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Thirty-nine pregnant women participated in a study to investigate the extent intake of grain fiber and maternal iron status affect cadmium accumulation during pregnancy. Results show that women who ate less grain fiber and maintained better iron status during pregnancy had lower cadmium accumulation in the placenta. Furthermore, it was shown that low iron status during the third trimester of pregnancy can cause as much as a four-fold increase in placental absorption of cadmium.

Sofia Köpsén, 1, 2 Rita Sjöström 2, 3 1Krokom Health Care Center, Region Jämtland Härjedalen, Krokom, Sweden; 2Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; 3Unit of Research, Education and Development, Region Jämtland Härjedalen, Östersund, SwedenCorrespondence: Sofia KöpsénKrokom Health Care Center, Genvägen 5, Krokom 834 31, SwedenTel +46 730-343099Email sofia.kopsen@gmail.comIntroduction: Stress and stress-related ill health have a multifactorial impact; both on physical and mental health. To better meet this category of patients a primary care unit started a stress-management programme using cognitive behavioural therapy and basic body awareness therapy.Purpose: To describe participant´s experiences of a primary care stress-management programme using cognitive behavioural therapy and basic body awareness therapy.Methods: In a qualitative study, a semi-structured interview guide was used in individual interviews with 9 people, all women aged 41– 57, working or on sick leave, who had enrolled in the stress-management programme. The material was analysed through qualitative content analysis.Results: The analysis resulted in the theme “Process of change for a sustainable everyday living”. The participants described having gained awareness of the symptoms of their stress, knowledge and tools to manage their stress, ways to relax, awareness of their body, and the means to develop better habits and to change their behaviour. Fundamental in the material was the importance of participants’ identification with the others in the group.Conclusion: The participants started a process of change with new knowledge and growth, but they encountered difficulties and obstacles. Behavioural change is a time-consuming process.Keywords: basic body awareness therapy, burnout, cognitive behavioural therapy, exhaustion syndrome, stress rehabilitation, stress-related ill health

Rita Sjöström,1,2 Ragnar Asplund,3 Marie Alricsson2,41Strömsund Health Centre, Jämtland County Council, Strömsund, 2Department of Health Sciences, Mid Sweden University, Östersund, 3The Research and Development Unit, Jämtland County Council, Östersund, 4School of Human Sciences, Linnaeus University, Kalmar, SwedenBackground: The aim of this investigation was to analyze temporal changes in anxiety, depression, and stress in patients with musculoskeletal pain for a period of up to 2 years after a multidisciplinary rehabilitation program, in relation to sick-listing (registered with The Swedish Social Insurance Agency [Forsakringskassan] for sickness benefit).Methods: Ten persons with full-time sick leave (absence from work for medical reasons) (group 1) and 49 with part-time or no sick leave (group 2) at the end of the 2-year study period participated. It was shown in a previous study that group 1 had higher pain rating and higher subjective physical disability than group 2, with little or no improvement during and after rehabilitation. In the present study, all participants were evaluated with the Hospital Anxiety and Depression scale and a self-rated stress test.Results: Participants with full-time sick leave during the study period (group 1) showed improved stress levels but no change in anxiety and depression levels. Anxiety, depression, and stress changed more favorably in participants with part-time or no sick leave than in those with full-time sick leave.Conclusion: The results of this study indicate that investigation and appropriate treatment of psychological symptoms, including anxiety and depression, are important in multidisciplinary rehabilitation of patients with musculoskeletal disorders.Keywords: anxiety, depression, musculoskeletal, rehabilitation, sick leave, stress

Background: Pediatric avulsion fractures of the anterior tibial spine are injuries similar to anterior cruciate ligament injuries in adults. Sparse data exists on the association between anterior tibial spine fractures (ATSFs) and injury to the meniscus or cartilage of the knee joint in children. This research presents a retrospective review of clinical records, imaging, and operative reports to characterize the incidence of concomitant injury in cases of ATSFs in children. The purpose of this study was to better delineate the incidence of associated injuries in fractures of the anterior tibial spine in the pediatric population., Methods: We identified 58 patients who sustained an ATSF and met inclusion criteria for this study between 1996 and 2011. The subjects were separated by the Myers and McKeever classification into type I, II, and III fractures, and each of these were subclassified by associated injury pattern., Results: 59% of children with an ATSF had an associated soft tissue or other bony injury diagnosed by magnetic resonance imaging or arthroscopy. The most prevalent associated injuries were meniscal entrapment, meniscal tears, and chondral injury. We found no meniscal or chondral injury associated with type I fractures. Twenty-nine percent of type II injuries demonstrated meniscal entrapment, 33% showing meniscal tears. Seven percent demonstrated chondral injury. Forty-eight percent of type III fractures had entrapment, whereas 12% showed meniscal tears. Eight percent had a chondral injury., Conclusions: A majority (59%) of displaced ATSF had either concomitant meniscal, ligamentous, or chondral injury. This finding suggests that magnetic resonance imaging evaluation is an important aspect of the evaluation of these injuries, particularly in type II and type III patterns. To date, this study reports the largest number of patients to evaluate the specific question of concomitant injuries in ATSFs in the pediatric population., Level of Evidence: Level IV.

Purpose: To analyze why some responded positively to rehabilitation and why some did not., Method: Sixty participants with musculoskeletal disorders, mainly neck and back pain participated in a 7-week rehabilitation programme which was based on a combination of theoretical and practical education and physical activities. Before and after the programme and 6, 12 and 24 months after completion of the programme all participants were evaluated with the Disability Rating Index (DRI) and Pain Intensity Rating on a Visual analogue scale (VAS)., Results: In the participants who had full-time sick leave from the start of the programme to the 2-year follow-up (Group I) self-experienced physical disability and pain ratings were high and showed no decrease and were maintained up until the 2-year follow-up. For the participants who had part-time sick leave or no sick leave (Group II) physical disability and pain ratings were initially lower than in Group I and decreased gradually, (p < 0.01) and (p < 0.05), respectively throughout the 2-year follow-up period., Conclusion: Participants in Group I did not benefit from the rehabilitation programme and did not show improvement in their physical disability and pain rating. Group II showed decreased physical disability and pain rating. The decrease was gradual and was maintained up until the 2-year follow-up period. These results may indicate that persons with musculoskeletal pain with severe disability and pain require other rehabilitation programmes than those with moderate symptoms. This research has highlighted the need for development of such programmes.