Abstract: AIM AND OBJECTIVES: The aim of this study was to identify risk factors for falls in older people living in nursing homes. BACKGROUND: Impaired cognitive function and a poor sense of orientation could lead to an increase in falls among those with impaired freedom of movement. Many accidents occur while an older person is walking or being moved. METHOD: The study was carried out over four years (2000-2003) and 21 nursing home units in five municipal homes for older people in Stockholm, Sweden, participated. A questionnaire was sent to staff nurses, including questions on fall risk assessments, falls, fractures, medication and freedom-restricting measures, such as wheelchairs with belts and bed rails. The data were aggregated and not patient-bound. The study covered 2,343 reported incidents. RESULTS: There was a significant correlation between falls and fractures (r = 0.365, p = 0.004), fall risk and use of wheelchairs (r = 0.406, p = 0.001, safety belts (r = 0.403, p = 0.001 and bed rails (r = 0.446, p = 0.000) and between the occurrence of fractures and the use of sleeping pills with benzodiazepines (r = 0.352, p = 0.005). Associations were also found between fall risk and the use of anti-depressants (r = 0.412, p = 0.001). CONCLUSION: In clinical practice, patient safety is very important. Preventative measures should focus on risk factors associated with individuals, including their environment. Wheelchairs with safety belts and bed rails did not eliminate falls but our results support the hypothesis that they might be protective when used selectively with less anti-depressants and sleeping pills, especially benzodiazepines.

Abstract: BACKGROUND: The number of Swedish women who are long-term sick-listed is high, and twice as high as for men. Also the periods of sickness absence have on average been longer for women than for men. The objective of this study was to investigate the associations between factors in work- and family life and long-term sick-listing in Swedish women. METHODS: This case-control study included 283 women on long-term sick-listing > or =90 days, and 250 female referents, randomly chosen, living in five counties in Sweden. Bivariate and multivariate logistic regression analyses with odds ratios were calculated to estimate the associations between long-term sick-listing and factors related to occupational work and family life. RESULTS: Long-term sick-listing in women is associated with self-reported lack of competence for work tasks (OR 2.42 1.23-11.21 log reg), workplace dissatisfaction (OR 1.89 1.14-6.62 log reg), physical workload above capacity (1.78 1.50-5.94), too high mental strain in work tasks (1.61 1.08-5.01 log reg), number of employers during work life (OR 1.39 1.35-4.03 log reg), earlier part-time work (OR 1.39 1.18-4.03 log reg), and lack of influence on working hours (OR 1.35 1.47-3.86 log reg). A younger age at first child, number of children, and main responsibility for own children was also found to be associated with long-term sick-listing. Almost all of the sick-listed women (93%) wanted to return to working life, and 54% reported they could work immediately if adjustments at work or part-time work were possible. CONCLUSION: Factors in work and in family life could be important to consider to prevent women from being long-term sick-listed and promote their opportunities to remain in working life. Measures ought to be taken to improve their mobility in work life and control over decisions and actions regarding theirs lives.

Abstract: OBJECTIVES: This study investigated the effect of lifelong physical load from work on the development of knee osteoarthrosis (OA) leading to prosthetic surgery among men and women. METHODS: In a population-based case-referent study, men and women (N=625) who had had prosthetic surgery due to primary tibiofemoral OA were compared with referents (N=548) as to job titles and exposure to physical load in occupational work, housework, and leisure-time activities from 15 to 50 years of age. RESULTS: Male forestry and construction workers, and both male and female farmers ran the highest risk of knee OA. The men had considerably higher exposure to lifting at work, and also to jumps and vibration, than the women. Among the men there was an association between lifting at work [odds ratio (OR) 3.0, 95% confidence interval (95% CI) 1.6-5.5], squatting or knee bending (OR 2.9, 95% CI 1.7-4.9), kneeling (OR 2.1, 95% CI 1.4-3.3), and jumping (OR 2.7, 95% CI 1.7-4.1) with knee OA. Exposure to physically demanding tasks at home, such as taking care of an elderly or handicapped person, was associated with knee OA among the women (OR 2.2, 95% CI 1.3-3.6). CONCLUSIONS: Working as a farmer or as a construction worker could be associated with the development of knee OA and lead to prosthetic surgery. Men and women differ in the quality and quantity of reported physical load and also in the strength of the risk estimates. A reduction of high physical load at work and at home could probably lower the risk of knee OA later in life.

Abstract: OBJECTIVES: To investigate the prevalence of musculoskeletal disorders, especially symptomatic osteoarthrosis (OA) of the knee and hip, health and lifestyle factors among physical education (PE) teachers, and whether they differed from the general population in these respects. METHODS: The study base was all Swedish men (n=290) and women (n=281) who graduated from the only training college for PE teachers in Sweden, between the years 1957 and 1965, and age matched referents, 255 men and 257 women, randomly selected from the Swedish population register. A postal questionnaire was sent to the subjects with questions on occupational history, participation in sports, musculoskeletal disorders, height, weight, smoking habits, and general health. RESULTS: The PE teachers had a higher prevalence ratio (PR) of symptomatic OA of the knee (men: 2.8 95% confidence interval (95% CI) 1.6 to 4.8; women: 3.2 95% CI 1.8 to 5.5) and knee injury compared with the referents. The PE teachers reported more absence from work, and the women had had to change jobs more often because of knee disorders. The prevalence ratio for symptomatic OA of the hip was 2.7 (95% CI 1.0 to 7.1) for the female PE teachers. At the age of 25 the body mass index (BMI) of male PE teachers was higher than the male referents, but at an older age both the female and male PE teachers had lower BMI than the referents. The participation in sports activities was considerably higher in the group of PE teachers. They also smoked less, reported less serious diseases, and better health than the referents. CONCLUSIONS: The PE teachers had a high risk of developing knee disorders, which entailed difficulties in continuing their work as PE teachers. They differed from the referents in lifestyle factors as they smoked less, were less overweight, and had a higher lifelong sports exposure.

Abstract: OBJECTIVES: The aim was to examine the relation between osteoarthrosis of the knee leading to prosthetic surgery among men and women and overweight, smoking, and hormone therapy. METHODS: A case-referent study was performed with a study base of all men and women, born 1921-1938, living in 14 counties in Sweden during 1991-95. The cases (n = 625) were identified through the Swedish Knee Arthroplasty Register. The referents (n = 548) were randomly selected through the central population register from the same counties. Detailed information on general health status, height, weight, smoking habits, medication, use of hormones, specific physical loads from occupation and housework, and sports activities was collected by a telephone interview and a postal questionnaire. The cases were classified in terms of high, medium or low/non-exposure to the factors studied, according to the distribution of variables among the referents. RESULTS: Women with high body mass index (BMI) at the age of 40 had a relative risk of 9.2 (95% CI 5.3, 16.0) of developing severe knee osteoarthrosis later in life, and for men at the same age the relative risk was 3.9 (95% CI 2.3, 6.4). Smokers were less likely to develop severe knee osteoarthrosis compared with nonsmokers. Oestrogen therapy for women over 50 showed an increased relative risk of 1.8 (95% CI 1.2, 2.6), while use of oral contraceptives did not influence the risk. CONCLUSION: Overweight is a risk factor for knee osteoarthrosis leading to prosthetic surgery in men and women, with the strongest relation for women. Oestrogen therapy after 50 increased the relative risk, while smoking decreased it.

Abstract: The relationship between sports activities and knee osteoarthrosis (OA) in the general population was investigated. Men (n=325) and women (n-=300) who underwent prosthetic surgery due to primary tibio-femoral OA were compared with referents (264 men and 284 women) regarding life-long sports exposure. The relative risk of severe knee OA among men aged between 55 and 65 years who were highly exposed to all kinds of sports was 2.9 (95% CI 1.3-6.5). For sports such as cross-country skiing, soccer and ice hockey/bandy, the relative risk was higher for those men who had been exposed. The women had only been active in sports to a limited extent, and no increased relative risk was found. Moderate daily general physical activity was not found to be a risk factor.

Abstract: The main objective was to measure and quantify exposure to physical work load in physical education teachers. A further aim was to establish the reproducibility of a three-week test-retest interval of self-reported physical load and to evaluate the agreement between registered and self-rated physical load. Thirty teachers, both female and male, volunteered to participate in the study. The physical load on the lower extremities, as well as the back and the cardio-vascular strain was recorded during one working day. The results indicate that the physical work load in this occupational group is considerable due to the load on the lower extremities. The demands of the cardio-vascular system are also relatively high in comparison to other occupational groups. The teachers could assess their activity quite well regarding heavy lifting and time spent sitting.

Abstract: We studied the influence of elite track and field activities on the musculoskeletal system in a cohort of 114 Swedish men 50-80 years of age compared to 355 randomly selected referents in the same age group. Arthrosis of the hip was increased more than threefold among the athletes (8 percent) compared to the referents (2 percent). For other musculoskeletal disorders the distribution was similar between the groups but the prevalence of arthrosis of the knee tended to increase while that of neck/shoulder disorders tended to decrease in the athlete group.

Abstract: The purpose of the present study was to assess five manual tests for pain provocation of the neck to determine their suitability for epidemiological investigations. To 75 randomly selected men, five manual pain-provoking tests were applied in a single-blind design. Prevalence of reported neck dysfunction, sensitivity, specificity, and positive and negative predicted value for each test were calculated. 22 of the 75 reported present neck pain, while the remainder reported freedom from neck pain for at least one year. Palpation over the facet joints in the cervical spine was found to be the most appropriate screening test to corroborate the replies in self-reported questionnaires on dysfunctions of the neck. The outcome of this test was quite consistent with the reported neck pain. The test of the formina intervertebralia and the upper limb tension test caused pain in almost all subjects with reported neck dysfunctions, though not causing referred pain in the arm as an indication of neurogenous tissue origin, as it was aimed to. Neither the neck rotation test nor the active flexion/extension test was sufficiently provocative to confirm the reported neck pain in these subjects, as both were insufficiently sensitive.

Abstract: The aim of the study was to develop a pain measurement instrument in Swedish intended for use in epidemiological surveys, and to report the pain assessments of individuals in a working population. The focus was on somato-sensory description in relation to work performance. The material comprised 22 randomly selected electricians attending health checkups, and reporting neck pain during the past week. The pain estimations were made in oral interviews using a specially developed questionnaire. Neck extension and hands above shoulder height caused increased neck pain in all the subjects. The quantitative assessments of present pain showed a limited intensity. To describe the pain quality a wide spectrum of words was used as pain descriptors, but five adjectives were preferred. The more the pain was spread on the pain drawing, the more differentiated was the assessment of its quality. The results concluded that the pain assessment instrument might be useful in epidemiological investigations of musculoskeletal neck dysfunctions.