To prevent work-related musculoskeletal disorders (MSDs), useful, reliable and valid methods for assessing physical workload and risks for MSDs are needed. Ergonomists often assess work by short visual observations without a specific tool. A branch-specific tool was developed for assessing working technique during cash register work (BAsiK observation protocol). Inclinometers are an alternative for assessing upper arm postures - over several days. Ergonomists need guidelines explaining how to analyze and interpret such data. The aim was to examine and investigate methods for assessing physical load at work, with focus on the neck and upper extremities. In Paper: I, the reliability and criterion validity of the BAsIK observation protocol were assessed. II, the reliability of risk assessments of repetitive work, based on visual observations performed by 21 ergonomists without a specific tool, was assessed. III, whole-day inclinometer measurements of upper arm elevation were compared between work and leisure, across 13 different occupations – before and after arm elevations during sitting time was excluded. IV, the association between inclinometer-based upper arm elevation and neck/shoulder pain was assessed among 654 blue-collar workers.   The intra-observer reliability of the BAsIK protocol was deemed acceptable, but only 3 of 10 questions in the protocol showed acceptable inter-observer reliability, and 3 showed acceptable criterion validity. Neither the inter- or intra-observer reliability of risk assessment without any specific method was acceptable for any upper body regions. None of the occupation groups, in paper III, had higher proportion of time with arm elevation during work than leisure. However, when arm elevation during sitting was excluded, 8 occupation groups had higher proportion of time with elevated arms during work than leisure. Whole-workday inclinometer-based upper arm elevation was not associated with neck/shoulder pain within the assessed population.    The results indicate that, in most cases, a single visual observation of a work sequence is not a reliable means of assessing repetitive work. A large proportion of arm elevation may derive from sitting time. At low exposure levels, arm elevation per se may not be a risk factor for neck/shoulder pain. This must be taken into account when evaluating the risk for MSDs.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Background: Insufficient exposure assessment is a suggested contributing factor to the current lack of clearly characterised relationships between occupational biomechanical risk factors and musculoskeletal disorders. Minimal attention has been paid to the potential bias of measurement tools from expected true values (i.e. accuracy) or between measurement tools, and empirical data on the magnitudes of variance contributed by methodological factors for measurement tool precision are lacking. Aim: The aim of this thesis was to quantify aspects of bias and precision in three commonly employed biomechanical risk factor assessment tools - inclinometry, observation, and electromyography (EMG) - and provide recommendations guiding their use. Methods: Upper arm elevation angles (UAEAs) were assessed using inclinometers (INC) and by computer-based posture-matching observation, and bias relative to true angles was calculated. Calibration models were developed for INC data, and their efficacy in correcting measurement bias was evaluated. The total variance of trapezius and erector spinae (ES) EMG recordings during cyclic occupational work was partitioned into biological and methodological sources, including the variance uniquely attributable to sub-maximal normalisation. Using algorithms to estimate the precision of a group mean, the efficacy of different trapezius EMG study designs was evaluated. Using precision criteria, the efficacy of different normalisation methods was assessed for ES EMG recordings. Results and Discussion: Inclinometer measured UAEAs were biased from true angles, with increasing bias at higher angles. In contrast, computer based posture-matching observations were not biased from true angles.  Calibration models proved effective at minimizing INC data bias. The dispersion of estimates between- and within- observers at any given set angle underlined the importance of repeated observations when estimating UAEAs.  For EMG, a unique but relatively small component of the total variance was attributable to the methodological process of normalisation. Performing three repeats of the trapezius EMG normalisation task proved optimal at minimizing variance for one-day EMG studies, while two repeats sufficed for multi-day EMG studies. A prone normalisation task proved superior for maximizing normalised lumbar ES EMG precision. Conclusion: Key aspects of measurement tool accuracy, bias between tools, and tool precision were quantified, and recommendations were made to guide future research study design.

Aim: The aim of the thesis was to investigate the impact of gaze-based assistive technology on daily activities in children with severe physical impairments and without speech. The objectives were to develop and pilot a gaze-based assistive technology intervention (GAT intervention) at home and in school for these children and to understand its impact on daily activities as experienced by their parents. Methods: Study I was a pilot study in which the basic components that were developed for the intervention were evaluated for students with physical impairments. The study aimed at improving the use of computers as assistive technology (AT) in school. Based on the findings in Study I, the GAT intervention was developed. The GAT intervention aimed at implementing gaze-based AT in daily activities. It consisted of two parts; having access to gaze-based AT and having access to services from a multi professional communication team during nine to ten months. Studies II-IV concerned gazebased AT for children with severe physical impairments without speech who participated in the GAT intervention. The participants were ten children (ages 1-15) (Studies II, III), and their parents (Study IV). Studies II and III had longitudinal designs and children were followed during 15-20 months with repeated measurements before, after and at follow-up. In Study II children’s repertoire of computer activities, extent of use, and goal attainment with gaze-based AT was evaluated, as well as parents’ satisfaction with the AT and with services. In Study III children’s eye gaze performance when using gaze-based AT was examined. In Study IV, parents were interviewed twice with the aim of  exploring their experiences of children’s gaze-based AT use in daily life. In Study IV a hermeneutical approach was used. Results: The findings of Study I showed that the basic components of intervention improved the use of computers in school. Study II showed an increased repertoire of computer activities with the gazebased AT, maintained use in daily activities for all at follow up, and that all children attained goals for gaze-based AT use in daily activities. Parents were satisfied with the gaze-based AT, and with the services in the GAT intervention. In study III, nine children improved in eye gaze performance over time when using the gaze-based AT in daily activities. Study IV revealed that children’s gaze-based AT usage in daily activities made a difference to parents since the children demonstrated agency, and showed their personality and competencies by using gaze-based AT, and for the parents this opened up infinite possibilities for the child to do and learn things. Overall, children’s gaze-based AT usage provided parents with hope of a future in which their children could develop and have influence in life. Conclusions: This thesis shows that these children with severe physical impairments and without speech acquired sufficient gaze control skills to use gaze-based AT for daily activities in the home and at school. The gaze-based AT had a positive impact on performing activities, for example, play activities and communication- and interaction-related activities. For the parents, children’s gaze-based AT usage made a difference since it shaped a hope of a better future for their children, where they can develop and gain influence in their future life. Furthermore, the children continued to perform daily activities with gaze-based AT over time. This finding suggests that key persons were provided with sufficient knowledge and skills to support children in maintained use of gaze-based AT after withdrawal of the services provided in the GAT intervention.

This thesis focused on factors contributing to improved work environment in small-scale enterprises and sustainable health for the entrepreneurs. In Study I, implementation of the provision of Systematic Work Environment Management (SWEM) with and without support was investigated. Two implementation methods were used, supervised and network method. The effect of the project reached the employees faster in the enterprises with the supervised method. In general, the work environment improved in all enterprises. However, extensive support to small-scale enterprises in terms of advice and networking aimed at fulfilling SWEM regulations had limited effect – especially considering the cost of applying these methods. Studies II, III, and IV focused on entrepreneurs’ health, work conditions, strategies for maintaining good health, and utilisation of Occupational Health Service (OHS). A closed cohort of entrepreneurs in ten different trades responded to two self-administered questionnaires on health and work conditions, with five years between the surveys: at baseline, 496 entrepreneurs responded, and 251 entrepreneurs responded at follow-up. Differences were tested by Chi2-test, and associations estimated with logistic regression analyses. Qualitative interviews on entrepreneurs’ strategies for maintaining good health were included. In Study II, the most frequently reported complaints, musculoskeletal pain and mental health problems, were associated with poor job satisfaction and poor physical work environment. In Study III, consistent self-reported good health, i.e. good health both at baseline and at follow up, was associated with self-valued good social life when adjusted for physical work conditions and job satisfaction. Entrepreneurs’ strategies for maintaining good health included good planning and control over work, flexibility at work, good social contact with family, friends and other entrepreneurs, and regular physical exercise. Study IV concerned entrepreneur’s utilisation of OHS. Entrepreneurs affiliated to OHS had either better or more adverse work conditions than non-affiliated entrepreneurs. Medical care and health check-ups were the services most utilised. Affiliation to OHS correlated with use of specific information sources and active work environment management. The entrepreneurs were not consistently affiliated to OHS over the five-year-period.

The purpose of this study on hand injury from powered wood splitters was to describe injury epidemiology and anatomy, to rate injury severity, to evaluate the outcome after injury and to describe factors of possible importance for the occurrence of injury. By searching a computerized patient registry, 131 patients injured by wood splitters from 1995 to 2001 were identified. Information was obtained from hospital records and radiographs, a written questionnaire and a structured telephone interview. Injury severity was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). Outcome was evaluated with the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (DASH) and, in 26 of the most severely injured patients, with the Sollerman test. Forty-six percent of the injuries occurred during April or May. Wedge splitters caused 82 % of all injuries and most often injured the index finger, while screw splitters caused 18 % of all injuries and most often injured the metacarpus. Screw splitters caused palmar perforation and thumb avulsion. Sixty-three percent of all patients had an amputation or devascularising injury. The reliability of HISS rating was good. The mean Hand Injury Severity Score (HISS) was 63 which is equivalent to a severe hand injury. The mean ISS was 3.7. Nineteen percent of patients had minor, 31 % had moderate, 23 % had severe and 27 % had major injury according to the HISS system. Children had more severe injuries than adults. There was no significant difference regarding HISS or DASH scores between wedge and screw splitter injuries. The mean DASH score was 15, indicating moderate residual sequelae, but patients without sequelae and patients with grave sequelae were found in all HISS severity grades. There was a weak but significant correlation between the HISS and DASH scores. The mean Sollerman score in the injured hand was 66, indicating significantly impaired hand function. Twenty-nine percent of splitters were home-made. Very few machines had the safety measures required by European Standards. Children were present during splitting in at least 15 % of cases. Not being alone at the machine was one cause of wedge splitter injury. Glove use was one cause of screw splitter injury. Hand injury from powered wood splitters is a significant problem. Many of the injuries are severe, and cause long term sequels and impairment of hand function. Prevention is essential and should focus on unsafe machines and dangerous patterns of use.

<p>14 juni 2007 beslutade regeringen att tillkalla en särskild utredare med uppdrag att utforma förslag till en svensk veteranpolitik, som skulle innefatta ansvaret för personalen före, under och efter internationella militära insatser. Utredningen, som tog namnet Veteransoldatutredningen, lämnade i oktober 2008 sitt slutbetänkande. Syftet med denna uppsats var att kritiskt granska utredningens förslag till förbättring i frågan om psykologisk ohälsa, stressprevention, inför insats och med utgångspunkt i litteraturen försöka förutsäga om förslaget skulle komma att ge effekt</p><p> Metodvalen i denna uppsats har utgjorts av kvalitativ textanalys samt deskription. Tyngdpunkten i essän ligger i att definiera stressreaktioner samt åtgärder för stressprevention. Därefter följer analysen för att kunna se om det finns en förankring i aktuell forskning, och mot slutet granskas om förslagen kommer att ge effekt.</p><p>I uppsatsen söktes svar på följande frågeställningar:</p><p>-          Finns det en förankring i förslagen från Veteransoldatutredningen i aktuell forskning med inriktning på preventiva åtgärder?</p><p>-          Är det rimligt att anta att med stöd av aktuell forskning att förslagen kan förebygga psykisk ohälsa efter internationell insats?</p><p>De viktigaste slutsatserna som har dragits från denna studie är:</p><p>Förslagen från veteransoldatutredningen finns till del förankrade i aktuell litteratur. De förslag som väntas kunna förebygga psykisk ohälsa efter internationell insats är som följer.</p><p>-          En förbättrad och mer effektiv rekrytering genom större personlig kontakt medger en noggrannare rekrytering som gör att man får rätt människor, på rätt plats med godkända vitsord samt psykisk lämplighet och detta minskar i sin tur risken för stressreaktioner.</p><p>-          Utökad och bättre information till allmänheten från den politiska ledningen och från Försvarsmakten om missioner minskar förhoppningsvis samhällets opposition genom att öka förståelsen för Försvarsmakten och dess uppgifter. Detta nedbringar i sin tur den kumulativa stress i soldatens vardag p g a externa stressorer från samhälle och media.</p><p>-          Ytterligare utbildning i mänskliga rättigheter och krigets lagar bidrar till att skapa trygghet i vad soldater får - och inte får - göra. Genom dylik utbildning kan frustrationen, som uppstår då soldaterna inte vet hur de skall hantera specifika situationer, minskas. </p> / <p>This essay - <em>Veteransoldatutredningen – a review of its proposals for improving the matter of mental ill-health</em> – is written by cadet Josefine Nilsson. The aim is to study the <em>Veteransoldatutredning’</em>s suggestions for improvement when it comes to e.g. stress prevention and psychological ill-health ahead on an international mission.</p><p>The methods used are description and trial of a hypothesis. Through a study of the immediate literature and by analyzing the proposals, my conclusions are that an improved and more efficient recruitment allows for a more accurate recruitment; increased and better information to the public from the political body and from the Armed Forces will reduce external stress that the soldiers sometime feel, and also that additional education in human rights and the law of war contributes to create a security in what the soldiers can, and can not do.</p>

In the end of the1940's Occupational Medicine was institutionalised in Sweden. Health hazilards in the work place was not a new field for the Swedish physicians. They had been preocrcupied with these problems for a long time. The aim of this thesis is to analyse and describe how health hazards in the work placees, ecpecially in the factories, were perceived and described by Swedish physicians at the turn of the 20t century. The aim is also to clarify the physicians' role m shaping, developing and supervising the Occupational Safety and Health Acts. The city of Norrköping is used as anexample in discussing how physicians at a local level paid attention to health and safety issues in the work place. According to the physicians, there were a number of harmful factors in the factory work that could endanger health, but these were also seen to be dependent on the worker. Workers ldisplayed different kinds of vulnerability to the harmful factors. Sex, heredity, age, health, physique, habits and behaviour were understood as determining components. The preventive measures not only contained guidelines for the factories. They also included advises on how '!the workers should organise and live their lives outside work. The life style and behaviour the physicians would like to encourage were aligned with the !cultural values of the bourgeoisie at the tum of the 20th century. It is vital to recognise the cultural lens through which the physicians perceived and spoke of the workers' situation, their way of life and their behaviour inside as well as outside the factory.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Background In Swedish working life, exposure to cold and exposure to hand-arm vibration (HAV) are two common health hazards. Health effects of HAV in the neurosensory, vascular and musculoskeletal systems are collectively denoted hand-arm vibration syndrome (HAVS), and have been thoroughly studied. Effects of cold exposure in terms of effects on the peripheral neurosensory and vascular system are on the contrary limited, especially in an occupational setting. Effects of cold exposure or cold injury have not previously been assessed with quantitative sensory testing (QST). Commonly reported symptoms after exposure to HAV and after cold injuries, includes cold sensitivity and sensation of cold. Cold sensitivity can also occur without previous exposure to vibration or cold and may have a major impact on quality of life. Other possible risk factors for cold sensitivity need to be assessed. Sensation of cold hands could theoretically imply an early manifestation of damage to the neurosensory or vascular system, and therefore be of importance to enable early detection of vascular and neurosensory HAVS. The purpose of this thesis was to increase the knowledge about health effects from cold and HAV on the peripheral neurosensory and vascular system, with an occupational perspective. The aims were: first, to identify and evaluate health effects and sequelae in the peripheral neurosensory and vascular system due to cold injury and cold exposure; second, to investigate if sensation of cold hands is a predictor for future onset of Raynaud's phenomenon or paresthesia; and third, to identify possible risk factors associated with cold sensitivity. Methods A case series on 15 military conscripts with local cold injuries in the hands or feet, involving QST and symptom descriptions, was conducted to investigate the hypothesis that cold injuries can result in similar neurosensory and vascular impairments as in HAVS. To assess health effects of cold exposure, a cohort study on 54 military conscripts in cold winter military training, with cold exposure assessments, was conducted. Possible health effects were assessed after 14 months of military training, containing considerable cold exposure, by means of QST, Finger systolic blood pressure after local cooling (FSBP) and a questionnaire. To investigate if sensation of cold hands is a predictor for vascular or neurosensory HAVS we investigated a cohort of 178 employees at a manufacturing company where HAV was a common exposure. The cohort was followed during 21 years and both vibration exposure and health outcomes were assessed regularly. Questionnaire items were used to assess sensations of cold hands as well as signs of Raynaud’s phenomenon and paresthesia. To identify risk factors for cold sensitivity a case-control study was conducted involving 997iiiparticipants from the general population in northern Sweden. The study was cross-sectional and explored possible risk factors for cold sensitivity. Results Cold injuries and cold exposure were associated with reduced sensibility in QST and increase severity and prevalence of neurosensory and vascular symptoms. Our results did not show any impairment in peripheral blood flow due to cold exposure, detectable by FSBP. The risk of developing Raynaud's phenomenon was increased for workers previously reporting sensation of cold hands (OR 6.3, 95% CI 2.3-17.0). No increased risk for paresthesia in relation to a sensation of cold hands was observed. The identified risk factors for cold sensitivity were frostbite in the hands, rheumatic disease, nerve injury in upper extremities or neck, migraine and vascular disease. When analysing women and men separately, women’s risk factors were frostbite in the hands, rheumatic disease, migraine and cold exposure. Men’s risk factors were frostbite in the hands, vibration exposure and nerve injury in upper extremities or neck. BMI &gt; 25 was a protective factor for both men and women. Conclusion Cold injury and cold exposure are associated with impairments in the neurosensory system, detectable by QST. Symptoms such as sensation of cold hands and white fingers indicate vascular involvement, even though no vascular impairments due to cold exposure could be detected by objective measurements. A sensation of cold hands is a risk factor for development of Raynaud´s phenomenon, but not for paresthesia. At the individual level, reporting cold hands does not appear to be useful information when considering the possibility of a future development of Raynaud’s phenomenon. Frostbite in the hands is a risk factor for cold sensitivity among both women and men. For women rheumatic disease, migraine and cold exposure are also independent risk factors, and for men, exposure to HAV. Being overweight is a protective factor for both women and men.