Christina Ahlgren

Perceived pain before and after three exercise programs--a controlled clinical trial of women with work-related trapezius myalgia.

Abstract The effect of exercise on neck–shoulder pain was studied in 103 women with work‐related trapezius myalgia randomized into three exercise groups and a control group. One group trained strength, the second muscular endurance and the third co‐ordination. The exercise groups met three times weekly for 10 weeks. Pain assessment was made on three visual analogue scales, indicating pain at present, pain in general and pain at worst. Pain thresholds were measured in the trapezius muscle with a pressure algometer. A pain drawing was completed. The rated pain decreased significantly (P<0.05) on the VAS describing pain at worst in the strength and endurance groups. Pressure sensitivity decreased significantly (P<0.05) in four triggerpoints in the exercise groups. No changes were seen in the extent of painful body area in any group. Comparison of exercisers (n=82) and controls (n=21) showed significantly larger pain reductions on VAS pain at present and VAS pain at worst among exercisers. All three exercise programs showed similar decreases of pain which indicates that the type of exercise is of less importance to achieve pain reduction.

Pathological mechanisms implicated in localized female trapezius myalgia

Abstract Myalgia localized to the neck and shoulder in women is a growing problem both in the general population and in the industrial world. The aim of this study was to investigate the mechanisms involved in work‐related myalgia. In 21 women (age, 38.7±5.5 years), muscle biopsies were obtained from the upper part of the trapezius and the morphologic and metabolic characteristics of muscle fibres were analyzed. The patients indicated the number of painful areas on a pain drawing and the intensity of pain was assessed using a visual analogue scale (VAS). Two groups were formed on the basis of the median values: lower pain level and higher pain level. Trapezius muscles were characterized by the large size of type I fibres and the low capillary to fibre area ratio for both type I and type IIA fibres. Patients with the highest pain scores had the lowest capillary to fibre area ratio for type I fibres (coefficient correlation r=−0.45 and P<0.05). Moreover, the proportion of cytochrome c oxidase (COX)‐negative fibres seen in the cross‐sections was significantly higher in the group of patients which had the higher pain and more painful areas than in the group of patients with lower pain level and painful areas (P<0.05). The significant increase (P<0.05) of the size of the type I fibres in trapezius myalgia point to the special strain imposed upon type I muscle fibres during work tasks. Cytochrome oxidase c deficiency which is indicative of an energy crisis within muscle cells and the low capillary to fibre area ratio which might impair oxygen delivery and removal of metabolites in the working muscles are both associated with pain in the trapezius muscle.

A life-course approach in explaining social inequity in obesity among young adult men and women.

Objective:To examine the cumulative influence of adverse behavioural, social, and psychosocial circumstances from adolescence to young adulthood in explaining social differences in overweight and obesity at age 30 years and if explanations differ by gender.Design:A 14-year longitudinal study with 96.4% response rate.Subject:Data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 years and prospectively followed up to age 30 years.Measurements:Overweight and obesity were ascertained at ages 16 and 30 years. Occupation and education were used to measure socioeconomic status. The explanatory measurements were: age at menarche, smoking, physical activity, alcohol consumption, TV viewing, home and school environment, social support, social network, and work environment.Results:No gender or social difference in overweight was observed at age 16 years. At age 30 years, significantly more men than women (odds ratio (OR)=2.81, 95% confidence interval (CI) 2.14–3.68) were overweight or obese. Educational level was associated with overweight at age 30 years, but not occupational class. Both men (OR=1.55, 95% CI 1.10–2.19) and women (OR=1.78, 95% CI 1.16–2.73) with low education (⩽11 years) were at risk of overweight. The factors that explained the educational gradient in overweight among men were low parental support in education during adolescence, and physical inactivity, alcohol consumption, and nonparticipation in any association during young adulthood. The educational gradient in overweight in women was explained mostly by adolescence factors, which include early age at menarche, physical inactivity, parental divorce, not being popular in school, and low school control. Restricted financial resource during young adulthood was an additional explanatory factor for women. All these factors were significantly more common among men and women with low education than with high education.Conclusion:Social inequities in overweight reflect the cumulative influence of multiple adverse circumstances experienced from adolescence to young adulthood. Underlying pathways to social inequity in overweight differ between men and women. Policy implications to reduce social inequity in overweight include reduction of social differences in health behaviours and social circumstances that take place at different life stages, particularly psychosocial circumstances during adolescence.

Effects on physical performance and pain from three dynamic training programs for women with work-related trapezius myalgia

To compare training programs for women with trapezius myalgia regarding physical performance and pain, 102 women were randomized to strength, endurance, co-ordination and non-training groups. Before and after the intervention, static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer. Muscle activity in shoulder muscles was monitored via surface EMG. The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax. Pain at present, pain in general and pain at worst were measured on visual analogue scales. After training, within group comparisons showed that the training groups rated less pain, and in the strength training group ratings of pain at worst differed from the non-training group. Using the non-training group as a reference, static strength increased in the strength and endurance training groups and muscular endurance in all training groups. The study indicates that regular exercises with strength, endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia.

Back to work? Gendered experiences of rehabilitation.

Gendered experiences of rehabilitation were studied in a strategic sample of young people with work-related disorders. Thematic interviews were conducted with seven women and four men, and analysed from a gender perspective using grounded theory. In comparison with women, men were more likely to receive specific diagnoses, to demand actions, and to strive for full-time waged work. Women experienced more often than men that doctors distrusted them, and that social insurance officers made decisions for them. The outcome of rehabilitation was better for men, whether they adapted to the offered measures or not. Gendered structures in the rehabilitation system, the construction of gender in the meeting between the client and the doctor/social security officer, as well as the division of domestic duties within marriage, strongly influenced the outcome of the rehabilitation process in favour of men.

Central gender theoretical concepts in health research: the state of the art

Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked—but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on womens and mens health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

The effects of different training programs on the trapezius muscle of women with work-related neck and shoulder myalgia

Abstract The aim of this study was to examine the effects of training on the structural characteristics of the trapezius muscle in women with work-related trapezius myalgia. Muscle biopsies were taken before and after 10 weeks of three different training programs (strength, endurance and coordination). Enzyme-immunohistochemical analysis was performed to assess muscle fibre types, fibre area, capillary supply and cytochrome c oxidase (COX) activity. There was an increase in the proportion of type IIA fibres in strength trained group (P < 0.05). Strength training elicited a preferential increase in the area of type II fibres (P < 0.05); both strength and endurance programs induced an increase in the number of capillaries around type I and IIA muscle fibres. Finally, all training programs induced a decrease in the proportion of COX-negative fibres. In conclusion, the trapezius muscle of women with neck and shoulder myalgia is characterised by a great potential of adaptation to physical exercise over a period of 10 weeks. The significant changes in the number of capillaries and the specific changes induced by training at the level of muscle fibres might well explain the improvement of muscle function.

Effects of Qigong in patients with burnout: a randomized controlled trial.

OBJECTIVE To evaluate the efficacy of Qigong in rehabilitation for patients with burnout. DESIGN Prospective, randomized controlled trial. SUBJECTS Eighty-two patients (68 women and 14 men, mean age 44.3 (standard deviation 9.1) years) diagnosed with burnout. METHODS Basic care was offered to both the intervention and the control group. Patients in the intervention group received basic care and, in addition, performed Qigong twice a week for 12 weeks. Psychological variables, health-related quality of life, perceived relaxation and physical measurements were assessed at baseline and after the intervention period. RESULTS No significant difference in treatment efficacy between the groups was found by either intention-to-treat or per-protocol analyses. Both groups improved significantly over time, with reduced levels of burnout, fatigue, anxiety and depression, and increased dynamic balance and physical capacity. CONCLUSION In this study, a Qigong intervention twice a week for 12 weeks had no additional effect beyond basic care for patients with burnout.

Facilitating factors for work return in unemployed with disabilities: A qualitative study

Despite the fact that equal services are offered to all disabled jobseekers who apply for jobs through jobcentres, only a small number of them return to work while the others remain unemployed. The aim of this study was to explore which factors disabled jobseekers, who had managed to get a job experienced had been important for their work return. A qualitative research method, Grounded Theory, was chosen. Ten thematized in-depth interviews were conducted. The narratives reflected that a common feature in the informants was a strong worker identity. They emphasized the importance of remaining as an active jobseeker despite disability and unemployment. Measures offered by the jobcentres such as timing, individual support, and a period of adjusted work were experienced to be empowering and enhanced the ability to continue job seeking. In parallel with these empowering measures the informants expressed a process of personal development (reorientation). The reorientation included concepts such as “adjusting to disability” and “finding a new work identity”.

Has increased focus on vocational rehabilitation led to an increase in young employees' return to work after work-related disorders?

The aim of this study was to determine whether the large investments in vocational rehabilitation made in Sweden during the 1990s had improved the level of return to work for young employees and to study the factors predicting return to work. The study population comprised all employees under 30 years of age whose reports on work-related disorders were under consideration at regional social insurance offices in Västerbotten county in 1990 and 1994 (n=266). Between these years, increased efforts were made by the Swedish government to improve vocational rehabilitation. Data was collected from the register and by means of questionnaires. It was found that employees with musculoskeletal disorders were more likely to return to work during periods of intensive vocational rehabilitation. No increase in the level of return to work was apparent if all disorders were considered. Men showed a higher level of return to work than women, although women were better educated.