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Background: There are conflicting reports in the literature regarding the risk of revision after primary total knee replacement (TKR) in obese patients. The purpose of this study was to investigate if body mass index (BMI) influences the risk of revision 3-9 years after primary TKR. Methods: All patients undergoing a primary TKR in our institution from 2014 to 2018 were included in a retrospective study. The effect of BMI on all-cause revision was estimated in a logistic regression analysis. A directed acyclic graph was created to identify variables affecting the primary endpoint (revision). According to the directed acyclic graph, adjustment was only needed for age and smoking. However, we also included variables thought to influence the revision risk based on clinical experience and previous research. The final logistic regression analysis was therefore adjusted for age, sex, smoking status, diabetes mellitus and the American Society of Anesthesiologists classification. Results: One thousand fifty-nine primary TKR patients with a mean age of 68.1 (standard deviation 9.4) years were included. There were 609 (57.5%) women, and the median follow-up time was 5.6 (range 3.0-9.0) years. There were 41 (3.9%) revisions. BMI did not affect the risk of revision when adjusted for relevant covariates in a multivariate logistic regression analysis (odds ratio 0.99, 95% confidence interval 0.93-1.05, P = .6). Conclusions: BMI did not influence the risk of revision rate 3-9 years after TKR.

Left ventricular aneurysm is a potentially serious but rare condition in children. This case describes delayed but fatal rupture of an occult posttraumatic left ventricular aneurysm in an 11-year-old boy with a history of blunt chest trauma from a high-impact automobile collision 7 months earlier. (Level of Difficulty: Intermediate.)

Background Surgical complications contribute to the significant mortality following hip fractures in the elderly. The purpose of this study was to increase our knowledge of surgical complications by evaluating compensation claims following hip fracture surgery in Norway. Further, we investigated whether the size and location of performing institutions would influence surgical complications. Methods We collected data from the Norwegian System of Patient Injury Compensation (NPE) and the Norwegian Hip Fracture Register (NHFR) from 2008 to 2018. We classified institutions into 4 categories based on annual procedure volume and geographical location. Results 90,601 hip fractures were registered in NHFR. NPE received 616 (.7%) claims. Of these, 221 (36%) were accepted, which accounts for .2% of all hip fractures. Men had nearly a doubled risk of ending with a compensation claim compared to women (OR: 1.8, CI, 1.4-2.4, P < .001). Hospital-acquired infection was the most frequent reason for accepted claims (27%). However, claims were rejected if patients had underlying conditions predisposing to infection. Institutions treating fewer than 152 hip fractures (first quartile) annually, had a statistically significant increased risk (OR: 1.9, CI, 1.3-2.8, P = .005) for accepted claims compared to higher volume facilities. Discussion The fewer registered claims in our study could be due to the relatively high early mortality and frailty in this patient group, which may decrease the likelihood of filing a complaint. Men could have undetected underlying predisposing conditions that lead to increased risk of complications. Hospital-acquired infection may be the most significant complication following hip fracture surgery in Norway. Lastly, the number of procedures performed annually in an institution influences compensation claims. Conclusions Our findings indicate that hospital acquired infections need greater focus following hip fracture surgery, especially in men. Lower volume hospitals may be a risk factor.

Background:. Ulnar styloid fractures (USFs) are often associated with distal radial fractures (DRFs). When unstable DRFs are treated surgically, any associated USF is most commonly left untreated. The purpose of this study was to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF. Methods:. Data from 2 randomized controlled trials on the treatment of unstable DRFs were pooled. The effect of a USF on the QuickDASH, EQ-5D, pain, and range of motion at 2 years was evaluated. Results:. Two hundred and eighty-one patients were included; 177 (63%) had an associated, untreated USF. An unadjusted analysis demonstrated no significant difference in functional or patient-reported outcome measures (PROMs) at 2 years between patients with or without a concomitant USF. When controlling for confounding factors, the presence of a USF did not predict change in any of the PROMs from baseline to 2 years. A concomitant USF also did not predict change in grip strength or range of motion, except for a small effect on extension (−4.1°; 95% confidence interval, −7.5° to −0.8°; p = 0.02), which probably does not have clinical relevance. Conclusions:. A USF in combination with a DRF does not affect PROMs, range of motion, or grip strength. We recommend that concomitant USFs be left untreated when treating a DRF with surgical fixation. Level of Evidence:. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background Research from the International Cancer Benchmarking Partnership (ICBP) demonstrates that international variation in lung cancer survival persists, particularly within early stage disease. There is a lack of international consensus on the critical contributing components to variation in lung cancer outcomes and the steps needed to optimise lung cancer services. These are needed to improve the quality of options for and equitable access to treatment, and ultimately improve survival. Methods Semi-structured interviews were conducted with 9 key informants from ICBP countries. An international clinical network representing 6 ICBP countries (Australia, Canada, Denmark, England, Ireland, New Zealand, Northern Ireland, Scotland & Wales) was established to share local clinical insights and examples of best practice. Using a modified Delphi consensus model, network members suggested and rated recommendations to optimise the management of lung cancer. Calls to Action were developed via Delphi voting as the most crucial recommendations, with Good Practice Points included to support their implementation. Results Five Calls to Action and thirteen Good Practice Points applicable to high income, comparable countries were developed and achieved 100% consensus. Calls to Action include (1) Implement cost-effective, clinically efficacious, and equitable lung cancer screening initiatives; (2) Ensure diagnosis of lung cancer within 30 days of referral; (3) Develop Thoracic Centres of Excellence; (4) Undertake an international audit of lung cancer care; and (5) Recognise improvements in lung cancer care and outcomes as a priority in cancer policy. Conclusion The recommendations presented are the voice of an expert international lung cancer clinical network, and signpost key considerations for policymakers in countries within the ICBP but also in other comparable high-income countries. These define a roadmap to help align and focus efforts in improving outcomes and management of lung cancer patients globally.

Purpose: Work-related musculoskeletal disorders are prevalent among healthcare workers. These workers experience high rates of low-back pain; partly due to the high physical demands of patient transfers. Understanding the specific transfer scenarios that contribute to high physical loads is therefore crucial for developing strategies to improve working conditions., Methods: This study utilized electromyography to measure muscle activity in the erector spinae muscles during patient transfers, performing measurements in real-life hospital settings to identify the physical load associated with different transfer scenarios. Using linear mixed models, the 95th percentile ranks of the normalized root mean square (nRMS) values were analyzed for a range of different patient transfers., Results: The results revealed significant differences in physical load across various patient transfer scenarios. High-load activities included sitting to lying down or lying down to sitting (nRMS 32.7, 95% CI: 28.9-36.6) and lifting the upper body (32.4, 95% CI: 28.8-35.9), while low-load activities such as supporting patients while walking or standing (21.9, 95% CI: 18.6-25.1) and mobilizing in bed (19.9, 95% CI: 16.1-23.8) required less muscle activation. Moderate-load activities included bed to chair transfers (28.1, 95% CI: 24.9-31.3) and lifting the head (26.3, 95% CI: 22.7-29.9)., Conclusion: Understanding the physical load associated with different patient transfer scenarios allows for better organization of work in healthcare settings. These novel findings emphasize the need for effective task allocation, rotational schedules, and the use of assistive devices to distribute physical load and reduce injury risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Vinstrup, Jakobsen, Nielsen and Andersen.)

Purpose: Low-back pain (LBP) is a prevalent condition among healthcare workers, negatively affecting well-being and work ability. Research has identified fear-avoidance beliefs, i.e., the belief that physical activities worsen or prolong pain, as a key psychological factor in LBP. Given the physical demands of healthcare work, understanding the link between fear-avoidance and LBP is crucial for effective prevention and management strategies. This study investigated the prospective association between fear-avoidance beliefs and risk of increased LBP intensity and duration in hospital workers., Methods: Fear-avoidance beliefs and LBP were assessed in 1933 healthcare workers from 389 departments at 19 hospitals at baseline and 1-year follow-up. Associations between baseline work-related fear-avoidance beliefs (FABW) and LBP intensity and duration at follow-up were analyzed using cumulative logistic regression, adjusting for various factors including age, sex, baseline LBP, education, seniority, patient transfers, psychosocial work environment, and lifestyle., Results: Moderate and high FABW was associated with higher odds of increased pain intensity (OR: 1.37 [95% CI 1.09-1.73] and 1.85 [95% CI 1.18-2.88], respectively) and prolonged pain duration (OR: 1.37 [95% CI 1.05-1.78] and 2.27 [95% CI 1.50-3.44], respectively). A sensitivity analysis including only female nurses showed similar results, with the high FABW group having significantly higher odds of increased pain intensity (OR 2.95, 95% CI 1.84-4.72) and duration (OR 2.64, 95% CI 1.55-4.49)., Conclusions: Fear-avoidance beliefs increase the risk of LBP intensity and duration among healthcare workers, emphasizing the need for interventions dealing with psychological aspects of LBP., (© 2024. The Author(s).)

Aims: The aim of this study was to investigate the age-varying mortality risk associated with different labour market status categories., Methods: Data from a population-based survey carried out among adults aged 30-62 years in Finnmark in 1987/1988 were linked to the Norwegian Cause of Death Registry to identify all deaths occurring by December 2017. We used flexible parametric survival models to examine the age-varying associations between different labour market status categories (no paid work/homemaker, part-time work, full-time work, unemployment benefits, sick leave/rehabilitation allowance, and disability pension) and mortality., Results: Men with part-time work, unemployment benefits, sick leave/rehabilitation allowance, or disability pension had an increased mortality risk compared with men with full-time work; however, these findings were restricted to ages below 60-70 years, varying with labour market status category. For women, excess mortality was linked to disability pension in the younger age groups; in older age groups it was linked to the labour market status category no paid work/homemaker. Non-employment was associated with low education level compared with full-time employment., Conclusions: The study showed increased mortality risk for some non-employment categories, with decreasing relative risk with age. Our findings suggest that the increased mortality risk is partly explained by health, pre-existing illnesses, and health-related behaviour and partly by other factors, such as social network and economic factors., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Socioeconomic status as measured by education, income, or occupation, has been associated with fibromyalgia but the underlying mechanism and the role of lifestyle factors are unclear. Thus, we examine the role of modifiable lifestyle factors (body mass index, physical activity, alcohol consumption and smoking) in the association between education and self-reported fibromyalgia., Methods: We used data from 74,157 participants in the population-based prospective Norwegian Women and Cancer (NOWAC) study. Socioeconomic position, operationalized as years of educational attainment, and lifestyle factors were assessed via self-reported questionnaires. Multiple mediation analysis was used to decompose total effects into direct and indirect effects. Estimates were reported as hazard ratios (HRs) with 95% confidence intervals (CIs)., Results: The cumulative incidence of fibromyalgia was 3.2% after a median follow up time of 13 years. Fibromyalgia was inversely associated with years of educational attainment for ≤ 9 years (HR = 2.56; 95% CI 2.32-2.91) and for 10-12 years (HR = 1.84; 95% CI 1.72-2.02), compared with ≥ 13 years of education. Overall, all lifestyle factors together jointly mediated 17.3% (95% CI 14.3-21.6) and 14.1% (95% CI 11.3-18.9) of the total effect for ≤ 9 years and 10-12 years of education, respectively. Smoking and alcohol consumption contributed the most to the proportion mediated, for ≤ 9 years (5.0% and 7.0%) and 10-12 years (5.6% and 4.5%) of education., Conclusion: The association between education and self-reported fibromyalgia was partly explained through lifestyle factors, mainly smoking and alcohol consumption., (© 2024. The Author(s).)

Background: Work-related musculoskeletal disorders (WMSDs) located in the low back and neck/shoulder regions are major concerns for both workers, workplaces, and society. Masons are prone to WMSD, because their work is characterized by repetitive work and high physical workload. However, the knowledge on the physical workload during bricklaying is primarily based on subjective measurements., Objective: This cross-sectional field study with technical measurements aimed to quantify physical workload in terms of muscular activity and degree of forward bending during bricklaying at different working heights among masons, i.e., knee, hip, shoulder, and above shoulder height., Methods: Twelve male (36.1±16.1 years) experienced masons participated in a cross-sectional field study with technical measurements. Surface electromyography from erector spinae longissimus and upper trapezius muscles and an inertial measurement unit-sensor placed on the upper back were used to assess the physical workload (level of muscle activation and degree of forward bending) different bricklaying heights. Manual video analysis was used to determine duration of work tasks, frequency, type, and working height. The working heights were categorized as 'knee', 'hip', 'shoulder', and 'above shoulder'. The 95 percentiles of the normalized Root Mean Square (RMSn) values were extracted assess from erector spinae and trapezius recordings to assess strenuous level muscle of muscle activation., Results: The RMSn of dominant erector spinae muscle increased from hip- to shoulder height (from 26.6 to 29.6, P < 0.0001), but not from hip to above shoulder height and decreased from hip to knee height (from 26.6 to 18.9, P < 0.0001). For the dominant trapezius muscle, the RMSn increased from hip- to shoulder- and above shoulder height (from 13.9 to 19.7 and 24.0, respectively, P < 0.0001) but decreased from hip- to knee height (from 13.9 to 11.5, P < 0.0001). Compared to hip height (27.9°), an increased forward bending was detected during bricklaying at knee height (34.5°, P < 0.0001) and a decreased degree of forward bending at shoulder- and above shoulder height (17.6° and 12.5°, P < 0.0001, respectively)., Conclusion: Based on technical measurements, bricklaying at hip height showed the best compromise between muscular load and degree of forward bending. This study contributes to the development of the work environment for masons and can help guide preventive initiatives to reduce physical workload.

Background: Despite extensive investigation of ergonomic risk factors for spinal pain in healthcare workers, limited knowledge of psychological risk factors exists., Aims: To assess the prospective association of mental health and vitality with development of spinal pain in healthcare workers., Methods: A prospective cohort study was carried out involving 1950 healthcare workers from 19 hospitals in Denmark. Assessments were done at baseline and at 1-year follow-up. Mental health and vitality were measured using the Short Form-36 Health Survey, while spinal pain intensity was measured using a 0-10 scale in the low-back, upper-back and neck, respectively. Cumulative logistic regressions adjusted for several confounding factors were applied, reporting risk estimates as odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Using good mental health as reference, moderate (but not poor) mental health at baseline was associated with increased pain intensity in the low-back (OR: 1.41 [95% CI: 1.21-1.77]), upper-back (OR: 1.63 [95% CI: 1.31-2.02]) and neck (OR: 1.31 [95% CI: 1.07-1.61]) at 1-year follow-up. Likewise, using high vitality as reference, both moderate and low vitality at baseline were associated with increased pain intensity in the low-back (OR: 1.54 [95% CI: 1.22-1.94] and OR: 2.34 [95% CI: 1.75-3.12], respectively), upper-back (OR: 1.72 [95% CI: 1.34-2.23] and OR: 2.46 [95% CI: 1.86-3.25], respectively) and neck (OR: 1.66 [95% CI: 1.34-2.06] and OR: 2.06 [95% CI: 1.61-2.63], respectively) at 1-year follow-up., Conclusions: Compared to healthcare workers with good mental health and high vitality, those with moderate mental health and low/moderate vitality, respectively, were more likely to increase spinal pain intensity at 1-year follow-up. These components should also be considered in the prevention of spinal pain in healthcare workers., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objectives: Our objectives were to examine what is known about the provision of healthcare services to older LGBT adults in the Nordic countries, identify knowledge gaps, map implications of this research for the education of healthcare professionals and delivery of healthcare, and identify key future research priorities to advance policy and practice for older LGBT adults in this region., Design: We conducted searches in nine databases. Peer-reviewed articles and PhD theses published in and after 2002 written in English, Norwegian, Swedish or Danish languages were included. 41 studies met our inclusion criteria. However, only eight of these studies focused specifically on older LGBT adults. Therefore, to answer all research questions, five book chapters about older groups were also included., Results: There were few studies from countries other than Sweden and few quantitative studies. Bisexual people represented a neglected group in research. The studies included showed that healthcare personnel lack knowledge on LGBT issues, particularly about older LGBT adults and non-binary gender identification. Older LGBT adults frequently reported being met with cis- and heteronormative expectations in healthcare encounters. For transgender people, access to medical treatment has been managed by gatekeepers influenced by a binary understanding of gender., Conclusions: Relevant measures to enhance practices are increased attention on LGBT issues in education; training of healthcare professionals; measures at the institutional level; and ensuring that transgender people identifying as non-binary receive the same quality of care as individuals identifying in a binary way.

Background: While the aetiology of fibromyalgia syndrome (FM) remains unknown, lifestyle factors have been linked to the disorder. However, there are few studies on the association between lifestyle factors and FM, thus we examine the risk of self-reported fibromyalgia given selected lifestyle factors., Methods: We used data from 75,485 participants in the Norwegian Women and Cancer study. Information on FM and the lifestyle factors body mass index (BMI), physical activity level, smoking status/intensity, and alcohol consumption were obtained from baseline and follow-up questionnaires. We used Cox proportional hazards model to calculate hazard ratios (HRs) with 95% confidence intervals (CIs)., Results: After a median follow-up time of 10 years, we observed 2,248 cases of self-reported fibromyalgia. Overweight (BMI 25-29.9 kg/m 2 ) and obese (BMI ≥ 30 kg/m 2 ) women had a relative risk of 1.34 (95% CI 1.21-1.47) and 1.62 (95% CI 1.41-1.87), respectively, compared to women with normal weight (BMI 18.5-24.9 kg/m 2 ). Very low physical activity level (1-2) was associated with a 31% higher risk of self-reported fibromyalgia (HR 1.31, 95% CI 1.09-1.57) when compared to moderate physical activity level (5-6). There was a strong dose-response relationship between smoking status/intensity and self-reported fibromyalgia (p for trend < 0.001). Compared with moderate alcohol consumption (4.0-10 g/day), the risk of self-reported FM was 72% (HR 1.72; 95% CI 1.45-2.03) higher among teetotallers, and 38% (HR 1.38, 95% CI 1.23-1.54) higher among those with low consumption (0.1-3.9 g/day)., Conclusions: Overweight and obesity, very low physical activity level, smoking, and alcohol consumption were associated with an increased risk of self-reported FM., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Musculoskeletal disorders of the upper extremity are among the most common occupational problems affecting nurses. The aim of this study was to analyze the prospective association between vitality and mental health and increased upper extremity pain intensity in female hospital nurses during a 1-year follow-up. A prospective cohort of 1185 female nurses from 19 hospitals in Denmark was conducted using baseline and 12-month follow-up questionnaires to identify potential associations between levels of vitality and mental health (SF-36 subscales) with pain intensity (0-10 scale) in the shoulder, elbow and hand/wrist regions. Associations were modeled using cumulative logistic regression. The fully adjusted model included the variables of age, baseline pain, body mass index, smoking status, years of occupation, leisure time physical activity level, number of daily patient transfers/handlings, as well as recognition and influence at work. The mean age was 48.3 (SD: 10.4) years. In the fully adjusted model, significant associations between low vitality levels and the odds of shoulder pain (OR = 1.96; 95%CI: 1.43-2.68) and hand/wrist pain (OR = 2.32; 95%CI: 1.58-3.42) were observed. Likewise, moderate levels of mental health was associated with increased odds of shoulder pain at follow-up (OR = 1.50; 95%CI: 1.16-1.93). These results provide an important incentive for nursing managers to assess vitality and mental health among hospital nurses and to consider this factor in prevention strategies to ensure good worker health and, by extension, high-quality care.

Objective: Two-thirds of the economic resources in Norwegian hospitals are used on 10% of the patients. Most of these high-cost patients are older adults, which experience more unplanned hospital admissions, longer hospital stays and higher readmission rates than other patients. This study aims to examine the individual and clinical characteristics of older patients with unplanned admissions to Norwegian somatic hospitals and how these characteristics differ between high-cost and low-cost older patients., Design: Observational cross-sectional study., Setting: Norwegian somatic hospitals., Participants: National registry data of older Norwegian patients (≥65 years) with ≥1 unplanned contact with somatic hospitals in 2019 (n=2 11 738)., Primary Outcome Measure: High-cost older patients were defined as those within the 10% of the highest diagnosis-related group weights in 2019 (n=21 179). We compared high-cost to low-cost older patients using bivariate analyses and logistic regression analysis., Results: Men were more likely to be high-cost older patients than women (OR=1.25, 95% CI 1.21 to 1.29) and the oldest (90+ years) compared with the youngest older adults (65-69 years) were less likely to cause high costs (OR=0.47, 95% CI 0.43 to 0.51). Those with the highest level of education were less likely to cause high costs than those with primary school degrees (OR=0.74, 95% CI 0.69 to 0.80). Main diagnosis group (OR=3.50, 95% CI 3.37 to 3.63) and dying (OR=4.13, 95% CI 3.96 to 4.30) were the clinical characteristics most strongly associated with the likelihood of being a high-cost older patient., Conclusion: Several of the observed patient characteristics in this study may warrant further investigation as they might contribute to high healthcare costs. For example, MDGs, reflecting comprehensive healthcare needs and lower education, which is associated with poorer health status, increase the likelihood of being high-cost older patients. Our results indicate that Norwegian hospitals function according to the intentions of those having the highest needs receiving most services., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To investigate and characterize the influence of sex, age, muscle strength, and cardiovascular fitness on manual lifting patterns using exposure variation analysis (EVA) during a full working day among blue-collar workers., Methods: Muscular activity (surface electromyography [sEMG]) of the thigh, low-back, and shoulder was measured throughout the working day in 173 employees with manual lifting tasks from 14 workplaces. Relative sEMG loading was expressed as % of maximal voluntary contraction (MVC). As an additional and more practically oriented analysis, calibration of load from standardized box lifts (5, 10, 20, and 30 kg) identified corresponding sEMG values in kg. Using an EVA 'lifting periods' of [1 to 5, >5 to 10, >10 to 20, >20 to 30, and >30] kg in time intervals [0 to 0.5, >0.5 to 1, >1 to 2, >2 to 5, >5 to 10, and >10] s were identified. Arm elevation and back inclination were measured using accelerometers., Results: Females and older workers (≥50 years) primarily used the thighs for lifting and were exposed to more frequent thigh muscle 'lifting periods' of varying duration and load and performed more thigh lifts >30 kg and >60% of MVC compared with males and younger workers (P < 0.05). Females had less brief shoulder lifting periods and more work with bent back >30° than the males (P < 0.05), whereas stronger workers performed more work with elevated arm >60° and >90° than workers with low muscle strength (P < 0.05). However, besides a single difference where workers with lower cardiovascular fitness were exposed to more light (1-5 kg) and moderate duration (5-10 s) trapezius loading, the number of lifting periods was not affected by muscle strength nor cardiovascular fitness (P > 0.05)., Conclusions: This EVA demonstrated sex- and age-related differences in exposure to lifting periods involving shoulder and thigh muscles., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

High physical work demands increase the risk of musculoskeletal disorders and sickness absence. Supermarket work involves a high amount of manual material handling. Identifying specific ergonomic risk factors is an important part of occupational health and safety efforts in the supermarket sector. In this cross-sectional field study among 64 supermarket workers, we used electromyography during the workday to determine the influence of lifting height and load mass on muscular workload of the low-back and neck/shoulder muscles during un-restricted manual material handling (grocery stocking). We found a significant effect of load mass, i.e., higher loads associated with higher muscular workload in the low-back and neck/shoulder muscles. We demonstrated a significant interaction between start and end position, i.e., lifts performed from 'Low' start positions to 'High' end positions demonstrated the highest low-back muscular workload, whereas 'High' positions were associated with increased neck/shoulder workload. In conclusion, lifting higher loads and lifting goods from low to high positions (low-back) and at high positions (neck/shoulder) are associated with higher muscular workload. These results can be used to guide highly warranted preventive initiatives to reduce the physical workload during supermarket work.

Multiple studies have reported high prevalence of musculoskeletal disorders among supermarket workers. Technical field measurements can provide important knowledge about ergonomic risk factors for musculoskeletal disorders in the physical working environment, but these measurements are lacking in the supermarket sector. Therefore, using wearable electromyography and synchronous video recording in 75 supermarket workers, this cross-sectional study measured muscular workload during stocking activities in six different types of general store departments and during the thirteen most common work tasks across five different supermarket chains. Our results showed that muscular workload varies, especially for the low-back muscles, across (1) supermarket chains, (2) departments, and (3) specific stocking activities. Highest workloads of the low-back and neck/shoulders were seen in the fruit and vegetables department and during heavy, two-handed lifts of parcels (especially without using technical aids). In conclusion, physical work demands during supermarket stocking activities differ between chains, departments, and work tasks. These results can be used by company representatives and work environment professionals to specifically address and organize the stocking procedures to reduce the muscular workload during supermarket stocking., (© 2022. The Author(s).)

Background: High physical exertion during healthcare work is a documented risk factor for musculoskeletal pain, long term sickness absence and disability pension. Understanding the underlying factors of physical exertion is important to make the necessary preventive efforts in the working environment., Objective: This study investigates factors associated with high physical exertion during healthcare work., Methods: A total of 2047 Danish health care workers replied to a questionnaire about work and health. Associations (odds ratios; OR) of physical exertion (outcome variable) with the number of patients and self-reliant patients, frequency and type of assistive device use, BMI, leisure time activity, smoking, and age were modelled using mutually adjusted binary logistic regression., Results: Factors associated with high physical exertion (OR and 95% CI) were high frequency of daily patient transfers 1.35 (1.23 - 1.48), less self-reliant patients 0.74 (0.62 - 0.89), less frequent use of necessary assistive devices 1.82 (1.50 - 2.21), as well as more frequent use of sliding pieces 1.23 (1.04 - 1.46), wheelchairs 1.23 (1.02 - 1.49), bed adjustments 0.88 (0.77 - 1.00) and intelligent beds 0.83 (0.71 - 0.95) during patient transfer. Age and lifestyle factors (BMI, smoking, and leisure time physical activity) were not associated with high physical exertion., Conclusions: The character of patient transfer specific healthcare work is associated with increased odds for high physical exertion whereas life-style factors are not. Thus, proper use of specific assistive devices and avoiding uneven distribution of difficult patients through appropriate planning may be protective strategies for lowering physical exertion during healthcare work.

Engaging occupational safety and health (OSH) professionals has scarcely been evaluated as a means for transferring knowledge to practice about physical workload in the construction industry. The aim of this work was to examine how participants used and incorporate research-based knowledge from a three-day training course into practice. Twenty OSH professionals from the Danish construction industry participated in a workshop-training course. Researchers presented new knowledge and results about physically demanding work. The participants selected which themes they wanted to work with and developed an action plan. Evaluation was done using surveys and phone interviews. Analysis was based on how the OSH-professionals describe themselves, organizations, and the construction industry. Participant's average scores on the level of implementation of their chosen action plans were 3 (on a response scale from 1-5, where 1 is 'to a very low degree' and 5 is 'to a very high degree') immediately after the workshop program and 2.5 at follow-up. Qualitative evaluations showed that actions had been initiated, and some progress had been made. The participants were satisfied with the workshop course and the possibility to increase their knowledge through inputs from researchers and colleges and strongly believe that they would succeed with implementing their action plans in the future.

Background: Hamstring injuries remain a major burden in football while the effective prevention exercise the Nordic Hamstring is poorly adopted, despite the added positive effects on performance. Better understanding of hamstring function during Nordic Hamstring compared to other exercises may provide better insight to the physiological adaptations of different types of hamstring curls., Purpose: This cross-sectional study therefore aimed to compare the Nordic Hamstring curl with a conventional prone Leg Curl at different loads, and novel high velocity Hamstring Catches; in terms of peak normalized electromyographical activity (nEMG) and rate of electromyographic rise (RER) of Biceps Femoris long head, and angular velocity of the knee., Study Design: Cross-sectional study., Methods: Out of 28 participants enrolled, the final sample included 23 recreationally active male participants who attended a session for determining RM (repetition maximum) to establish loading (8 and 16RM for Hamstring Catches, and 8, 16 and 24RM for Leg Curl) and to familiarize themselves with the three different exercises (Nordic Hamstring, Leg Curl and Hamstring Catch), and a testing session >4 days after during which EMG data were collected during 3 repetitions of each exercise performed in a random order., Results: The Nordic Hamstring evoked higher RER (1091.8 nEMG/s) than Hamstring Catches (mean difference: 421 nEMG/s, p<0.0001) and Leg Curl (mean difference: 705 nEMG/s, p<0.001), and at the earliest numerical timepoint from onset of muscle contraction (the Nordic Hamstring: 6 ms; Hamstring Catches: 36-41 ms; Leg Curl: 12-14 ms). Hamstring Catches displayed high peak angular velocity (mean: 471°/s). There was no difference in peak nEMG, irrespective of load for Leg Curl (8, 16 or 24RM) or Hamstring Catches (8- or 16RM)., Conclusion: The Nordic Hamstring displayed the highest level muscle activity and most explosive recruitment characteristics with early and high rate of electromyographic rise, compared to even high velocity exercises, thus providing a possible mechanism by which it may increase performance and reduce injuries., Levels of Evidence: 3., What Is Known About the Subject: Early phase force and muscle recruitment have been linked to both performance and hamstring-related inhibition and fatiguability. However, the potential for different hamstring exercises to elicit explosive recruitment is unknown., What This Study Adds to Existing Knowledge: Early phase recruitment was higher and faster during the Nordic Hamstring exercise compared with conventional hamstring Leg Curl exercises with different loads and a high-velocity hamstring exercise., Clinical Relevance: The surprisingly fast and explosive recruitment characteristics during the Nordic Hamstring exercise suggests the possibility that this exercise have the potential to improve the rate of force development and perhaps counter the effects of hamstring-related inhibition and fatigue.

Background: General health perception as measured by self-rated health (SRH) is an individual's synthesis of personal overall health and has value in its own right. In addition, this subjective perspective has a unique predictive power of subsequent mortality and adds valuable information not captured by objective measures. We studied the relationship between SRH and subsequent mortality to demonstrate how simple self-ratings can enhance our understanding of health inequities., Methods: Data from a population-based survey conducted in Finnmark 1987/1988 were linked to the Norwegian Cause of Death Registry for information on all deaths by the end of 2017. We used Cox proportional hazard regression modelling to estimate the relative effects of all-cause mortality separately for sex and age (30-49 and 50-62 years) with stepwise adjustment for socio-demographics and various other health status and behavioural measures., Results: The age-adjusted power of mortality prediction of SRH was strong (most pronounced in the youngest age-group) but markedly attenuated by other factors. Education inequality in mortality was most substantial in the youngest age-group, which might partly be due to a combination of selective mortality and historical changes in health inequality. In comparison, educational inequality in SRH was clearly pronounced regardless of age. Work disability pension appeared as the common key factor affecting the mortality prediction of SRH and educational inequity for both subsequent mortality and SRH., Conclusion: SRH adds unique information to our understanding of health inequities. The consistency in shared predictors of educational inequity concerning both mortality and SRH underscores the correspondence of these measures. In addition to predicting the fatal effects of social selection mechanisms, SRH adds non-fatal effects and seems less prone to selective mortality. The results are relevant to approaches in health equity research and have important policy implications., Competing Interests: The authors declare that they have no conflict of interest., (© 2021 The Authors.)

Knee osteoarthritis is a chronic joint disease which damages articular cartilage. In its severe stages, it results in impairments in balance and muscle strength loss, which affect daily life activities such as walking or climbing stairs. This study sought to investigate associated factors with stair-climbing ability in this population, with special interest in measuring the relevance of postural balance for this task. Forty-four patients scheduled to undergo unilateral total knee arthroplasty were assessed. Timed up and go test, stair ascent-descent test, three different isometric strength tests (knee flexion, knee extension and hip abduction), active knee extension and flexion range of movement and static postural balance assessment were evaluated. Spearman's correlation coefficients and multiple linear regression analysis determined the strength of association between the different variables and stair-climbing time. No significant association between the stair-climbing time and static balance was found. Significant associations were found between stair-climbing time and timed up and go (r = 0.71; p < 0.0001) and maximal knee extensor strength (r = -0.52; p = 0.0003). One-year increase in age was associated with 0.15 s (95% CI 0.00 to 0.30) slower stair-climbing time. In conclusion, muscle strength is more important than postural balance for stair-climbing ability in this population.

Background: Food hypersensitivity (FH) has received considerable attention in the scientific community in recent years. However, little attention has been given to the efforts people make to manage their FH. We aimed to explore these efforts by using Normalization Process Theory, which is a conceptual framework formerly used to describe the self-management 'work' of long-term conditions., Methods: We carried out qualitative individual interviews with 16 women with FH. Transcripts from recorded interviews were analyzed using template analysis., Results: 16 women participated; some had diagnoses from conventional medicine (celiac disease, lactose intolerance, food allergies, irritable bowel syndrome) and some did not. Participants described carrying out several tasks, some of which were time-consuming, to manage their FH. Women who had clarified once and for all what food(s) caused symptoms, described that they could concentrate on carrying out a restricted diet, which could become routine. Conversely, participants who had not achieved such clarification described carrying out tasks to identify what food(s) caused symptoms, and to implement and evaluate a tentative diet. Participants' descriptions also revealed a heightened vigilance when they ate food that others had prepared, and some made efforts to conceal their FH., Conclusions: Self-management of FH may, like the self-management of other long-term conditions, imply a large workload and burden of treatment. Efforts made to conceal FH may be considered part of this workload, while help in clarifying which food(s) cause symptoms has the potential to reduce the workload., Competing Interests: The authors have declared that no competing interests exist.

Background: While the psychosocial work environment within the hospital sector is a topic of great debate, surveys assessing stress often do not differentiate between stress related to work- and private life. Identifying risk factors associated with these domains of daily life would help improve policies as well as target relevant treatment options. Therefore, the aim of this study was to evaluate associations between stress during to work- and private time with Cohen's Perceived Stress Scale (CPSS)., Methods: Perceived stress was assessed by the full version of CPSS (scores 0-40) as well as by two single-item questions related to stress related to work- and private life, respectively. Associations between these single-items and CPSS were modelled using general linear models controlling for lifestyle factors., Results: Overall, stress due to both work- and private time was strongly associated with CPSS scores. In the full population (n = 3,600), "never experiencing stress" during both work- and private time was associated with low stress scores (6.0, 95%CI 5.1-6.9). "Never experiencing" work-related stress but experiencing private time stress "very often" was associated with high stress scores (22.4, CI 19.8-25.1). Likewise, experiencing work-related stress "very often" but "never experiencing" private time stress was also associated with high stress scores (22.2, CI 20.3-24.2). Lastly, Spearman's r between the full CPSS and the two single-item questions about work- and private time stress were 0.62 (p < 0.0001) and 0.52 (p < 0.0001), respectively, while the two items were only weakly correlated (r = 0.32)., Conclusion: The present study shows that perceived stress due to both work and private time is strongly associated with Cohen's Perceived Stress Scale scores. The results illustrate the feasibility of using single-item questions related to work- and private time in identifying domain-specific risk factors for psychosocial stress.

Background: Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs., Methods: By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure., Results: Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively., Conclusions: Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.

Aim: This study investigates the effect of a participatory organizational intervention on social capital and organizational readiness for change., Design: Cluster randomized controlled trial., Methods: In 2016, 27 departments from five hospitals in Denmark were randomly allocated at the department level to 1 year of participatory intervention (14 clusters, 316 healthcare workers) or a control group (13 clusters, 309 healthcare workers). The participatory intervention consisted of 2 × 2 hr workshops, where managers, 2-5 healthcare workers from each department, and the hospital's health and safety staff, developed action plans for implementing solutions for improving the use of assistive devices at the department throughout the 1-year intervention period. Workplace social capital: (a) within teams (bonding); (b) between teams and nearest leaders (linking A); and (c) between teams and distant leaders (linking B) and organizational readiness for change were measured using questionnaires at baseline, 6, and 12 months., Results: No group-by-time interaction occurred for any of the outcome measures. However, explorative post hoc analysis showed within-group improvements in bonding and linking B social capital and organizational readiness for change following the participatory intervention., Conclusion: Participatory organizational interventions may improve social capital within teams and between teams and distant leaders and organizational readiness for change., Impact: Implementing participatory interventions at the workplace may be a cost-effective strategy as they provide additional benefits, e.g., increased social capital and improved organizational readiness for change, that exceed the primary outcome of the intervention., Trial Registration: ClinicalTrials.gov (NCT02708550) March 2016., (© 2020 John Wiley & Sons Ltd.)

This study utilised a cross-sectional design to perform measurements of muscle activity as well as forward - and lateral trunk inclination angle during a full workday among 52 female healthcare workers from 16 different departments at five Danish hospitals. Using linear mixed models, the 95th percentile ranks of the normalised root mean square (nRMS) values were analysed for the different types of assistive devices. Compared to no assistive device (mean nRMS 27.9%, 95% CI 24.8%-31.0%), the use of intelligent beds (23.9%, CI 20.2%-27.6%) and ceiling-lifts (24.0%, CI 20.3%-27.7%) led to lower erector spinae nRMS values across all types of patient transfers. Conversely, the use of bedsheets (30.6%, CI 27.1%-34.2%), sliding-sheets (30.3%, CI 26.8%-33.9%) and sliding-boards (33.5%, CI 29.5%-37.6%) were associated with higher levels of erector spinae muscle activity.Consistent use of ceiling-lifts and intelligent beds reduces the physical workload and may thereby decrease the risk of musculoskeletal disorders among healthcare workers. Practioner Summary: Frequent patient transfer is associated with an increased risk of back pain and injury among healthcare workers. This analysis compares the level of physical load during patient transfer with commonly used assistive devices. The results show that use of the ceiling-lift and intelligent bed is associated with relatively low physical load during patient transfer. Abbreviations: RMS: root mean square; nRMS: normalized root mean square; EMG: electromyography; MSD: musculoskeletal disorder; LBP: low-back pain; VAS: visual analogue scale; MVC: maximal voluntary contraction.

Objective: This study aimed to investigate the association between perceived stress and odds of low-back pain (LBP) in a population of Danish healthcare workers. Methods: Utilizing a prospective cohort design with 1-year follow-up, a total of 1,944 healthcare workers from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Using Cohen's Perceived Stress Scale, associations between baseline stress levels and LBP intensity (0-10 scale) at follow-up were modeled using cumulative logistic regression, accounting for clustering at the department level and adjusting for age, sex, baseline intensity of LBP, education, seniority, number of daily patient transfers, psychosocial work environment, and lifestyle factors. Results: For the entire population, moderate and high stress (reference: low stress) at baseline increased the odds of LBP at 1-year follow-up with odds ratios (ORs) of 1.39 (95% CI 1.13-1.71) and 1.99 (95% CI 1.49-2.66), respectively. Sensitivity analyses among female nurses showed similar results [ i.e ., OR 1.40 (95% CI 1.08-1.80) and OR 2.08 (95% CI 1.44-3.00) for moderate and high stress, respectively], while only high stress significantly increased the odds among those without LBP at baseline. Conclusions: Psychological stress increases the odds of LBP among healthcare workers. Identifying and diminishing work-related psychosocial stressors should be included in strategies that aim to prevent musculoskeletal disorders in this population., (Copyright © 2020 Vinstrup, Jakobsen and Andersen.)

The aim was to evaluate the effects of judo combat on the athletes' postural control (PC) and physiological loading before, during and after a simulated match. Seventeen under-20 regional and national level athletes completed one modified 7-min match. At baseline, during the combat (3rd and 7th minutes) and 2-min post-match centre of pressure (CoP) parameters were assessed. Heart rate (HR), blood lactate (BLa) and rating of perceived exertion (RPE) and local RPE (LRPE) were collected. Significant increments were observed in CoP mean positioning and velocity at 3rd and 7th minutes, but the CoP deviation in both axes was unaffected. HR and BLa were elevated at 3rd and 7th minutes, and they remained elevated 2-min post-match. However, CoP returned to baseline 2-min post-match. RPE was elevated at 3rd and 7th minutes and the greatest effort was displayed in the Deltoid and Quadriceps. Thus, one simulated judo match stimulates a significant metabolic response and balance is degraded, with the greatest effects on the anterior-posterior axis and it recovers to baseline level after 2 min of passive rest. The physiological load cannot be regarded as a potential predictor variable of CoP. Overall, a judo match predominantly affects the upper body than the other body parts.

This study aimed to investigate the association between poor sleep and risk of low-back pain (LBP) in healthcare workers. Using a prospective cohort design with 1-year follow-up, a total of 1955 healthcare workers (60% nurses) from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Associations between sleep scores (0-100) at baseline and LBP intensity (0-10) at follow-up were modelled using cumulative logistic regression accounting for clustering at the department level and adjusted for lifestyle and psychosocial confounders. In the full population of healthcare workers, 43.9% and 24.4% experienced moderate and poor sleep, respectively. In the fully adjusted model with good sleep as reference, moderate, and poor sleep increased the risk of LBP at follow-up, with odds ratios (OR's) of 1.66 (95% confidence interval (CI) 1.35-2.04) and 2.05 (95% CI 1.57-2.69), respectively. Three sensitivity analyses including healthcare workers free from LBP, nurses, and nurses free from LBP at baseline, respectively, yielded similar results. In conclusion, poor sleep constitutes a potent risk factor for LBP among healthcare workers. The presented results provide strong incentives to evaluate and weigh current prevention policies against an updated biopsychosocial framework.

Purpose: Numerous daily tasks such as walking and rising from a chair involve bilateral lower limb movements. During such tasks, lower extremity function (LEF) may be compromised among older adults. LEF may be further impaired due to high degrees of between-limb asymmetry. The present study investigated the prevalence of between-limb asymmetry in muscle mass, strength, and power in a cohort of healthy older adults and examined the influence of between-limb asymmetry on LEF., Methods: Two hundred and eight healthy older adults (mean age 70.2 ± 3.9 years) were tested for LEF (400 m walking and 30-seconds chair stand). Furthermore, maximal isometric and dynamic knee extensor strength, leg extensor power, and lower limb lean tissue mass (LTM) were obtained unilaterally., Results: Mean between-limb asymmetry in maximal muscle strength and power ranged between 10% and 13%, whereas LTM asymmetry was 3 ± 2.3%. Asymmetry in dynamic knee extensor strength was larger for women compared with men (15.0 ± 11.8% vs 11.1 ± 9.5%; P = .005) Leg strength and power were positively correlated with LEF (r 2  = .43-.46, P < .001). The weakest leg was not a stronger predictor of LEF than the strongest leg. Between-limb asymmetry in LTM and isometric strength was negatively associated with LEF (LTM; r 2  = .12, P = .005, isometric peak torque; r 2  = 0.40, P = .03.) but dynamic strength and power were not., Conclusion: The present study supports the notion that in order to improve or maintain LEF, healthy older adults should participate in training interventions that increase muscle strength and power, whereas the effects of reducing between-limb asymmetry in these parameters might be of less importance., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers ( n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51-5.10) for 1-4 transfers per day, OR 7.60 (5.14-11.22) for 5-8 transfers per day, and OR 8.03 (5.26-12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85-5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers., Competing Interests: The authors declare no conflict of interest.

Background: Persistent bodily fatigue after working days may indicate an imbalance between work demands and capacity of the workers. This study aimed to investigate associations between physical exposures at work and bodily fatigue after work., Methods: Danish workers with physical work (N=5377) answered questions about various physical exposures during work and bodily fatigue after work in the 2010 round of the Danish Work Environment Cohort Study. Associations were modeled using binary logistic regression controlled for various confounders., Results: Mean age among the younger (<50 years) and older (≥50 years) workers was 36 and 56 years, respectively. Younger and older workers exposed to various physical exposures (e.g. 'bending/twisting the back') for more than a quarter of the workday were more fatigued after work. An exposure-response relationship was observed between the number of physical exposures and bodily fatigue, with odds ratios (OR) for fatigue in the body among younger workers being 1.01 (95%CI 0.63-1.63), 1.59 (95%CI 1.01-2.50), 2.37 (95%CI 1.54-3.66) and 2.84 (95%CI 1.85-5.36) for 1, 2, 3 and ≥4 types of combined physical exposures, respectively. Correspondingly, for older workers, ORs were 1.95 (95%CI 1.09-3.51), 4.06 (95%CI 2.32-7.12), 4.10 (95%CI 2.28-7.37) and 4.90 (95%CI 2.72-8.82) for 1, 2, 3 and ≥4 exposures, respectively., Conclusion: While some of the single factor exposures were associated with increased bodily fatigue, the most marked associations were found when summing the number of different exposures. These results indicate that workplaces should focus on the sum of combined physical exposures rather than focusing solely on single exposures., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: Managing a chronic condition takes work, and it is considered important that patients carry out this work. However, knowledge is lacking on what elements enhance self-management work. Persons with food hypersensitivity (FH) seem to do self-management work despite the relatively little support they receive. Our aim is to explore what makes women with FH carry out the work of managing their condition. Our research will shed light on the health care needs of women with FH and contribute to the knowledge on self-management among persons with chronic conditions., Methods: We used the Self-determination theory and the Conservation of resources theory to analyze 16 qualitative individual interviews with women with FH aged 39-67 years., Results: Our participants reported that eating selected foods resulted in uncomfortable symptoms, and their main motivation for carrying out self-management work was the wish to avoid these symptoms and their consequences. Participants' individual resources were crucial to the management of FH, and those who had a social network that included people with relevant competencies clearly benefited from this. Hindrances to the management of FH included competing priorities and not wanting to break with the social expectation of sharing a meal., Conclusions: Women with FH carried out self-management work because they were highly motivated. Important motivators included the uncomfortable symptoms that resulted from consuming some foods, which had negative consequences on their lives or could bring shame. The ability to perform self-management work was dependent on the availability of individual and social resources. Indeed, women with FH who have the individual and social resources necessary to manage their condition may not need health services, whereas those who do not have these resources, or have significant competing priorities, may need assistance from health services. The desire to avoid uncomfortable symptoms can be a motivator for persons with chronic conditions to do self-management work, while a lack of symptoms can reduce motivation. The competing role of basic needs can take two forms: when fulfilled, these needs may contribute to self-management work; however, people may opt out of self-management in order to fulfil basic needs.

Background: In the early phase after a total knee arthroplasty (TKA), patients experience multi-level weakness in the operated leg, which is caused primarily by reduced central nervous system (CNS) activation failure of the muscles - especially the knee extensors (quadriceps muscle). Whether similar levels of neuromuscular activity of the muscles in the operated leg, elicited during strength training exercises in machines, can be reached during strength training exercises in more simple forms is unknown. Many clinicians are faced with the problem of not having strength training equipment at their institution or having to prescribe simple strength training exercises for home-based training. Therefore, the purpose of this study was to determine which strength training exercises that activated the muscles in the operated leg the most after TKA. The hypothesis was that strength training exercises performed in machines would elicit higher levels of voluntary peak quadriceps and hamstring muscle activity than strength training exercises performed in more simple forms, using elastic bands or the patients' own body weight., Methods: A cross-sectional electromyographic study investigated voluntary peak muscle activity in the operated leg during 6 different strength training exercises. Twenty-four patients, who received a TKA 4 to 8 weeks earlier, performed the exercises in a randomized order, using a pre-determined loading of 10 RM (repetition maximum). Voluntary peak muscle activity (%EMGmax) was calculated for the quadriceps and hamstring muscles for each exercise., Results: Knee extensions with elastic band showed significantly higher voluntary peak quadriceps muscle activity than knee extensions in machine (93.3 vs. 74.9; mean difference, 18.3 %EMGmax [95% confidence interval (CI), 11.7 to 24.9]; P < 0.0001). Similarly, one-legged squat (and sit to stand) elicited higher voluntary peak quadriceps muscle activity than leg press in machine (86.7 vs. 66.8; mean difference, 19.9 %EMGmax [95% CI, 14.8 to 25.0]; P < 0.0001)., Conclusions: Strength training exercises in more simple forms elicited higher voluntary peak quadriceps muscle activity than strength training exercises in machines early after TKA. Consequently, simple home-based strength training exercises using e.g. elastic bands or the patients' own bodyweight should be considered to alleviate muscle strength losses early after TKA., Trial Registration: ClinicalTrials.gov identifier: NCT01708980 .

Background: Sleep problems are common in the general population and negatively affect both private and work life. A vicious circle may exist between poor sleep and an unhealthy lifestyle. For example, poor sleep may drain the energy to do health-promoting physical activity during leisure-time after work. The aim of the present study was to investigate the association between sleep problems and the duration of low- and high-intensity leisure-time physical activity in sedentary and physical workers. Methods: This cross-sectional study employ data from the Danish Work Environment Cohort Study in 2010, where currently employed wage-earners in Denmark on daytime schedule ( N = 7,706) replied to questions about sleep quality (cf. the Bergen Insomnia Scale) and participation in low- and high-intensity leisure-time physical activity. Associations were modeled using general linear models controlling for various confounders. Results: Workers with high levels of sleep problems reported less high-intensity leisure-time physical activity. Specifically, the weekly duration of high-intensity leisure-time physical activity was 139 (95%CI 111-168), 129 (95%CI 101-158), and 122 (95%CI 92-151) min in sedentary workers with sleep problems < 1, 1-3, and ≥3 days per week, respectively. The same pattern was observed among physical workers. In sedentary workers ≥50 years, the fully adjusted model showed a weekly duration in high-intensity physical activity during leisure of 122 (95%CI 83-161), 102 (95%CI 64-141), and 90 (95%CI 51-130) among those with sleep problems < 1, 1-3, and ≥3 days per week, respectively. Conclusions: Workers, particularly sedentary older workers, having sleep problems report less high-intensity leisure-time physical activity. These data suggest that a vicious circle may indeed exist between poor sleep and reduced leisure-time physical activity.

Aim: In spite of the many health-related benefits of regular physical activity, fatiguing work may be a barrier to performing leisure-time physical activity. This study investigates the association between work-related fatigue and the duration of low- and high-intensity leisure-time physical activity in workers with sedentary and physically demanding jobs., Methods: From the 2010 round of the Danish Work Environment Cohort Study, currently employed wage earners from the general working population ( N=10,427) replied to questions about work-related fatigue (predictor) and duration of low- and high-intensity leisure-time physical activity (outcome). Associations were modelled using general linear models controlling for various confounders., Results: Among workers with physically demanding jobs, higher levels of work-related fatigue were associated with gradually lower levels of leisure-time physical activity - for low, moderate and high levels of work-related fatigue the duration of high-intensity leisure-time physical activity was 133 (95% confidence interval (CI) 127-178), 134 (95% CI 109-160) and 113 (95% CI 86-140) min per week, respectively (trend test p<0.001). The duration of high-intensity leisure-time physical activity was lower among older workers (≥50 years) compared to younger workers (<50 years) (132 ± 126 vs 168 ± 150 min per week) ( p<0.0001)., Conclusions: The duration of high-intensity leisure-time physical activity gradually decreases with increased work-related fatigue in workers with physically demanding jobs. Older workers perform less high-intensity physical activity than younger workers. Workplaces should consider initiatives to allow workers with physically demanding jobs and older workers to perform physical exercise during working hours and thereby increase physical capacity to meet the job demands.

Objectives This randomized controlled trial (RCT) evaluated the effect of a participatory organizational intervention for improved use of assistive devices (AD) in patient transfer. Methods We randomly allocated 27 departments from five hospitals in Denmark to a participatory intervention (14 clusters, 316 healthcare workers) or a control group (13 clusters, 309 healthcare workers). The intervention consisted of 2×2 hour workshops with managers, the hospital's health and safety staff, and 2-5 healthcare workers from each department. Based on an assessment of barriers and solutions conducted prior to randomization, participants developed an action plan for implementing department-specific solutions for improving the use of AD. Use of necessary AD (using digital counters as primary outcome), and general use of AD (using accelerometers as secondary outcome), pain intensity in the low-back, work-related back injuries during patient transfer, and communication and guidance in the use of AD were measured at baseline, 6 and 12 months. Results Use of necessary AD (primary outcome), low-back pain, and back injuries did not change in the intervention compared with control group at 12-month follow-up. However, general use of AD measured with accelerometers as well as communication and guidance improved significantly in the intervention versus control group. Conclusion The intervention did not result in more frequent use of the necessary AD but led to more general use of AD, as well as increased communication and guidance.

Background and aims Musculoskeletal pain may negatively affect work ability, especially when work demands are high and/or physical capacity of the worker is low. This study investigated the association between intensity of musculoskeletal pain in multiple body regions and work ability among young and old workers with sedentary and physical demanding jobs. Methods Currently employed wage earners (n=10,427) replied to questions about pain intensity, work ability, and physical work demands. The odds ratio (OR) for having a lower level of work ability in relation to the physical demands at work were modeled using logistic regression controlled for various confounders. Results The OR for lower work ability increased with higher pain intensity in all regions among workers with sedentary and physical work. The same pattern was observed among workers <50 years and ≥50 years in both work types. The association was quite consistent across age and work activity groups, although it tended to be more pronounced among those with physically demanding work in some of pain regions. Conclusions This study shows that increasing pain intensity in multiple sites of the body is associated with lower work ability. This was seen for both younger and older workers as well as those with sedentary and physical work. Implications Physical workers with multiple-site pain may especially be at increased risk of the consequences of reduced work ability. Therefore, extra attention is needed and this group may benefit from better targeted preventive measures.

Objective: The aim of this cross-sectional study was to examine whether an internal focus on different core muscles during the isometric prone plank exercise increased muscle activity., Design: Twenty university students performed the following five different conditions: regular prone plank (external focus) and prone plank with an internal focus on different muscles. Surface electromyography signals were recorded for the upper rectus abdominis, lower rectus abdominis, external oblique, and lumbar erector spinae., Results: For the upper rectus abdominis, an internal focus on using any muscle increased activity. For the lower rectus abdominis, internal focus on any muscle except the lumbar erector spinae increased activity. No changes were found for external oblique and lumbar erector spinae activity., Conclusions: Upper rectus abdominis and lower rectus abdominis activities increased during an internal focus on the abdominal muscles. external oblique and lumbar erector spinae activities were nonaffected by an internal focus on any muscle.

Background: Construction work frequently involves heavy physical work, and a reduction of the physical workload should have high priority. Technological development has made it possible to obtain field measurements with surface electromyography (sEMG), kinematics measured with inertial measurement units (IMUs), and video recordings. However, no studies have used these methods simultaneously to detect situations with excessive physical workload (events) during a working day. Thus, knowledge about these specific events may combat work-related risk factors. Participatory ergonomics (PE) has shown promising results, but whether it can be used as a tool to reduce the physical workload during construction work remains unknown., Objective: This cluster randomized controlled trial investigated whether a PE intervention with technical measurements consisting of IMUs, sEMG, heart rate monitoring, and video recordings of physical workload could reduce the number of events with excessive physical workload during a working day. Furthermore, other outcomes were obtained from questionnaires., Methods: A total of 80 male full-time construction workers (aged 19 to 67 years) were randomized at the cluster level (gang) to a PE intervention consisting of 3 workshops (7 gangs and 32 workers) or to a control group (8 gangs and 48 workers). The physical workload was recorded by technical measurements, that is, IMUs, sEMG, heart rate monitoring, and video recordings during a full working day at baseline and 3 and 6 months' follow-up. On the basis of the technical measurements, a custom-made computer program detected the situations (events) where the construction workers were exposed to excessive physical workload and used in the intervention. Differences in the number of events from baseline to follow-up between intervention and control were evaluated using linear mixed models (intention-to-treat), with individual nested in cluster as a random factor. Furthermore, questionnaires were filled out on test days., Results: The results of the primary outcome showed no change in the number of events with excessive physical workload. However, compared with the control group, the other outcomes showed decreased general fatigue after a typical working day (P=.001) and increased influence on own work (P=.04)., Conclusions: This PE intervention with technical measurements did not reduce the number of events with excessive physical workload during construction work. However, the intervention led to decreased general fatigue and increased influence on own work., Trial Registration: ClinicalTrials.gov NCT02498197; https://clinicaltrials.gov/ct2/show/NCT02498197 (Archived by WebCite at http://www.webcitation.org/74SZ3DIWS)., (©Mikkel Brandt, Pascal Madeleine, Afshin Samani, Jeppe ZN Ajslev, Markus D Jakobsen, Emil Sundstrup, Lars L Andersen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.12.2018.)

Background: While acute stress and pain are part of our inherent survival mechanisms, persistent stress and pain can negatively impact health and well-being. This may also lead to poor sleep and thus a lack of recovery. This study investigated the influence of stress and musculoskeletal pain on sleep quality. Methods: A total of 3,593 Danish hospital workers replied to a questionnaire about work and health. Pain intensity was evaluated using subjective values as an average of 9 body parts. Stress was assessed using the full version of Cohen's Perceived Stress scale. Sleep quality was rated using 3 questions on sleep characteristics. Associations between stress and pain (mutually adjusted predictors) and sleep (outcome) were modeled using binary logistic regression controlling for gender, age, education, BMI and smoking. Results: The risk ratio of moderate stress (compared to no/low stress) on poor sleep was 1.27 (CI 1.26-1.29), whereas the risk ratio of high stress on poor sleep was 1.87 (CI 1.83-1.91). Similarly, for pain, the risk ratio of moderate pain (compared to no/low pain) on poor sleep was 1.18 (95% CI 1.16-1.19), whereas the risk ratio of a high pain score on poor sleep was 1.48 (95% CI 1.44-1.52). Conclusion: This study demonstrates that both stress and musculoskeletal pain are associated with poor sleep among hospital workers. Hospital management should consider implementing strategies for preventing stress and musculoskeletal pain to improve the overall health and workability among hospital workers.

Objectives The capability of safety climate to predict accidents has been the target of widespread debate in occupational health and safety research. The objective of this prospective cohort study was to employ a shortened five-item safety climate survey to investigate whether safety climate reports in 2012 are predictive for accidents reported within the last 12 months in 2014. Methods In both 2012 and 2014, 3864 blue-collar workers answered the Danish Working Environment and Health Cohort Study. Logistic regression was used to study the association [odds ratio (OR)] of reporting a work-related accident (yes/no) with more than one day of sickness absence (outcome) within the last 12 months in 2014 with the number of safety climate problems (predictor). The analyses were cumulatively adjusted for age, gender (model 1), socioeconomic class, occupational group, lifestyle (model 2), and previous accidents in 2012 (model 3). Results Of the safety climate problems reported in 2012, 1017 (28%) participants reported one problem, 357 (10%) reported two and 614 (17%) reported three or more problems. Using the number of safety climate problems as a continuous variable, all models showed a dose-response relationship between number of safety climate problems in 2012 and at least one accident in 2014 (trend-test, P<0.001). Compared to participants with no safety climate problems, participants reporting two safety climate problems in 2012 had a higher risk for reporting an accident in 2014 [OR 1.84, 95% confidence interval (CI) 1.22-2.77], and the risk was higher for participants reporting three or more safety problems (OR 2.22, 95% CI 1.60-3.09). Conclusions A higher number of safety climate problems progressively increased the OR for reporting at least one accident within the last 12 months at the two-year follow-up. The five-item safety climate survey is a simple and important tool that can be used as part of risk assessment in blue-collar workplaces.

This study aims to quantify physical workload of the low-back using exposure variation analysis (EVA) during a full working day among blue-collar workers with manual lifting tasks. One hundred and ten male employees (39 warehouse workers, 27 operators, 24 postal workers and 20 slaughterhouse workers) with manual lifting tasks from 12 workplaces participated. The workers performed standardized box lifts using 5, 10, 20 and 30 kg before and after a working day. Muscular activity of the low-back was measured throughout the working day using surface electromyography (sEMG). Corresponding sEMG-values for 0-30 kg lifts were identified using linear regression. EVA at exposure levels corresponding to "lifting periods" of [1-5, 5-10, 10-20, 20-30 and >30] kg in time intervals [0-0.5, 0.5-1, 1-2, 2-5, 5-10, >10] sec was computed. Back inclination was measured using tri-axial accelerometers. Compared to the other job groups, the operators' low-back muscles were exposed to more short duration "lifting periods" with varying loads and more frequent medium duration high load "lifting periods", respectively. The operators also worked more with their back inclined (>30°, >60°, and >90°) than the remaining job groups. Nonetheless, more than 41% of the workers performed heavy "lifting periods" that exceeded Danish lifting guidelines. This EVA demonstrates that almost half of the blue-collar workers were exposed to heavy low-back loading which puts them at risk of developing musculoskeletal disorders and low-back injury. Operators are, in particular, exposed to more short duration and medium duration "lifting periods" with varying load compared to warehouse-, postal- and slaughterhouse workers., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Lifting and falls comprise a large proportion of work related injuries. Repetitive lifting to the point of fatigue can affect postural sway, which is associated with fall risk. To investigate the effects of lifting and fatigue on postural sway in males and females, 35 participants (18 male, 17 female) were asked to lift a weighted box in sets of 25 lifts at 5 different incremental weights (10, 15, 20, 25, and 30 kg) until fatigue. Before and after each lifting set, participants performed a single leg balance test on a force platform to assess postural sway by means of center of pressure mean velocity. Analysis of pre-fatigue to post-fatigue postural sway measurements indicated that there were no significant differences in mean velocity when males and females were grouped together. However, when analyzed as separate groups, mean postural sway center of pressure velocity increased for males but did not for females, indicating that males and females use different strategies to maintain balance when fatigued., (Copyright © 2018 Elsevier B.V. All rights reserved.)