävle: Gävle University Press , 2018, p. 145-Conference paper (Other academic)
    Abstract [sv]

    Inledning

    Human Lean började som ett samarbete mellan Bengt Halling och några produktionslinor hos Scania för att se om hälsoteorin Känsla av sammanhang (Kasam) kunde hjälpa cheferna vid dessa arbetsplatser att öka hälsoläget bland medarbetarna med bibehållande av den positiva utveckling av produktiviteten som företaget uppvisat. Lärdomar från samarbetet låg som grund för etablerandet av Human Lean Center (HLC) vid högskolan i Gävle. Human Lean kan beskrivas som ett koncept som kombinerar Kasam och Lean filosofi och där människan ses som central för produktivitet och kvalitet.

    Syfte

    Syfte med etablerande av HLC är att erbjuda organisationer en utbildning som kombinerar hälsoteori och Lean filosofi för långsiktigt uthållig och konkurrenskraftig verksamhet. HLC nyttjas numera även vid olika studentutbildningar.

    Metod

    Metod vid utbildningen vid HLC bygger på att kombinera teori och praktik. Teorin handlar om hälsoteori och hälsofrämjande kombinerat med beskrivning av Lean konceptets historiska framväxt och Lean filosofi. Den praktiska delen av utbildningen handlar om att montera trampbilar längs en taktad produktionslina med hjälp av Lean metoder och verktyg utgående från att människan är central för produktion, att hälsa är en resurs med påverkan på människans förmåga och det innebär att arbetsplatser bör utformas så att de stödjer tillgången till människors förmåga att göra sitt bästa varje dag på jobbet. Att skapa arbetsplatser som stöder människor genom ett hälsofrämjande perspektiv behöver en strategi på daglig basis i human Lean sker detta genom komb-inationen Kasam och Lean filosofi. Med det menas att arbetsmiljön runt människor skall utformas med syftet skapa en känsla av att deras arbetssituation upplevs som meningsfull, begriplig och hanterbar.

    Resultat

    Resultat från de arbetsplatser där Human Lean konceptet prövats visar på positiva effekter på såväl hälsa som produktivitet och kvalitet. Fagersta stainless avdelning för dragen tråd var ett av de första att genomgå utbildning vid HLC. Mikael Bergman från Fagersta finns på plats vid presentationen för att berätta om hur utbildningen uppfattats av personal och företaget.

    Slutsatser

    Slutsatser utifrån erfarenheter från utvecklingen av Human Lean konceptet och Human Lean Centers verksamhet är att Human Lean konceptet genom kombinationen hälsoteori och Lean filosofi samt teori och praktisk träning kan ge positiva effekter på verksam-heters produktivitet och kvalitet samtidigt som hälsonivån bland medarbetare höjs i form av minskad sjukskrivning och minskat behov av rehabilitering.

  • 118.
    Halling, Bengt
    et al.
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. Ergonomi, KTH .
    Bergman, Mikael
    Fagersta Stainless.
    Wijk, Katarina
    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.
    Intervention för ökad produktivitet och minskad sjukskrivning vid ett svenskt stålföretag2018In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö?   10-12 juni 2018 Gävle: Program och abstracts / [ed] Lindberg, Per, Gävle: Gävle University Press , 2018, p. 49-Conference paper (Refereed)
    Abstract [sv]

    Bakgrund

    Vid Fagersta stainless produktionsenhet för dragen tråd vidareförädlas rostfri valsad tråd till dragen tråd som sedan kan användas för tillverkning av olika produkter. Vid produk-tionsenhet för dragen tråd hade de under en längre tid haft lönsamhetsproblem och hög sjukfrånvaro och företagets ledning ansåg att något måste göras för att ändra detta. En ny produktionschef och tre produktionsledare anställdes med uppdraget att vända den negativa situationen. Beslut togs om en intervention som påbörjades år 2015.

    Interventionen

    Samtlig personal vid produktionsenheten (n=46, inkluderande en produktionschef, tre produktions-ledare samt operatörer) genomgick utbildning under våren 2015 vid Human Lean Center, Högskolan i Gävle. Utbildningen bestod av en teoretisk och en praktisk del. Utbildningens teoretiska del handlade om hälsa och hälsofrämjande samt Lean filosofi. Utbildningens praktiska del innebar att montera trampbilar vid taktad monteringslina med hjälp av Lean metoder och ett hälsofrämjande perspektiv utgående från att arbete skall vara meningsfullt, begripligt och hanterbart. Kunskapen från utbildningen omsattes sedan vid Fagersta stainless produktionsenhet för dragen tråd genom att fyra förändringar gen-omfördes. 1. Skapa möjlighet för arbetsledarna att tillbringa tid på produktionsgolvet för att stödja produktionspersonalen. 2. Introduktion av ”whiteboardmöten” för information vid början av alla skift. 3. Byggandet av gemensam lunchplats. 4. Standardiserat arbets-sätt vid avvikelser.

    Metod

    Resultatet av interventionen mättes av Fagersta stainless med företagets system för upp-följning av produktivitet mätt i producerat ton stål per arbetare och sjukskrivningar mätta i procent av förlorad arbetstid i förhållande till möjlig arbetstid. Mätningar gjordes för år 2014, året före interventionen och för åren 2015-2017.

    Resultat

    Resultatet efter interventionen visar att Produktivitet per arbetare ökade för åren 2015-2017. År 2014 som var året före interventionen var produktiviteten per arbetare 158,3 ton. År 2015 ökade den med 24,9%, 2016 ökade produktiviteten per arbetare med 3,6% och för 2017 var ökningen 11,4%. Under samma tid åren 2015-2017 som produktiviteten ökade så minskade sjukskrivningar. 2014 året före interventionen uppgick sjukskriv-ningarna till 15% av total möjlig tid för arbete (100%). År 2015 sjönk sjukskrivningarna till 7% och 2016 sjönk de till 3% för att 2017 sjunka ytterligare till 2,5%.

    Slutsats

    Genom att kombinera hälsofrämjande teorier och Lean filosofi som delar i en utbildning med teoretiska och praktiska moment kan en kunskapsgrund läggas för en kontext-anpassad intervention som kan resultera i ökad produktivitet per arbetare samtidigt som sjukskrivningar kan minska. Verksamheter som vill öka produktivitet och samtidigt minska sjukskrivningar bör överväga att kombinera Lean filosofi med hälsofrämjande teori som strategi.

  • 119.
    Halling, Bengt
    et al.
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. 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.
    Renström, Jonas
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. Swedish Royal Institute of Technology.
    From Fantasy to Reality: Learning From Seven Years of Lean Implementation2013In: Journal of US-China Public Administration, ISSN 1548-6591, Vol. 10, no 4, p. 368-378Article in journal (Refereed)
    Abstract [en]

    The purpose of this paper is to address the question of how manager’s views on Lean in terms of “toolbox Lean” or“Lean thinking” impact their view of the implementation process. This paper is based on a case study at a globallyestablished Swedish manufacturing company. Findings show that managers’ definitions of Lean have evolved froma “toolbox” view toward more of a “Lean thinking” view during the implementation process, due to the learningtaking place in the organization during the implementation. As the understanding of Lean develops, new andunforeseen deviations or needs may be identified. This in turn affects the managers’ views on the implementationprocess and perceived needs in regard to Lean development. The study also shows that fragmented development ofan organization, such as production units developing individually without support from middle management orhuman resources (HR) may impede Lean development efforts. Lean implementation and development requiresystem wide change in order to be sustainable, which primarily concerns the management system and managementapproach but also all support functions within an organization. The use of external consultants in selected parts ofan organization, thereby by-passing management levels and support functions may generate conflicting prioritiesand tension within an organization. The paper contributes to a deeper understanding regarding the learning processrelated to Lean implementations and to the aspects of people development and leadership required for sustainableLean development.

  • 120.
    Halling, Bengt
    et al.
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. 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. KTH.
    Renström, Jonas
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. KTH .
    Lean leadership: a matter of dualism2014In: International Journal of Human Resources Development and Management, ISSN 1465-6612, E-ISSN 1741-5160, Vol. 14, no 4, p. 242-253Article in journal (Refereed)
    Abstract [en]

    On the basis of previous literature, this study takes a snowball approach to identify people influential on the topics through their writings. The aim was to conceptualise leadership and management in regard to lean, thus increasing understanding of the roles of leadership and management in lean development. The findings showed that leadership and management are two different but complementary action systems, similar to the duality of Toyota's two foundational principles: respect for people and continuous improvement. Differentiating between leadership and management is important in order to meet organisational needs during a lean implementation; each has complementary functions. Practical implications include the need to further train managers in leadership and to work within organisational culture to influence on–the–job behaviour. This lack of leadership competence may be one reason companies tend to address lean as a toolbox rather than an enterprise–wide system that covers all its operations and entails cultural and behaviour standards.

  • 121.
    Halling, Bengt
    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. University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Development, IT and Land Management, Industrial economics. University of Gävle, Center for Logistics and Innovative Production. Royal Institute of Technology, Stockholm, Sweden.
    Wijk, Katarina
    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 Public Health Medicine, County Council of Gävleborg, Gävle, Sweden; County Council of Gävleborg, Sweden; Faculty of Educational Science, Uppsala University, Sweden.
    Experienced Barriers to Lean in Swedish Manufacturing and Health Care2013In: International Journal of Lean Thinking, ISSN 2146-0337, Vol. 4, no 2Article in journal (Refereed)
    Abstract [en]

    A B S T R A C T  

    Purpose: The purpose is to compare similarities and divergences in how the concepts of Lean and barriers to Lean are described by key informants at a production unit in a large manufacturing company and two emergency health care units in Sweden.

    Design/methodology/approach: Data was collected via semi-structured interviews and analyzed with the constant comparative method (CCM) and Porras and Robertson’s

    (1992) change model.

    Findings: In both organizations, the view of Lean changed from a toolbox to a human behavior view. Eight barriers were experienced in both organizations. Three barriers

    were unique to manufacturing or to health care, respectively. Nine barriers were elements of social factors;five were elements of organizing arrangements.

    Research limitations/implications: Only people practically involved and responsible for the implementation at the two organizations participated in the study.

    Practical implications: Persons responsible for implementing Lean should consider organizational arrangements and social factors in order to limit barriers to

    successful implementation.

    Originality/value: Most research on Lean has been about successful Lean implementations. This study focuses on how Lean is viewed and what barriers personnel in

    manufacturing and health care have experienced. In comparing the barriers to Lean experienced in the two groups, common, archetypical, and unique barriers for manufacturing and health care can be identified, thus contributing to knowledge about barriers to Lean implementation.

  • 122.
    Hallman, David
    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.
    Autonom reglering, fysisk aktivitet och stress hos personer med långvarig smärta i nacke-skuldra2013In: Best Practice Smärta, Vol. 1, no 5, p. 20-23Article in journal (Other academic)
  • 123.
    Hallman, David
    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. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
    Autonomic nervous system regulation in chronic neck-shoulder pain: Relations to physical activity and perceived stress2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Neck-shoulder pain (NSP) is a highly prevalent musculoskeletal disorder with unclear causes, and effective prevention and treatment require a further understanding of the underlying mechanisms. Aberrant autonomic nervous system (ANS) regulation is a hypothesized causal element in the development and maintenance of chronic muscle pain.

    The overall aim of this thesis was to investigate possible differences in ANS regulation between chronic NSP and healthy control (CON) groups using both laboratory assessment and ambulatory monitoring in daily life.

    Four papers are included in this thesis, based on data from three groups with chronic NSP. Autonomic responses to laboratory stressors were assessed using heart rate variability (HRV), blood pressure, trapezius muscle activity and blood flow measurements (Study І) in NSP and CON. Long-term ambulatory monitoring of HRV, physical activity and perceived symptoms were assessed in Studies ІІ and IV to investigate group differences in real-life conditions. Finally, the effects of a ten-week intervention (using individually adjusted HRV biofeedback) to reinstating ANS balance in subjects with chronic NSP were evaluated using self-reported symptoms and health ratings, as well as autonomic regulation testing (i.e., evaluating HRV at rest and in response to stress) (Study ІІІ).

    The main findings from the four studies demonstrated aberrant ANS regulation in the NSP group compared to CON, which was predominantly characterized by diminished parasympathetic cardiac activity during rest and sleep, and altered sympathetic reactivity to laboratory stressors (Studies І, ІІ and IV). Different patterns in physical activity were observed between the NSP and CON groups, with reduced physical activity during leisure time in the NSP group (Studies ІІ and IV). Physical activity was found to be positively associated with HRV. Positive effects of HRV-biofeedback were found on perceived health, including social function, vitality and bodily pain, and improved HRV (Study ІІІ).

    In conclusion, imbalanced ANS regulation was demonstrated among persons with chronic NSP at both the systemic and local levels. Diminished parasympathetic activity in NSP was modulated by lower levels of physical activity in leisure time. Interventions targeting ANS functions might benefit persons with chronic NSP.

  • 124.
    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.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Contrasting effect of objectively measured physical activity during work and leisure on heart rate variability during sleep2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 2S, p. 32-33Article in journal (Refereed)
    Abstract [en]

    Aim: Leisure-time physical activity (LTPA) has a beneficial effect on cardiovascular health and longevity, while occupational physical activity (OPA) is associated with an increased risk of cardiovascular diseases and mortality. The physiological mechanism of this apparently contrasting relationship between LTPA and OPA on cardiovascular health remains unknown. A possible explanation is that OPA and LTPA exert different effects on the autonomic nervous system. Thus, we aimed to investigate whether objectively measured OPA and LTPA are differentially associated with cardiac autonomic regulation in an occupational sample.

    Methods: Cross-sectional data from the Danish cohort DPHACTO were analysed. The study comprised 514 bluecollar workers who took part in ambulatory monitoring of physical activity and heart rate variability (HRV). Physical activity (i.e. time spent in walking, climbing stairs, running and cycling) was assessed objectively using accelerometers (Actigraph) worn on the thigh, hip and trunk over 4–5 working days. Simultaneously, a heart rate monitor (Actiheart) was used to collect inter-beat intervals from the ECG signal. Heart rate and HRV indices were analysed during nocturnal sleep as markers of cardiac autonomic activity. Multiple regression analysis was used to determinethe main effects of OPA and LTPA and their interaction on heart rate and HRV indices, adjusting for multiple confounders (age, gender, body mass index, smoking and cardiovascular ailments).

    Results: Time spent in physical activity was on average (SD) 1.4 (0.6) hours/day for OPA and 0.9 (0.4) hours/day for LTPA. OPA showed generally negative associations with nocturnal HRV indices, while positive estimates were observed for LTPA. There was a statistically significant interaction effect between OPA and LTPA on heartrate (P < 0.0001) and HRV indices in time (root mean square of standard deviation, P = 0.004: standard deviation of normal to normal sinus beat, P = 0.019) and frequency domains (high frequency power, P = 0.022; low frequency power, P = 0.033). The favourable effect of LTPA on nocturnal HRV clearly diminished with higher levels of OPA, and high levels of both OPA and LTPA had a detrimental effect. The observed associations persisted after adjustment for possible confounders.

    Conclusion: Our findings suggest that time spent in OPA and LTPA have interactive effects on nocturnal autonomic regulation. Future longitudinal studies should examine whether autonomic regulation is a mediator for the effect of OPA and LTPA on cardiovascular disease and mortality.

  • 125.
    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.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    On the health paradox of occupational and leisure-time physical activity using objective measurements: effects on autonomic imbalance2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 5, article id e0177042Article in journal (Refereed)
    Abstract [en]

    Objective

    Leisure-time physical activity (LTPA) has considerable benefits for cardiovascular health and longevity, while occupational physical activity (OPA) is associated with an elevated cardiovascular risk. This “health paradox” may be explained by different effects on the autonomic nervous system from OPA and LTPA. Thus, we aimed to investigate whether objectively measured OPA and LTPA are differentially associated with autonomic regulation among workers.

    Methods

    The study comprised 514 blue-collar workers from the Danish cohort DPHACTO. Physical activity (i.e. walking, climbing stairs, running and cycling) was assessed objectively using accelerometers worn on the thigh, hip and trunk over multiple working days. During this period, a heart rate monitor was used to sample heart period intervals from the ECG signal. Heart rate and heart rate variability (HRV) indices were analyzed during nocturnal sleep as markers of autonomic regulation. Multiple regression analysis was used to determine the main effects of OPA and LTPA and their interaction on heart rate and HRV, adjusting for multiple confounders.

    Results

    Statistically significant interaction was found between OPA and LTPA on heart rate (adjusted p<0.0001) and HRV indices in time (rMSSD, adjusted p = 0.004) and frequency-domains (HF, adjusted p = 0.022; LF, adjusted p = 0.033). The beneficial effect of LTPA on nocturnal heart rate and HRV clearly diminished with higher levels of OPA, and high levels of both OPA and LTPA had a detrimental effect.

    Conclusion

    We found contrasting associations for objectively measured OPA and LTPA with heart rate and HRV during sleep. Differential effects of OPA and LTPA on autonomic regulation may contribute to the physical activity health paradox.

  • 126.
    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, ISSN 2044-6055, 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.

  • 127.
    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 Center for the Working Environment, Copenhagen, Denmark.
    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.
    Holtermann, Andreas
    National Research Center for the Working Environment, Copenhagen, Denmark.
    Association between objectively measured sitting time and neck-shoulder pain among blue-collar workers2015In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 88, no 8, p. 1031-1042Article in journal (Refereed)
    Abstract [en]

    Objectives Prolonged sitting has been suggested as a risk factor for neck-shoulder pain (NSP). Using a cross-sectional design, we investigated the extent to which objectively measured time sitting is associated with NSP among blue-collar workers.

    Methods Sitting time was measured during multiple working days on male (n=118) and female (n=84) blue-collar workers (n=202) using tri-axial accelerometers (Actigraph) placed on the thigh and trunk. Workers were categorized into having, on average, a low, moderate, or high sitting time, with mean values (SD between subjects) of 4.9 (1.0), 7.3 (0.5), and 9.6 (1.1) hours in total per day. Workers rated their largest NSP intensity during the previous month on a numerical scale (0-9), and were subsequently dichotomized into a low and high NSP intensity group (ratings 0-4 and >4, respectively). Logistic regression analyses adjusted for several individual and work-related factors were used to investigate the association between average sitting time per day (work, leisure and total) and NSP intensity.   

    Results For total sitting time, workers in the high sitting category were more likely (adjusted OR 2.97, CI 1.25-7.03) to report high NSP intensity than those who sat moderately (reference category). Low sitting during work was associated with a reduced NSP intensity, but only for males (adjusted OR 0.26 CI 0.07-0.96). No significant association was found between sitting during leisure and NSP intensity.

    Conclusion These findings suggest an association between sitting time, in total per day and specifically during work, and NSP intensity among blue-collar workers. We encourage studying the structure and explanation of this association further in prospective studies on larger populations.

  • 128.
    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.
    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.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Is there an association between objectively measured occupational sitting and intense neck-shoulder pain among blue-collar workers?2015In: / [ed] University of Limerick, 2015, p. 74-Conference paper (Refereed)
    Abstract [en]

    Introduction

    Prolonged occupational sitting has been suggested to be a risk factor for neck-shoulder pain (NSP). However, studies using valid and precise methods for assessing sitting are lacking. We investigated the extent to which objectively measured sitting time is associated with intense NSP among blue-collar workers.

    Methods

    In a cross-sectional study, sitting time was measured for two working days on male (n=118) and female (n=84) blue-collar workers using tri-axial accelerometers (Actigraph) placed on the thigh and trunk. Workers were categorized in tertiles having low, moderate, or high sitting time at work. Workers rated their NSP intensity during the previous month on a numerical scale (0-9), and were then dichotomized into a low (0-4) and high (>4) NSP intensity group. Binary logistic regression analyses, with multiple adjustments for individual and occupational risk factors besides sitting, were performed to investigate the association between occupational sitting time and intense NSP, separately for males and females.  

    Results

    We found that low occupational sitting was associated with a reduced NSP intensity compared to moderate sitting among males (OR 0.28, 95%CI 0.08-0.98). This association remained significant after adjustment for individual and occupational covariates (adjusted OR 0.26, 95%CI 0.07-0.96). We found no such relationship among females (OR 1.01, 95%CI 0.28-3.59), and high sitting was not associated with pain.

    Conclusion

    Our findings suggest a gender-specific association between occupational sitting time and intense NSP among blue-collar workers. We encourage further studies to investigate the nature of this association, using prospective designs in larger, gender-stratified populations.

  • 129.
    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.
    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.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Temporal patterns of physical activity during work and leisure: exposure variation analysis of accelerometer recordings processed by the ACTI4 software2015Conference paper (Other academic)
    Abstract [en]

    Introduction

    Previous studies have found substantial differences in the health effects of occupational (OPA) and leisure time physical activity (LTPA): LTPA is generally beneficial to health, while OPA may be detrimental. Why these differences occur is, however, so far not clear. Different time patterns of OPA and LTPA may be an explanation. Thus, we aimed to investigate the extent to which time patterns of OPA and LTPA differ in a population of blue-collar workers.

    Methods

    This study was conducted on a cross-sectional sample of 191 blue-collar workers from seven workplaces in Denmark. Physical activity and sedentary behavior were estimated using the Acti4 method on recordings from accelerometers (Actigraph GT3X+) worn on the thigh and trunk for four consecutive days. Time patterns of OPA and LTPA were retrieved separately for work and leisure using Exposure Variation Analysis (EVA), and expressed in terms of percentage time spent in uninterrupted periods of different durations (<1min, 1-5 min, 5-10 min, 10-30 min, 30-60 min and > 60 min) of sitting, standing, and walking. Differences between OPA and LTPA in selected EVA derivatives were tested using repeated measures ANOVA with adjustments for differences between work and leisure in total time for each activity.

    Results

    We found significant differences between work and leisure time for several EVA derivatives, with OPA showing a larger percentage time walking and standing in short periods (<5 min), and less percent time in prolonged sitting (>30 min) than LTPA. Apart from standing (p=.10), these differences remained significant even after adjusting for the difference between work and leisure in total time spent in each activity.

    Conclusion

    We found, among blue-collar workers, that the time patterns of OPA and LTPA were markedly different even after adjustment for total PA time. We suggest using EVA derivatives in future studies investigating potential associations of OPA and LTPA with health outcomes.

  • 130.
    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.
    Hed Ekman, Annika
    Manpower Hälsopartner, Sandviken, Sweden.
    Lyskov, Eugene
    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.
    Changes in physical activity and heart rate variability in chronic neck-shoulder pain: monitoring during work and leisure time2014In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 87, no 7, p. 735-744Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Neck-shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation in relation to physical activity and perceived symptoms during work and leisure time among workers with chronic NSP (n = 29) as compared to a healthy control group (CON, n = 27).

    METHODS: Physical activity was objectively monitored for 7 days using accelerometry. Beat-to-beat heart rate was collected continuously for 72 h, with simultaneous momentary ratings of pain, stress, and fatigue. Duration of sitting/lying, standing and walking, number of steps, and energy expenditure were used as measures of physical activity. Heart rate variability (HRV) indices were extracted in time and frequency domains as reflecting autonomic regulation. Data were divided into work hours, leisure time, and sleep.

    RESULTS: The NSP group rated higher levels of stress and fatigue at work and leisure, and reduced sleep quality as compared to CON. Elevated heart rate and reduced HRV were found in NSP compared with CON, especially during sleep. The NSP group demonstrated a different pattern of physical activity than CON, with a lower activity level in leisure time. Higher physical activity was associated with increased HRV in both groups.

    CONCLUSION: Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP.

  • 131.
    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.
    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.
    Gupta, Nidhi
    National Research Centre for the Working Environment, Copenhagen.
    Korshøj, Mette
    National Research Centre for the Working Environment, Copenhagen.
    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.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen.
    Association between sitting time at work and favorable changes in neck-shoulder pain among blue-collar workers2016Conference paper (Refereed)
    Abstract [en]

    Background. Previous studies suggest that prolonged sitting at work is a risk-factor for neck-shoulder pain (NSP). However, a majority of studies on the association between occupational sitting and NSP have relied on cross-sectional designs and self-reported measurements of sitting time. Our aim was to determine the extent to which occupational sitting time, assessed using accelerometry, is associated with the 1-year time course of NSP intensity among blue-collar workers.

    Methods. Our study included 494 Danish workers (female n=220) from three occupational sectors: cleaning (n=96), manufacturing (n=356) and transportation (n=42). At baseline, sitting was monitored continuously for several working days (mean (SD) wear time: 2.6 (0.9) days) using accelerometers attached to the thigh and trunk. During the following 12 months, data on self-reported NSP intensity (NRS scale, range 0-10) were collected on a monthly basis using SMS tracking. Repeated measures ANOVA adjusted for gender, occupational sector, seniority, and pain at baseline was used to examine the association between per cent time spent sitting (at work and leisure) and changes in NSP across time.

    Results. We found a significant interaction between occupational sitting at baseline and the time course of NSP (F(11,491)=6.37, p=0.01), which remained significant with adjustment for covariates (F(11,464)=6.64, p=0.01). We found no main effect of occupational sitting on NSP (p>0.05). Categorizing sitting time revealed that more sitting at work was accompanied by larger reductions in NSP over time. The effect of time on NSP was stronger in the high sitting group (F(11,162)=30.4, p<0.0001) than in the low (F(11,162)=4.9, p=0.05) and moderate (F(11,167)=5.10, p=0.02) sitting groups. We found no association between leisure-time sitting and NSP (p>0.05).

    Discussion. In contrast to previous studies, our results indicate that prolonged sitting is associated with a favourable prognosis of NSP across one year in workers. The clinical significance of this result needs to be examined further

  • 132.
    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.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Can the daily time-pattern differentiate the health effects of physical activity?2018In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, no 10 Suppl. 1, p. S3-Article in journal (Refereed)
  • 133.
    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.
    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, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 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.

  • 134.
    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.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Søgaard, Karen
    Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Krustrup, Peter
    Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and Health, University of Copenhagen, Copenhagen, Denmark.
    Kristiansen, Jesper
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Korshøj, Mette
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Effect of an aerobic exercise intervention on cardiac autonomic regulation: A worksite RCT among cleaners2017In: Physiology and Behavior, ISSN 0031-9384, E-ISSN 1873-507X, Vol. 169, p. 90-97Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of this randomized controlled trial (RCT) was to determine whether aerobic exercise during work hours affects cardiac autonomic regulation in cleaners characterized by high levels of occupational physical activity and poor cardiorespiratory fitness.

    Method

    Eligible cleaners (n=116) were randomized to an aerobic exercise group (n=59) or a reference group (n=57) with lectures. The intervention group received two 30-min sessions per week of supervised aerobic exercise over 4 months. Diurnal measurements of heart rate variability (HRV) and physical activity (accelerometry) were obtained at baseline and at 4-month follow-up. Time and frequency domain indices of HRV were derived during work, leisure time and sleep to evaluate cardiac autonomic regulation. Linear mixed models were used to determine the effect of the intervention on HRV indices, with adjustment for age, gender and daily use of antihypertensive and/or heart medication.

    Results

    Compared with the reference group, the exercise group increased all HRV indices apart from a reduction in LF/HF ratio from baseline to follow-up both during work (p<0.05) and leisure (p<0.05). In contrast, during sleep, the HRV indices tended to decrease in the exercise group compared with the reference group from baseline to follow-up, being significant for the HF spectral component (p=0.03).

    Conclusion

    Among cleaners, a worksite aerobic exercise intervention improved cardiac autonomic regulation during work and leisure, but not during sleep. The health effect of this contrasting change in autonomic regulation needs further investigation.

  • 135.
    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.
    Jørgensen, Marie Birk
    Holtermann, Andreas
    Har fysisk aktivitet på arbete och fritid betydelse för återhämtning från nacksmärta hos arbetare?: En prospektiv studie med objektiva mätningar2016Conference paper (Refereed)
    Abstract [en]

    Syfte

    Kunskapen om vilka faktorer som påverkar förloppet av smärta i nacke/skuldra hos personer med manuella arbeten är mycket begränsad. Syftet med föreliggande prospektiva studie var att undersöka sambandet mellan objektivt registrerad fysisk aktivitet på arbetet och fritiden med förloppet av smärta över ett år hos kvinnor och män med manuellt arbete.

    Metod

    Data samlades in från 625 arbetare inom industri, städning och transport sektorerna från den Danska kohorten DPHACTO. Fysisk aktivitet mättes objektivt vid baslinje med 4 accelerometrar (Actigraph GT3X+) under 1-5 arbetsdagar. Mjukvaran Acti4 användes för att klassificera olika typer av fysisk aktivitet (gå, gå i trapport, cykla, springa). Andel tid i fysisk aktivitet beräknades separat för arbete och fritid. Textmeddelanden (SMS) med frågor om smärtintensitet i nacke/skuldra (skala 0-10) sändes ut till deltagarna med fyra veckors intervall under 12 månader. Linear mixed models användes för att fastställa samband mellan fysisk aktivitet på arbete och fritid med nivå och förändring av smärta över tid, med justering för potentiella konfounders.

    Resultat

    Fysisk aktivitet på arbetet var inte associerat med genomsnittlig smärtnivå, men fysisk aktivitet på fritiden var associerat med lägre smärta både hos kvinnor (B=-0.71, 95 % CI -1.31‒-0.11) och män (B=-0.85, 95 % CI -1.57‒-0.13). Vi fann en signifikant interaktion mellan fysisk aktivitet och kön på förändring av smärta. Fysisk aktivitet på arbetet var relaterat till långsammare återhämtning av smärta hos män (B=0.03, 95 % CI 0.01‒0.05), medan fysisk aktivitet på fritiden var associerat med långsammare återhämtning hos kvinnor.

    Slutsatser

    Resultaten indikerar att fysisk aktivitet på fritiden har en skyddande effekt på smärta i nacke/skuldra hos personer med manuellt arbete. Betydelsen av fysisk aktivitet på arbetet och fritiden för återhämtning av smärta tycks skilja sig mellan kvinnor och män, vilket kan bero på skillnader i exponering, vila och återhämtning. 

  • 136.
    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.
    Lyskov, Eugene
    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.
    Monitoring of autonomic regulation and physical activity in workers with musculoskeletal pain2013Conference paper (Refereed)
    Abstract [en]

    Purposes

    Neck-shoulder pain (NSP) is a common work-related musculoskeletal disorder (1). The autonomic nervous system (ANS) is a potential element in the pathogenesis of regional muscle pain (2). Altered cardiovascular regulation has been observed in chronic NSP at rest and in response to stressors (3, 4). Importantly, the ANS control of the cardiovascular system is strongly influenced by daily physical activity. Thus, the observed aberrations in ANS regulation in chronic NSP may be due to pain-related changes in daily physical activity. The present study aimed at investigating ANS regulation and physical activity in workers with chronic NSP (N = 29) and symptom-free controls (N = 27) during work and leisure time.

     

    Methods

    Ambulatory monitoring of physical activity (seven days) and ANS cardiac activity (72-hours) were performed using accelerometry and electrocardiography, respectively. Time walking, sitting/lying and standing, as well as number of steps were calculated for each hour and averaged for work and leisure time. Heart rate variability indices were calculated in both time and frequency domains, and averaged over work, leisure time and sleep.

     

    Results

    The results indicated a reduced level of leisure time physical activity in NSP compared to controls (p<0.05), while no differences were observed for sedentary time. NSP demonstrated diminished HRV during sleep (p<0.05). Positive correlations were found between leisure time physical activity and HRV during sleep (p<0.05).

     

    Conclusions

    Reduced leisure time physical activity and diminished nocturnal HRV were seen in persons with chronic muscle pain. Correlations between leisure time physical activity and HRV may indicate that ANS regulation was partly modulated by physical activity in leisure time

  • 137.
    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.
    Lyskov, Eugene
    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.
    Seven Days Activity Monitoring in Workers with Musculoskeletal Pain: Daily Patterns, Associations with Symptoms2013Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION:

    Musculoskeletal pain is highly common among the working population. It has been assumed that chronic pain may reduce the activity level in daily life, which in turn may aggravate pain and associated symptoms. However, it is not known whether pain impacts on daily activities among workers. Commonly accepted and validated protocols are needed to gain objective information about possible deviations in physical activity patterns in subjects with chronic musculoskeletal pain.

     

    PURPOSE:

    The aim of this cross-sectional study was to investigate the volume and time-pattern of daily physical activity in workers with chronic musculoskeletal pain compared with healthy controls.

     

    METHODS:

    Twenty-seven workers with chronic muscle pain primarily in the neck-shoulder region, and 27 age- and gender- matched controls participated in the study. Both groups were recruited from the same global manufacturing company within the industrial sector at a site in Sweden. Physical activity and sedentary behaviour were monitored for seven days, both during work and leisure time, using a single tri-axial accelerometer (PAL Technologies Ltd, Glasgow). Time spent walking, standing and sitting/lying and steps were calculated for each hour. The mean metabolic equivalent (MET) was estimated and used as a measure of energy expenditure. The coefficient of variation (CV) between daytime hours was calculated as a measure of variation.

     

    RESULTS:

    For overall daily activity, the mean standing time was significantly higher in the pain group (263 min/day) compared with controls (209 min/day) (p=0.04), whereas no difference was found in energy expenditure or sedentary time. The analyses of time patterns revealed lower energy expenditure in the evening and morning hours among those with pain (mean 1.6 MET/h) compared with the control group (mean 1.8 MET/h) (p<0.05). The pain group showed on average a smaller CV in MET (9%) than the control group (11%) (p=0.02), which indicated a reduced variation in physical activity. There were no significant associations between pain intensity and physical activity.

     

    CONCLUSION:

    Despite a normal level of total physical activity, workers with chronic musculoskeletal pain had an altered activity pattern in terms of reduced variation and a lower activity level in leisure time.

  • 138.
    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.
    Lyskov, Eugene
    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.
    Stress och muskelsmärta - mekanismer och behandling2013In: Stress: Gen, Individ, Samhälle / [ed] Bengt Arnetz, Rolf Ekman, Stockholm: Liber, 2013, 3, p. 181-193Chapter in book (Other academic)
  • 139.
    Hallman, David M.
    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.
    Birk Jørgensen, Marie
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark; University of Southern Denmark, Odense, Denmark.
    Objectively measured physical activity and 12-month trajectories of neck-shoulder pain in workers: a prospective study in DPHACTO2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 3, p. 288-298Article in journal (Refereed)
    Abstract [en]

    Aims: This study aimed to investigate the association between objectively measured physical activity at work and leisure and the intensity (mean level and time course) of neck–shoulder pain (NSP) over 12 months among male and female blue collar workers. Methods: Data were obtained from 625 blue collar workers from the Danish cohort DPHACTO. Physical activity was measured objectively at baseline using accelerometers. The percentage of time spent in physical activity (walking, climbing stairs, running and cycling) was calculated for both work and leisure time. Longitudinal data on the intensity of NSP (numerical rating scale 0–10) were collected using text messages every fourth week over 12 months. Linear mixed models were used to investigate the associations between occupational physical activity (OPA) and leisure time physical activity (LTPA) and the trajectories of the intensity of NSP, adjusted for individual, biomechanical and psychosocial factors, and baseline pain. Results: OPA was not associated with the mean intensity of NSP over 12 months. LTPA was negatively associated with the mean intensity of NSP both among men (B=−0.71, 95% CI −1.31 to −0.11) and women (B=−0.85, 95% CI −1.57 to −0.13). Sex interactions on the 12-month trajectories of NSP showed that higher physical activity was associated with a slower reduction in NSP among men for OPA only (B=0.03, 95% CI 0.01-0.05) and women for LTPA only (B=0.05, 95% CI 0.00-0.09). Conclusions: We found that more time in LTPA was associated with a lower overall intensity of NSP over 12 months among blue collar workers. However, depending on sex and domain, high physical activity had an unfavourable effect on the course of NSP over 12 months.

  • 140.
    Hallman, David M.
    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.
    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.
    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.
    Gupta, Nidhi
    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.
    Temporal patterns of sitting at work are associated with neck-shoulder pain in blue-collar workers: a cross-sectional analysis of accelerometer data in the DPHACTO study2016In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 89, no 5, p. 823-833Article in journal (Refereed)
    Abstract [en]

    Background

    Our aim was to examine the extent to which temporal patterns of sitting during occupational work and during leisure-time, assessed using accelerometry, are associated with intense neck–shoulder pain (NSP) in blue-collar workers.

    Methods

    The population consisted of 659 Danish blue-collar workers. Accelerometers were attached to the thigh, hip, trunk and upper dominant arm to measure sitting time and physical activity across four consecutive days. Temporal sitting patterns were expressed separately for work and leisure by the proportion of total time spent sitting in brief bursts (0–5 min), moderate (>5–20 min) and prolonged (>20 min) periods. The peak NSP intensity during the previous 3 months was assessed using a numerical rating scale (range 0–10) and dichotomized into a lower (≤4) and higher (>4) NSP score. Logistic regression analyses with multiple adjustments for individual and occupational factors were performed to determine the association between brief, moderate and prolonged sitting periods, and NSP intensity.

    Results

    Time in brief bursts of occupational sitting was negatively associated with NSP intensity (adjusted OR 0.68, 95 % CI 0.48–0.98), while time in moderate periods of occupational sitting showed a positive association with NSP (adjusted OR 1.32, 95 % CI 1.04–1.69). Time in prolonged periods of occupational sitting was not associated with NSP (adjusted OR 0.78, 95 % CI 0.78–1.09). We found no significant association between brief, moderate or prolonged sitting periods during leisure, and NSP.

    Conclusion

    Our findings indicate that the association between occupational sitting time and intense NSP among blue-collar workers is sensitive to the temporal pattern of sitting.

  • 141.
    Hallman, David M.
    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.
    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.
    Lyskov, Eugene
    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.
    Long-term monitoring of physical behavior reveals different cardiac responses to physical activity among subjects with and without chronic neck pain2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, Vol. 2015, article id 907482Article in journal (Refereed)
    Abstract [en]

    Background We determined the extent to which heart rate variability (HRV) responses to daily physical activity differ between subjects with and without chronic neck pain.

    Method Twenty-nine subjects (13 women) with chronic neck pain and 27 age- and gender-matched healthy controls participated. Physical activity (accelerometry), HRV (heart rate monitor) and spatial location (Global Positioning System (GPS)) were recorded for 74 hours. GPS data were combined with a diary to identify periods of work, and of leisure at home and elsewhere. Time- and frequency-domain HRV indices were calculated, and stratified by period and activity type (lying/sitting, standing, or walking). ANCOVAs with multiple adjustments were used to disclose possible group differences in HRV.

    Results The pain group showed a reduced HRV response to physical activity compared with controls (p=.001), according to the sympathetic-baroreceptor HRV index (LF/HF, ratio between low and high frequency power), even after adjustment for leisure time physical activity, work stress, sleep quality, mental health, and aerobic capacity (p=.02). The parasympathetic response to physical activity did not differ between groups.

    Conclusions Relying on long-term monitoring of physical behavior and heart rate variability, we found an aberrant sympathetic-baroreceptor response to daily physical activity among subjects with chronic neck pain.

  • 142.
    Hallman, David M.
    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.
    Nørregaard Rasmussen, Charlotte D.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Jørgensen, Marie Birk
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Time course of neck-shoulder pain among workers: A longitudinal latent class growth analysis.2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 1, p. 47-57, article id 3690Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aims of this study were to (i) identify trajectories of neck-shoulder pain (NSP) over one year in an occupational population and (ii) determine whether these trajectories are predicted by NSP characteristics as well as personal and occupational factors at baseline.

    Methods

    This longitudinal study was conducted among Danish workers (N=748) from 2012-2014. Text messages were used to collect frequent data on NSP over one year (14 waves in total). Peak NSP intensity in the past month was rated on a 0-10 numeric scale. A baseline questionnaire covered NSP characteristics (pain intensity, duration, comorbidity, pain medication, and pain interference) as well as personal (age, gender, body mass index) and occupational (seniority, work type, physical strain at work) factors. Latent class growth analysis was used to distinguish trajectories of NSP. Multivariate regression models with odds ratios (OR) were constructed to predict trajectories of NSP.

    Results

    Six distinct trajectories of NSP were identified (asymptomatic 11%, very low NSP 10%, low recovering NSP 18%, moderate recovering NSP 28%, strong fluctuating NSP 24% and severe persistent NSP 9% of the workers). Female gender, age, physical strain at work, NSP intensity and duration, pain medication, and pain interference in daily work at baseline were positively associated with severe persistent NSP and strong fluctuating NSP (all P<0.05). Altogether, personal and occupational factors accounted for 14% of the variance, while NSP characteristics accounted for 54%.

    Conclusions

    In an occupational sample, six distinct trajectories of NSP were identified. Physical strain at work appears to be a pertinent occupational factor predicting strong fluctuating and severe persistent NSP.

  • 143.
    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.
    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.
    Gupta, Nidhi
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Korshøj, Mette
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Differences between work and leisure in temporal patterns of objectively measured physical activity among blue-collar workers2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1, article id 976Article in journal (Refereed)
    Abstract [en]

    Background

    Leisure time physical activity (LTPA) is generally associated with favorable cardiovascular health outcomes, while occupational physical activity (OPA) shows less clear, or even opposite, cardiovascular effects. This apparent paradox is not sufficiently understood, but differences in temporal patterns of OPA and LTPA have been suggested as one explanation. Our aim was to investigate the extent to which work and leisure (non-occupational time) differ in temporal activity patterns among blue-collar workers, and to assess the modification of these patterns by age and gender.

    Methods

    This study was conducted on a cross-sectional sample of male (n = 108) and female (n = 83) blue-collar workers, aged between 21 and 65 years. Physical activity and sedentary behavior were assessed using accelerometers (Actigraph GT3X+) worn on the thigh and trunk for four consecutive days. Temporal patterns of OPA and LTPA were retrieved using Exposure Variation Analysis (EVA), and expressed in terms of percentage of work and leisure time spent in uninterrupted periods of different durations (<1 min, 1–5 min, 5–10 min, 10–30 min, 30–60 min and > 60 min) of sitting, standing, and walking. Repeated measures ANOVA and linear regression analyses were used to test a) possible differences between OPA and LTPA in selected EVA derivatives, and b) the modification of these differences by age and gender.

    Results

    OPA showed a larger percentage time walking in brief (<5 min) periods [mean (SD): 33.4 % (12.2)], and less time in prolonged (>30 min) sitting [7.0 % (9.3)] than LTPA [walking 15.4 % (5.0); sitting 31.9 % (15.3)], even after adjustment for the difference between work and leisure in total time spent in each activity type. These marked differences in the temporal pattern of OPA and LTPA were modified by gender, but not age.

    Conclusion

    We found that the temporal patterns of OPA and LTPA among blue-collar workers were markedly different even after adjustment for total physical activity time, and that this difference was modified by gender. We recommend using EVA derivatives in future studies striving to disentangle the apparent paradoxical cardiovascular effect of physical activity at work and during leisure.

  • 144.
    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.
    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.
    Hed-Ekman, Annika
    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.
    Lyskov, Eugene
    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.
    Physical activity patterns in workers with neck pain assessed using accelerometry and GPS2014Conference paper (Refereed)
    Abstract [en]

    Background:

    Decreased physical activity levels have been found among subjects with work-related musculoskeletal disorders (MSD). Still, little is known about the distribution of physical activity and sedentary behavior over a work day, and whether these patterns differ between work and leisure time. Our aim was to characterize and compare physical activity patterns at work and leisure time (spent at home or elsewhere) among office workers with MSD and asymptomatic controls.

    Methods:

    Seventeen office workers (11f, 6m; mean age 41(SD=11) years) with neck-shoulder pain, and 17 age- and gender-matched asymptomatic office workers participated. Physical activity and sedentary behavior were monitored continuously for seven days using a single tri-axial accelerometer (ActivPAL). During four consecutive work-days within this period, data from a geographical positioning system (GPS) detector installed on a smartphone was combined with a written diary to identify the location (work place, leisure "at home" and "elsewhere") of the participants. Differences between groups in mean physical activity levels (excluding sleep) stratified by location were analysed with ANOVA. Physical activity patterns were expressed using Exposure Variation Analysis (EVA), showing the percentage of time spent in periods of different durations (<1min, 1-5min, 5-10min, 10-30min, 30-60min, >60min) of sitting/lying, standing, and walking.

    Results:

    In both groups, the lowest activity levels were found at work. Leisure "elsewhere" showed less %time in long bouts (>30min) of sitting/lying and more %time in walking (5-10 and 10-30 min bouts) compared with "home". Workers with pain did not increase their leisure activity level "elsewhere" compared with "home" to the same extent as controls, which was mainly reflected in a larger %time in prolonged periods (>30 min) of sitting/lying among those with pain.

    Conclusion:

    The combination of accelerometry and GPS allowed a detailed characterization of physical activity patterns stratified by location among office workers. Some differences were found between workers with and without MSD, which need further investigation as to their effects on health and well-being.

  • 145.
    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.
    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.
    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.
    Birk Jørgensen, Marie
    Holtermann, Andreas
    Rudolfsson, Thomas
    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.
    Björklund, Martin
    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.
    Svedmark, Åsa
    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.
    Hellström, Fredrik
    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.
    Rönnlund Borg, Tina
    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.
    Häger, Charlotte
    Sommar, Johan
    Wahlström, Jens
    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.
    Symposium: Arbete, individ och nacksmärta: Forskning vid Forte-centret “Kroppen i arbete – från problem till potential”2018In: FALF KONFERENS 2018 Arbetet - problem eller potential för en hållbar livsmiljö? 10-12 juni 2018 i Gävle: Program och Abstracts / [ed] Per Lindberg, Gävle: Gävle University Press , 2018, p. 102-Conference paper (Refereed)
    Abstract [sv]

    Besvär ifrån kroppens muskler och leder såsom nack- och ryggbesvär är fortfarande ett stort problem inom arbetslivet. Muskuloskeletal diagnos är den vanligaste orsaken till lång sjukfrånvaro inom privat sektor och näst vanligast inom kommuner och landsting. Orsakerna till dessa besvär kan vara relaterade till exponering både under arbete och på fritid, men även till individfaktorer. Vår forskargrupp har en bred ansats för att fylla kunskapsluckor inom detta område och kommer att presentera resultat från flera forskningsprojekt i symposiet Arbete, individ och nacksmärta.

    Långvarigt sittande har blivit alltmer vanligt förekommande i många yrkesgrupper. Långvarigt sittande och låg fysisk aktivitet har också uppmärksammats som ett betydande hälsoproblem i dagens arbetsliv och även som en möjlig riskfaktor för smärta i nacke-skuldra. Men forskningen om betydelsen av långvarigt sittande för smärta i nacke-skuldra är fortfarande begränsad. Likaså är det oklart om huvudets hållning vid sittandet och nackens funktion, exempelvis nackens rörelsefunktion och styrka, har betydelse för besvärsutveckling. Statiskt arbete med nacken i vridna och böjda positioner misstänks vara en riskfaktor för nack-skuldersmärta i yrken såsom tandläkare, men det är oklart varför vissa exponerade individer drabbas medan andra inte får ont. För de med långvarig smärta krävs ofta rehabiliterande åtgärder, och hur väl dessa åtgärder lyckas kan även det vara beroende av individens fysiska och psykosociala arbetsmiljö. Individens arbetsmiljö påverkar således inte bara risken för om man får besvär utan kan också ha betydelse för hur rehabiliteringen av besvären lyckas.

    Syftet med detta symposium är att presentera studier från Centrum för belastningsskadeforskning som handlar om nacksmärta i arbetslivet, sammanfatta kunskapsläget inom området och diskutera hur arbetet kan utformas för att bli hållbart och inkluderande. De forskningsexempel som presenteras berör stillasittande och hållning i arbetslivet och dess tänkbara konsekvenser för nacksmärta och hälsa, riskfaktorer för nacksmärta i tandläkaryrket och arbetsmiljöns betydelse för resultatet av rehabilitering vid nacksmärta. Symposiet avslutas med en frågestund och gemensam diskussion.

  • 146.
    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.
    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.
    Jahncke, Helena
    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.
    Sitting patterns after relocation to activity-based offices: a controlled study of a natural intervention2018In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 111, p. 384-390Article in journal (Refereed)
    Abstract [en]

    This study determined the effect of relocating workers from traditional to activity-based offices on objectively measured sitting patterns. Office workers (n=493) from five office-sites within a large Swedish government agency were included in a controlled study of a natural intervention (2015-2017). At four sites, traditional offices were replaced by activity-based offices, while workers at one site with no relocation acted as controls. Sitting, standing and walking were measured objectively for 5-8days in a sub-sample (n=110) using accelerometry (Actigraph). Total sitting time (% of working time) and time spent in short (<5min), moderate (5-30min) and prolonged (>30min) uninterrupted periods in sitting were determined. Intervention effects were determined at 3- and 12-month follow-ups using linear mixed models adjusted for baseline age, gender and office type, and stratified by office-site (referencing controls). The relocation to activity-based offices did not result in an overall effect (across sites) on occupational sitting time (all p>0.05), while walking time had increased significantly by 1.4% of the working time at 12months compared with controls. Heterogeneous results were found across offices after 12months on total sitting time compared with controls (estimated change -18.3% time-1.4% time), prolonged sitting (change -18.3% to -3.8%), walking (change 0.5%-3.5%) and standing (change -1.4%-13.9%). In conclusion, relocation to activity-based offices had a limited overall effect on occupational sitting patterns in the studied organization, but differed considerably between office sites. Site-specific determinants of sitting behavior in activity-based offices need be identified.

  • 147.
    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.
    Sato, Tatiana
    Physical Therapy Department, Federal University of São Carlos (UFSCar), São Paulo, Brazil.
    Kristiansen, Jesper
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Gupta, Nidhi
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Skotte, Jørgen
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Prolonged sitting is associated with attenuated heart rate variability during sleep in blue-collar workers2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 11, p. 14811-14827Article in journal (Refereed)
    Abstract [en]

    Prolonged sitting is associated with increased risk for cardiovascular diseases and mortality. However, research into the physiological determinants underlying this relationship is still in its infancy. The aim of the study was to determine the extent to which occupational and leisure-time sitting are associated with nocturnal heart rate variability (HRV) in blue-collar workers. The study included 138 blue-collar workers (mean age 45.5 (SD 9.4) years). Sitting-time was measured objectively for four days using tri-axial accelerometers (Actigraph GT3X+) worn on the thigh and trunk. During the same period, a heart rate monitor (Actiheart) was used to sample R-R intervals from the electrocardiogram. Time and frequency domain indices of HRV were only derived during nighttime sleep, and used as markers of cardiac autonomic modulation. Regression analyses with multiple adjustments (age, gender, body mass index, smoking, job-seniority, physical work-load, influence at work, and moderate-to-vigorous physical activity) were used to investigate the association between sitting time and nocturnal HRV. We found that occupational sitting-time was negatively associated (p < 0.05) with time and frequency domain HRV indices. Sitting-time explained up to 6% of the variance in HRV, independent of the covariates. Leisure-time sitting was not significantly associated with any HRV indices (p > 0.05). In conclusion, objectively measured occupational sitting-time was associated with reduced nocturnal HRV in blue-collar workers. This indicates an attenuated cardiac autonomic regulation with increasing sitting-time at work regardless of moderate-to-vigorous physical activity. The implications of this association for cardiovascular disease risk warrant further investigation via long-term prospective studies and intervention studies.

  • 148.
    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.
    Srinivasan, Divya
    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.
    Short- and long-term reliability of heart rate variability indices during repetitive low-force work2015In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 115, p. 803-812Article in journal (Refereed)
    Abstract [en]

    Purpose Heart rate variability (HRV) is often monitored in occupational studies as a measure of cardiac autonomic activation, but the reliability of commonly used HRV indices is poorly understood. In the present study, we determined the variability between and within subjects of common HRV indices during a repetitive low-force occupational task, i.e. pipetting, and interpreted the results in terms of necessary sample sizes in studies comparing HRV between conditions or groups.

    Methods Fourteen healthy female subjects performed a standardized pipetting task in the laboratory on three separate days within a short time-span (<2 weeks), and on one additional occasion six months later. A number of standard HRV indices were calculated in both time and frequency domains. For each HRV index, variance components were estimated between subjects, within subjects between occasions far apart in time, and within subjects between days within a two-week period.

    Results We found that the time interval between repeated measurements did not influence the extent of HRV variability, and that the reliability of most HRV indices was sufficient for even small study samples (30 subjects or less) to be able to detect, with satisfying power (>0.80), a significant 10% to 20% difference in HRV between groups, and between conditions within individuals.

    Conclusions We conclude that HRV can be used as a reliable and feasible marker of autonomic activity in occupational studies of repetitive low-force work.

  • 149.
    Hansson, Gert-Åke
    et al.
    Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Arvidsson, Inger
    Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Ohlsson, Kerstina
    Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Nordander, Catarina
    Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Mathiassen, Svend Erik
    University of Gävle, Centre for Musculoskeletal Research. University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science.
    Skerfving, Staffan
    Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Balogh, Istvan
    Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
    Precision of measurements of physical workload during standardised manual handling: Part II : Inclinometry of head, upper back, neck and upper arms2006In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 16, no 2, p. 125-136Article in journal (Refereed)
    Abstract [en]

    For measuring the physical exposure/workload in studies of work-related musculoskeletal disorders, direct measurements are valuable. However, the between-days and between-subjects variability, as well as the precision of the method per se, are not well known. In a laboratory, six women performed three standardised assembly tasks, all of them repeated on three different days. Triaxial inclinometers were applied to the head, upper back and upper arms. Between-days (within subjects) and between-subjects (within tasks) variance components were derived for the 10th, 50th and 90th percentiles of the angular and the angular velocity distributions, and for the proportion of time spent in predefined angular sectors. For percentiles of the angular distributions, the average between-days variability was 3.4 degrees , and the between-subjects variability 4.0 degrees . For proportion of time spent in angular sectors, the variability depended on the percentage of time spent in the sector; the relative variability was scattered and large, on average 103% between days and 56% between subjects. For the angular velocity percentiles, the average between-days variability was 7.9%, and the average between-subjects variability was 22%. The contribution of the measurement procedure per se to the between-days variability, i.e., the imprecision of the method, was small: less than 2 degrees for angles and 3% for angular velocity.

  • 150.
    Hartig, Terry
    et al.
    Institute for Housing and Urban Research and Department of Psychology, Uppsala University, Uppsala, Sweden.
    Jahncke, Helena
    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.
    Letter to the editor: Attention restoration in natural environments: Mixed mythical metaphors for meta-analysis2017In: Journal of toxicology and environmental health. Part B, Critical reviews, ISSN 1093-7404, E-ISSN 1521-6950, Vol. 20, no 5, p. 305-315Article in journal (Other academic)
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