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Biomedical subjects

J Ekholm

Publications and source records attributed to J Ekholm.

At least 19 recordsLinked to original sources
PubMed2002

Return to work following vocational rehabilitation for neck, back and shoulder problems: risk factors reviewed.

PURPOSE: The present aim was an overview of factors associated with return to work following vocational rehabilitation for problems in the neck, back, and shoulders. METHOD: Studies were identified through a systematic keyword search in databases. For inclusion, return to work had to be in focus and studies to have been published between 1980 and 2000. RESULTS AND CONCLUSION: A great number of demographic, psychological, social, medical, rehabilitation-related, workplace-related and benefit-system-related factors are associated with return to work. The different types of risk factor are associated in many ways. People with greater chances of job return after vocational rehabilitation are younger, native, highly educated, have a steady job and high income, are married and have stable social networks, are self-confident, happy with life, not depressed, have low level of disease severity and no pain, high work seniority, long working history and an employer that cares and wishes them back to the work place. Unfortunately, people with the above profile are seldom found among the long-term sick.

Back Injuries↗
PubMed2001

Change in pattern of absenteeism as a result of workplace intervention for personnel support.

The aim was to investigate whether a preventive intervention carried out in a predominantly female workplace, that of hospital cleaners (consisting of a group of 97 women), had any effect on patterns of absenteeism. As a background, a model for analysing complex patterns of absenteeism, including sickness absences, was also developed. A further aim was to study the interactions between different forms of absenteeism. Comparison was made with a reference group consisting of employees in the same job category who only received the customary personnel support. For individuals in the intervention group who were < 42 years of age, total absence due to sickness decreased. In a multiple regression analysis, the contribution from the intervention to the decrease was significant at the 5% level. This change was particularly obvious in those who had a previous history of high absence due to sickness. No clear relationship was shown between short-term absenteeism and the interventions applied. For those who were > 42 years, short-term absence decreased for those who had been in the same jobs for a long time. The combination of increased age and experience showed a tendency to enhance this decline in short-term absenteeism due to sickness. For those > 42 years, and who at the same time have a previous history of high absenteeism, long-term absenteeism due to sickness seemed to be increasing. Increased experience tended to reduce this increase in long-term sickness absence. This combination of different effects possibly indicated the presence of a process of selection which determined who remained in the job as opposed to those who did not. An important conclusion is that different forms of absenteeism need to be looked at in parallel, and at the same time multivariate statistical analysis needs to be carried out to determine the different interactions between the factors.

Absenteeism↗
PubMed2001

Seasonal affective disorder and serotonin-related polymorphisms.

Disturbances in central serotonergic systems have been hypothesized to be involved in seasonal affective disorder (SAD). Association between SAD and the shorter allele of the serotonin transporter promoter repeat length polymorphism (5-HTTLPR) has been reported in an American sample. We have genotyped 82 SAD patients and 82 healthy controls from Sweden, Finland, and Germany for this and five other polymorphisms in the genes coding for serotonin receptors 5-HT2A and 5-HT2C, tryptophan hydroxylase and white. No associations with SAD or seasonality (seasonal variations in mood and behavior) were detected. Although minor effects cannot be excluded, our results suggest that these polymorphisms do not play a major role in the pathogenesis of SAD in the northern European population.

ATP Binding Cassette Transporter, Subfamily G, Mem↗
PubMed2001

Factors associated with successful vocational rehabilitation in a Swedish rural area.

The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three time-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.

Adult↗
PubMed2001

Women at work despite ill health: diagnoses and pain before and after personnel support. A prospective study of hospital cleaners/home-help personnel with comparison groups.

The present study sought to elicit the diagnoses behind the pain conditions causing complaints by female hospital cleaners and home-help personnel who were working despite their symptoms. We also wished to describe the prevalence of musculoskeletal diagnoses and the intensity, frequency and location of pain, and changes in the clinical picture and pain after personnel supporting interventions. A prospective study was carried out with intervention groups and non-randomized comparison groups. The hospital cleaners intervention programme comprised occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The home-help programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, comrade massage, purchase of training equipment and stress management. Myalgia/ tendinitis occurred in 61% of shoulder girdle elevators, 18% of rotator cuffs, 16% of dorsal neck muscles and 29% of hip muscles. There was musculoskeletal pain in the lower back in 28% of cases. Referred pain from a musculoskeletal focus occurred in about one-sixth to one-third of individuals with the diagnosis in question. Neurogenic pain occurred in 6% of cases. No fibromyalgia syndrome was found. One-third of individuals felt pain all the time or almost all the time. The mean rated perceived "worst pain" was 70 mm on a visual analogue scale of 1-100 mm. Comparisons between intervention and reference groups indicated that some improvement in the clinical picture can be attained using this kind of general support programme for employees.

Adult↗
PubMed2001

Mobility, muscular strength and endurance in the cervical spine in Swedish Air Force pilots.

PURPOSE: Muscle strength, endurance and range of movement of the cervical spine in a group of Swedish Air Force jet pilots (AF) and in a reference group of conscripts doing their military service (RG) were compared. METHODS: We tested 30 (AF) 24-42 yr and 33 (RG) 19-22 yr. A questionnaire was used to document complaints. Maximum voluntary isometric muscle strength of the flexor and extensor muscles of the cervical spine and sub-maximum isometric endurance in the flexor and extensor muscles were measured. RESULTS: Eleven AF (37%) and four RG (12%) had experienced discomfort in the neck within the previous year. The pilots' flexor and extensor muscle strength (47 Nm and 65 Nm) was superior to that of the conscripts (36 Nm and 59 Nm) (p = 0.0001, p = < 0.05, respectively). However, the RG group had greater isometric endurance in the flexor muscles than AF (p = < 0.05) and greater neck rotation (p = <0.005). There was no difference between the two groups in the other variables. CONCLUSION: Differences between the groups with regard to muscle strength and endurance might depend on variations in work-related physical muscle strain, and/or differences in fiber composition in the muscles, which might be reflected by pilot selection procedures.

Adult↗
PubMed2000

Health-related quality of life in women at work despite ill-health. A prospective, comparative study of hospital cleaners/home-help staff before and after staff support.

The aims of this prospective, non-randomized, comparative study were to elucidate how 99 female hospital cleaners and home-helps, at work despite ill-health, experienced their quality of life, and to study whether this was affected by a particular programme of staff support. The SF-36 questionnaire was used. This contains questions on physical, mental and social health status. Health status, i.e. experienced health, was assessed by the respondents themselves. Low quality of life relating to the dimensions bodily pain, general health perceptions and vitality proved to apply both to the hospital cleaners and the home-help staff, compared to a normal Swedish female population. No significant differences between the intervention group and the reference group were demonstrated among either the cleaners or the home-helps. Following the intervention/period of customary measures, experienced quality of life was somewhat changed in the groups compared with the normal Swedish female population. This may indicate a certain unspecific improvement in experienced quality of life in both the intervention groups and the reference groups.

Adult↗
PubMed1999

Relationship of pain drawings to invasive tests assessing intervertebral disc pathology.

It has been found that the pain patterns in pain drawings are related to the presence of herniated disc identified by myelography. The purpose of this study was to determine whether the pattern of pain in the drawings or the type of pain indicated (aching, burning, numbness, pins and needles, stabbing) was related to the presence of symptomatic disc pathology identified by CT/discography. In a subgroup of patients who underwent myelography, the relationship of the drawings to myelographic findings was also investigated. Pain drawings were completed by 187 patients with low back and/or radicular pain who were undergoing CT/discography. The drawings were scored in two ways, first by the system described by Ransford and secondly by visual inspection. They were classified as being indicative, or not, of disc pathology. The CT/discograms were classified as disrupted, or not, and the pain responses were recorded upon injection of each disc, based on the similarity of the pain provoked to clinical symptoms. Among the 133 patients with discogenic pain confirmed by discography, 110 (82.7%) had pain drawings that were classified as indicative. Among the 45 patients without discogenic pain, 29 (64.4%) had pain drawings classified as non-indicative. Patients with discogenic pain used more symbols indicating burning pain and aching pain than did non-discogenic pain patients. Our results confirmed those reported earlier by Uden, who found a relationship between the pattern of pain in the drawings and myelographic findings. Pain drawings may be helpful in the diagnosis of symptomatic disc pathology.

Adult↗
PubMed1999

Pressure pain thresholds in different tissues in one body region. The influence of skin sensitivity in pressure algometry.

This study aimed at determining whether there are differences in pressure pain sensitivity in different tissues in the same body region when systematically assessed, before and after skin hypoesthesia. Pressure pain thresholds (PPTs) were assessed bilaterally in 15 healthy females at the bony part of the epicondylus lateralis humeri, at the belly of m. extensor carpi ulnaris and at m. brachioradialis where the superficial radial nerve branches pass underneath ("muscle/nerve" site). Following a double blind design, a local anaesthetic cream (EMLA) or a control cream was applied to the skin and PPTs were reassessed. The PPT was significantly (p < 0.001) lower at the "muscle/nerve" site than at the bony and "pure" muscle sites. The PPTs over the bony and "pure" muscle sites did not differ. There was no significant difference when PPTs were compared before and after application of EMLA cream. However, PPTs after control cream were lower (p < 0.001) over all examined areas than those obtained prior to cream application. Thus, EMLA cream increased PPTs compared to control sites in all examined areas (p < 0.001). Under the given circumstances, skin pressure pain sensitivity was demonstrated to influence the PPT.

Adult↗
PubMed1999

The effect of vocational rehabilitation on later sick leave.

PURPOSE: The aim of this study was to examine the effect of vocational rehabilitation on later sick leave for employed and unemployed people on long-term sick leave. METHOD: The study was based on long-term sick-leave cases initiated during 1992-1994 in Stockholm, Sweden. Of 1704 cases, 383 (321 employed and 62 unemployed) underwent vocational rehabilitation. These were individually matched with sick-leave cases not undergoing rehabilitation, using the variables age, sex, diagnoses and employment status. RESULTS: The hypotheses were (1) that people who underwent rehabilitation, both employed and unemployed, would have less later sick leave than those who did not, and (2) that rehabilitation would affect employed people more than unemployed people. These hypotheses were only partly supported. CONCLUSIONS: The results indicate that vocational rehabilitation has a positive effect regarding later sick leave only for unemployed men. For unemployed women the effect is negative and for those employed, both men and women, rehabilitation has no demonstrable effect.

Adult↗
PubMed1999

Relation between pain location and disc pathology: a study of pain drawings and CT/discography.

OBJECTIVE: The purpose of this study was to determine whether pain location indicated in pain drawings was related to the specific lumbar disc level(s) that was abnormal in appearance and painful upon discographic injection. DESIGN: Data were collected prospectively. SETTING: This study was conducted in a spine specialty clinic. PATIENTS: The study group consisted of 187 patients (118 men, 69 women; mean age = 37.2 years, range = 18-62 years) with low back pain with or without leg pain. All patients were undergoing computed tomography (CT)/discography at the three lowest lumbar levels for diagnostic purposes. INTERVENTIONS: Pain drawings were completed the day of but prior to undergoing discography. Discographic pain responses were recorded with respect to the similarity to the patient's clinical symptoms. Pain drawings were classified based on the presence or absence of pain in five areas: low back and/or buttocks, posterior thigh, posterior leg, anterior thigh, and anterior leg. The drawings were scored with the system described by Ransford et al. (1976, Spine 1: 127-34), and those likely to be indicative of psychological problems were analyzed separately (n = 43). OUTCOME MEASURES: Results were determined by analyzing the relation between the location of pain in the drawings and the specific lumbar disc level(s) found to be painful and disrupted by discography. RESULTS: There was a significant relation between pain location indicated in the drawing and the lumbar disc level(s) identified as clinically painful and disrupted by CT/discography (p < 0.05, chi-square). Pain limited to the low back and buttocks was frequently associated with the absence of disc pathology (58.3%). When pain in the posterior thigh or leg was present but there was no pain in the anterior drawing, patients frequently had a positive L5-S 1 disc (> or =75%). In patients with anterior thigh pain, with or without posterior thigh or leg pain, the L4-5 disc was frequently symptomatic (>63%). The pattern of no posterior thigh or leg pain but with pain radiating into the leg anteriorly was most commonly associated with the L3-4 disc (71.4%). CONCLUSIONS: The results of this study indicate that pain drawings may be helpful in identifying which specific discs are associated with pain complaints. As with any evaluation, the drawings should be considered in combination with findings from other assessments.

Adolescent↗
PubMed1999

Vocational rehabilitation--early versus delayed. The effect of early vocational rehabilitation compared to delayed vocational rehabilitation among employed and unemployed, long-term sick-listed people.

The aim of the present study was to examine whether the wait before vocational rehabilitation affected the outcome for employed and unemployed, long-term sick-listed people. The study is based on sick-leave cases 90 days or longer, which started during 1992-1994 in a rural area in Sweden. The study included all sick-leavers with non-malignant musculoskeletal diagnoses from the neck, shoulder and back regions and who had undergone vocational rehabilitation. Of these, 391 were employed and 78 unemployed. Our hypothesis was that those who undergo early vocational rehabilitation, irrespective of employment status, often get well sooner, have fewer sick days and lower benefit levels after vocational rehabilitation than those who have to wait a long time for their rehabilitation. Our hypothesis was supported only regarding the employed who mainly reported well at 6 and 12 months after vocational rehabilitation. In the longer term (24 months) the effect was however no longer evident. Earlier studies indicate that more factors than an early start to rehabilitation are important for a successful outcome. A more important factor is probably that the right measures have been initiated at the right time, that the measures are of high quality and that the sick-leaver is mentally prepared for the measure. Although early vocational rehabilitation did not prove to be a determining factor for a successful outcome there is still reason to emphasize early involvement in the case to guarantee rehabilitation of high quality.

Absenteeism↗
PubMed1998

Properties of person hoist spreader bars and their influence on sitting/lifting position.

The purpose of this study is to analyse mechanical lifts with regard to how the spreader bar design, e.g. frontal length, height and sagittal depth, affects sitting positions and safety during lift and transfer. The seven spreader bars available on the Swedish market had two-point to four-point suspensions. Twelve subjects were photographed individually sitting in each of three types of sling: divided, one-piece with divided leg support, and one-piece. All the slings had significant effects on all specific sitting aspects. However, the spreader bar design only affected the sitting position in the hoist. A long (0.62 m) spreader bar gave a relatively upright sitting position. A deep (0.18 m) spreader bar gave a backward inclination. For all specific sitting aspects, there was a significant interaction between slings and spreader bars. This study demonstrates that the design of the spreader bar, as well as that of the sling, is of decisive importance for the sitting position during lifting.

Biomechanical Phenomena↗
PubMed1998

The process of vocational rehabilitation for employed and unemployed people on sick-leave: employed people vs unemployed people in Stockholm compared with circumstances in rural Jämtland, Sweden.

The likelihood that a period of sick-leave will result in a temporary disability pension is about three times greater for unemployed people than for those with jobs. The aim of this study was 1) to compare the vocational rehabilitation of the employed with the rehabilitation of the unemployed in the city of Stockholm and 2) to compare the results with previous results from rural Jämtland. The study was based on 156 matched cases on long-term sick-leave (90 days or more) initiated during 1992 and 1993. Two inclusion criteria were that the diagnoses should indicate low-back pain or problems in the neck/shoulders, and that the patients should be below 58 years of age. Our hypothesis was that the unemployed were disregarded in vocational rehabilitation. The results confirm this in that rehabilitation plans are not established to the same extent for the unemployed as for the employed. Against our hypothesis, however, no difference exists in rehabilitation impulse, rehabilitation investigation or rehabilitation measures received. The major finding of the study is, instead, that rehabilitation in general seems beset with problems. Rehabilitation activities seem far too few and initiated unnecessarily late. Neither the employers nor the social insurance offices seem to be fulfilling their statutory duties. The results of the study correspond well with the results previously found in rural Jämtland.

Adult↗
PubMed1998

Vocational rehabilitation and future sick-leave.

The aim of the present pretest-posttest study was to examine and compare the impact of vocational rehabilitation on future sick-leave for employed and unemployed people, respectively, on long-term sick-leave. The study is based on 416 registered long-term sick-leave cases that were initiated during 1992-94 in the city of Stockholm, and that became objects for vocational rehabilitation. The hypotheses were (1) that the number of sick-days and levels of benefit for both employed and unemployed would be less after rehabilitation than before and (2) that rehabilitation would affect employed people more than unemployed people. The hypotheses are supported in that both employed and unemployed have less sick-days and lower levels of benefits after vocational rehabilitation than before and that unemployed people have more sick-days and higher levels of benefits than employed people after rehabilitation. However, since unemployed people also have more sick-days before rehabilitation, the proportional decrease is about the same. Another finding was that men, especially among the unemployed improved more than women.

Adult↗
PubMed1997

Degree of disc disruption and lower extremity pain.

STUDY DESIGN: Data were collected prospectively from patient-completed pain drawings, lumbar discographic pain responses, and computed tomographic-discographic images. OBJECTIVES: To determine if there were differences in pain location or the type of pain associated with the severity of symptomatic disc disruption. SUMMARY OF BACKGROUND DATA: Lower extremity pain related to spinal pathology was for a long time attributed primarily to nerve root compression. However, this simple model could not explain all lower extremity pain. Other mechanisms such as biochemical agents have been implicated. Also, nerve endings have been found in the outer layers of the anulus. Such endings could be associated with pain referred from the disc into the lower extremities. Pain drawings have been used in several studies to investigate various back pain origins and provide an easily administered method to document pain location. METHODS: Pain drawings were completed by 187 patients undergoing discography at the three lowest levels. The study group consisted of 118 men and 69 women with an average age of 37.2 years (range, 18-62 years). Computed tomographic discograms were scored using the Dallas discogram description, which assigns separate scores for discs with disruption of outer anular fibers (Grade 2) and those with disruption of the outermost anular layers associated with deformation or herniation of the outer anular well (Grade 3). The pain response provoked with each disc injection was recorded as pressure only or painless, pain dissimilar to clinical symptoms, similar to symptoms, or the exact reproduction of clinical pain, in this study, the similar and exact reproduction responses were combined and considered to be "symptomatic." The drawings were classified based on the presence or absence of pain in three regions: low back or buttocks, thigh, and leg. The drawings were also scored using the system described by Ransford, and those that were likely to be indicative of psychological problems were analyzed separately (N = 43). RESULTS: There was no significant difference in the distal location of lower extremity pain among patients whose most severe symptomatic disc disruption was a Grade 2 compared with those with symptomatic Grade 3 disruption (62.2% vs. 61.7%; P > 0.75; chi-square). The figure was similar for patients with both symptomatic Grade 2 and 3 disruption (72.7%). However, patients with symptomatic Grade 2 disruption used significantly more symbols to describe their pain, and in particular aching pain, than did those with symptomatic Grade 3 disruption. CONCLUSIONS: These results indicate that disc disruption passing into the outer layers of the anulus, but not resulting in deformation of the outer anular wall, was as frequently associated with lower extremity pain as were discs with more severe disruption deforming the outer anular wall; however, they were associated with a greater degree of aching pain. These findings support that lower extremity pain may be referred from the disc.

Adolescent↗
PubMed1997

The unemployed sick-listed and their vocational rehabilitation.

The unemployed on long-term sick-leave are many and difficult to rehabilitate. The likelihood that a period of sick leave will result in a temporary disability pension is about three times greater for the unemployed than for those with jobs. The aim of this current study was to examine the vocational rehabilitation process of the unemployed on long-term sick-leave. The study was based on 118 matched cases on long-term sick-leave, 59 employed and 59 unemployed. Data were collected at seven social insurance offices in rural areas of Jämtland, Sweden. Our hypothesis was that the unemployed were disregarded in vocational rehabilitation. The results partly confirm this. Unemployed people's potential need for rehabilitation is not investigated to the same extent as employed people's. Also the unemployed have to wait longer for an investigation. Against our hypothesis, however, no difference exists between the employed and the unemployed in rehabilitation impulse, rehabilitation plan or rehabilitation allowance. Nor do the unemployed, except for those awaiting investigation, wait longer than the employed. The major result of the study is, instead, that vocational rehabilitation in general, regardless of employment status, seems beset with problems. Rehabilitation activities seem far too few and initiated unnecessarily late. Neither the employer nor the social insurance office seem to be fulfilling their statutory duties.

Absenteeism↗