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Lemming, D., Börsbo, B., Sjörs, A., Lind, E.-B., Arendt-Nielsen, L., Graven-Nielsen, T. & Gerdle, B. (2017). Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects. Pain medicine (Malden, Mass.), 18(8), 1573-1581
Open this publication in new window or tab >>Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects
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2017 (English)In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 18, no 8, p. 1573-1581Article in journal (Refereed) Published
Abstract [en]

Purpose. The aim of this study was to evaluate pressure pain sensitivity on leg and arm in 98 healthy persons (50 women) using cuff algometry. Furthermore, associations with sex and physical activity level were investigated.

Method. Normal physical activity level was defined as Godin Leisure-Time Exercise Questionnaire (GLTEQ) score ≤ 45 and high activity level as GLTEQ > 45. A pneumatic double-chamber cuff was placed around the arm or leg where a single chamber was inflated. The cuff inflation rate (1 kPa/s) was constant, and pain intensity was registered continuously on a 10 cm electronic visual analogue scale (VAS). The pain detection threshold (PDT) was defined as when the pressure was perceived as painful, and pain tolerance (PTT) was when the subject terminated the cuff inflation. For PTT, the corresponding VAS score was recorded (VAS-PTT). The protocol was repeated with two chambers inflated.

Result. Only single cuff results are given. For women compared with men, the PDT was lower when assessed in the arm (P = 0.002), PTTs were lower in the arm and leg (P < 0.001), and the VAS-PTT was higher in the arm and leg (P < 0.033). Highly active participants compared with less active had higher PDT (P = 0.027) in the leg. Women showed facilitated spatial summation (P < 0.014) in the arm and leg and a steeper VAS slope (i.e., the slope of the VAS pressure curve between PDT and PPT) in the arm and leg (P < 0.003).

Conclusion. This study indicates that reduced pressure pain sensitivity is associated both with male sex and physical activity level.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2017
Keywords
Experimental Pain, Pain Assessment, Cuff Pressure Sensitivity, Physical Activity, Sex, Gender
National Category
Physiotherapy Sport and Fitness Sciences Occupational Health and Environmental Health
Identifiers
urn:nbn:se:liu:diva-140496 (URN)10.1093/pm/pnw309 (DOI)000409845200018 ()
Note

Funding agencies: Swedish Research Council [K2011-69X-21874-01-6]; FORTE The Swedish Research Council for Health, Working life and Welfare [2010-0913]

Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2018-04-16Bibliographically approved
Sjörs Dahlman, A. & Jonsdottir, I. H. (2015). NO ALTERATIONS IN DIURNAL CORTISOL PROFILES BEFORE AND DURING THE TREATMENT IN PATIENTS WITH STRESS-RELATED EXHAUSTION. International Journal of Occupational Medicine and Environmental Health, 28(1), 120-129
Open this publication in new window or tab >>NO ALTERATIONS IN DIURNAL CORTISOL PROFILES BEFORE AND DURING THE TREATMENT IN PATIENTS WITH STRESS-RELATED EXHAUSTION
2015 (English)In: International Journal of Occupational Medicine and Environmental Health, ISSN 1232-1087, E-ISSN 1896-494X, Vol. 28, no 1, p. 120-129Article in journal (Refereed) Published
Abstract [en]

Objectives: Several theories have emerged in recent years suggesting that neuroendocrinological alterations, mainly changes in cortisol, could be of importance with respect to the link between chronic stress and disease. This study investigated possible deviations in the diurnal cortisol profiles of patients with clinically diagnosed stress-related exhaustion (exhaustion disorder - ED) compared with healthy controls. Material and Methods: Salivary cortisol samples taken at home in the morning directly after waking up, 30 min later, and in the evening were compared between ED patients (N = 122; 25% men) and healthy controls (N = 98; 44% men). Follow-up measurements were performed after 6 months (79 patients) and 12 months (68 patients) of the treatment. Results: There were no clear differences in diurnal salivary cortisol profiles between the patients and healthy controls. Moreover, salivary cortisol levels and diurnal profiles did not change significantly during the treatment in the patient group. There was some indication of a smaller cortisol awakening response in the male patients compared to the male controls, but the difference appeared to be mainly related to the antidepressant use. Conclusions: Diurnal salivary cortisol profiles, at least as measured in this study, give a rather poor reflection of the prolonged stress exposure experienced by patients with ED. Such basal salivary cortisol measurements do not seem suitable as biomarkers for stress-related conditions such as ED or burnout, or as an aid to assess the effects of prolonged stress load in a routine clinical practice.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH, 2015
Keywords
Burnout; Follow-up; Hypothalamus-pitutiary-adrenal axis; Longitudinal study; Salivary cortisol
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-117263 (URN)10.13075/ijomeh.1896.00208 (DOI)000351491600014 ()
Available from: 2015-04-22 Created: 2015-04-21 Last updated: 2017-12-04
Lemming, D., Börsbo, B., Sjörs, A., Lind, E.-B., Arendt-Nielsen, L., Graven-Nielsen, T. & Gerdle, B. (2015). Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects. PLoS ONE, 10(5), Article ID e0125432.
Open this publication in new window or tab >>Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0125432Article in journal (Refereed) Published
Abstract [en]

Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation.

Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). 

Besides the well-known gender difference in pressure pain sensitivity this study demonstrates  that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people.

Place, publisher, year, edition, pages
Public Library of Science, 2015
Keywords
Pain assessment, Cuff algometry, Tonic muscle pressure sensitivity, Experimental pain
National Category
Public Health, Global Health, Social Medicine and Epidemiology Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-131422 (URN)10.1371/journal.pone.0125432 (DOI)000353887100112 ()25933412 (PubMedID)
Note

Research data for the above article to be published in Plos One.

Available from: 2014-11-04 Created: 2014-11-04 Last updated: 2017-12-05Bibliographically approved
Sjörs, A., Ljung, T. & Jonsdottir, I. (2014). Diurnal salivary cortisol in relation to perceived stress at home and at work in healthy men and women. Biological Psychology, 99, 193-197
Open this publication in new window or tab >>Diurnal salivary cortisol in relation to perceived stress at home and at work in healthy men and women
2014 (English)In: Biological Psychology, ISSN 0301-0511, E-ISSN 1873-6246, Vol. 99, p. 193-197Article in journal (Refereed) Published
Abstract [en]

This study investigated the association between diurnal salivary cortisol profile and perceived stress at work and at home. Healthy participants (N = 180, 52% women) collected saliva cortisol samples immediately after waking up, 15 min later, 30 min later, and at 9:00, 12:00, 15:00, 18:00 and 21:00. The area under the cortisol awakening curve with respect to ground (AUCgCAR) and increase (AUCiCAR), and diurnal slope between 9:00 and 21:00 were analyzed. Perceived stress at work and at home was measured with the Stress-Energy Questionnaire. Participants reporting stress at home had significantly lower AUCgCAR and a flatter diurnal slope. When performing separate analyses for men and women, this association was only significant among women. Perceived stress at work was not associated with any cortisol measure. This study highlights the importance of stress outside the workplace. The sex differences may indicate an increased vulnerability to non-work stress in women.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
HPA axis; Awakening cortisol response; Circadian rhythm; Psychosocial stress; Job stress
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-107450 (URN)10.1016/j.biopsycho.2014.04.002 (DOI)000335928700020 ()24746849 (PubMedID)
Available from: 2014-06-12 Created: 2014-06-12 Last updated: 2017-12-05Bibliographically approved
Palstam, A., Larsson, A., Bjersing, J., Lofgren, M., Ernberg, M., Bileviciute-Ljungar, L., . . . Mannerkorpi, K. (2014). PERCEIVED EXERTION AT WORK IN WOMEN WITH FIBROMYALGIA: EXPLANATORY FACTORS AND COMPARISON WITH HEALTHY WOMEN. Journal of Rehabilitation Medicine, 46(8), 773-780
Open this publication in new window or tab >>PERCEIVED EXERTION AT WORK IN WOMEN WITH FIBROMYALGIA: EXPLANATORY FACTORS AND COMPARISON WITH HEALTHY WOMEN
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2014 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 8, p. 773-780Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate perceived exertion at work in women with fibromyalgia. Design: A controlled cross-sectional multi-centre study. Subjects and methods: Seventy-three women with fibromyalgia and 73 healthy women matched by occupation and physical workload were compared in terms of perceived exertion at work (0-14), muscle strength, 6-min walk test, symptoms rated by Fibromyalgia Impact Questionnaire (FIQ), work status (25-100%), fear avoidance work beliefs (0-42), physical activity at work (7-21) and physical workload (1-5). Spearmans correlation coefficient and linear regression analysis were conducted. Results: Perceived exertion at work was significantly higher in the fibromyalgia group than in the reference group (p=0.002), while physical activity at work did not differ between the groups. Physical capacity was lower and symptom severity higher in fibromyalgia compared with references (pless than0.05). In fibromyalgia, perceived exertion at work showed moderate correlation with physical activity at work, physical workload and fear avoidance work beliefs (r(s) = 0.53 0.65, pless than0.001) and a fair correlation with anxiety (r(s) = 0.26, p=0.027). Regression analysis indicated that the physical activity at work and fear avoidance work beliefs explained 50% of the perceived exertion at work. Conclusion: Women with fibromyalgia perceive an elevated exertion at work, which is associated with physical work-related factors and factors related to fear and anxiety.

Place, publisher, year, edition, pages
Foundation for Rehabilitation Information, 2014
Keywords
work ability; fibromyalgia; tender points; chronic pain; physical capacity; physical workload
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-111457 (URN)10.2340/16501977-1843 (DOI)000342037500008 ()25074026 (PubMedID)
Note

Funding Agencies|Swedish Rheumatism Association; Swedish Research Council; Health and Medical Care Executive Board of Vastra Gotaland Region; ALF-LUA at Sahlgrenska University Hospital

Available from: 2014-10-21 Created: 2014-10-17 Last updated: 2018-01-11
Hadrevi, J., Ghafouri, B., Sjörs, A., Antti, H., Larsson, B., Crenshaw, A. G., . . . Hellstrom, F. (2013). Comparative metabolomics of muscle interstitium fluid in human trapezius myalgia: an in vivo microdialysis study. European Journal of Applied Physiology, 113(12), 2977-2989
Open this publication in new window or tab >>Comparative metabolomics of muscle interstitium fluid in human trapezius myalgia: an in vivo microdialysis study
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2013 (English)In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 113, no 12, p. 2977-2989Article in journal (Refereed) Published
Abstract [en]

The mechanisms behind trapezius myalgia are unclear. Many hypotheses have been presented suggesting an altered metabolism in the muscle. Here, muscle microdialysate from healthy and myalgic muscle is analysed using metabolomics. Metabolomics analyse a vast number of metabolites, enabling a comprehensive explorative screening of the cellular processes in the muscle. less thanbrgreater than less thanbrgreater thanMicrodialysate samples were obtained from the shoulder muscle of healthy and myalgic subjects that performed a work and stress test. Samples from the baseline period and from the recovery period were analysed using gas chromatography-mass spectrometry (GC-MS) together with multivariate analysis to detect differences in extracellular content of metabolites between groups. Systematic differences in metabolites between groups were identified using multivariate analysis and orthogonal partial least square discriminate analysis (OPLS-DA). A complementary Mann-Whitney U test of group difference in individual metabolites was also performed. less thanbrgreater than less thanbrgreater thanA large number of metabolites were detected and identified in this screening study. At baseline, no systematic differences between groups were observed according to the OPLS-DA. However, two metabolites, l-leucine and pyroglutamic acid, were significantly more abundant in the myalgic muscle compared to the healthy muscle. In the recovery period, systematic difference in metabolites between the groups was observed according to the OPLS-DA. The groups differed in amino acids, fatty acids and carbohydrates. Myristic acid and putrescine were significantly more abundant and beta-d-glucopyranose was significantly less abundant in the myalgic muscle. less thanbrgreater than less thanbrgreater thanThis study provides important information regarding the metabolite content, thereby presenting new clues regarding the pathophysiology of the myalgic muscle.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2013
Keywords
Metabolomics, Trapezius myalgia, Microdialysis, Repetitive work, Recovery, GC-MS, Metabolites
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102492 (URN)10.1007/s00421-013-2716-6 (DOI)000327087000009 ()
Note

Funding Agencies|Swedish Research Council|K2011-69X-21874-01-6|Swedish Council for Working life and Social research|2009-17612010-0913|

Available from: 2013-12-13 Created: 2013-12-12 Last updated: 2017-12-06
Sjörs, A., Jansson, P.-A., Eriksson, J. W. & Jonsdottir, I. H. (2013). Increased insulin secretion and decreased glucose concentrations, but not allostatic load, are associated with stress-related exhaustion in a clinical patient population. Stress, 16(1), 24-33
Open this publication in new window or tab >>Increased insulin secretion and decreased glucose concentrations, but not allostatic load, are associated with stress-related exhaustion in a clinical patient population
2013 (English)In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 16, no 1, p. 24-33Article in journal (Refereed) Published
Abstract [en]

Allostatic load (AL) has been shown to be a useful marker of physiological strain during chronic stress and burnout in non-clinical working populations. The usability of the AL index for a clinical population with severe stress-related exhaustion was tested in this study. Thirteen biomarkers assembled as an AL index were analysed using blood samples from 90 patients with stress-related exhaustion (43 men and 47 women, age 31-61 years) and 90 healthy controls (46 men and 44 women, age 25-56 years). The AL scores did not differ between patients and controls. For men, some indication of higher cardiovascular risk was seen in the patient group: male patients had higher body mass index and waist-hip ratio and a poorer blood lipid status than male controls. We found lower plasma glucose concentrations in both female and male patients than those in controls. The male patients also showed increased fasting serum insulin concentrations. Further analysis using homeostasis model assessment for insulin resistance and beta-cell function showed indications of insulin resistance in the patient group, particularly in the males, and an increased insulin secretion in both male and female patients. In conclusion, AL index does not seem to capture plausible physiological strain in patients diagnosed with stress-related exhaustion. The finding of lower plasma glucose concentrations, probably due to higher insulin secretion, in patients with severe stress-related exhaustion, needs to be further investigated, including mechanisms and the clinical relevance.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
Allostatic load, beta-cell function, burnout, glucose, insulin resistance, stress-related exhaustion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87239 (URN)10.3109/10253890.2012.688082 (DOI)000312225400004 ()
Note

Funding Agencies|Swedish government||

Available from: 2013-01-14 Created: 2013-01-14 Last updated: 2017-12-06
Forsman, F., Sjörs-Dahlman, A., Dahlman, J., Falkmer, T. & Lee, H. C. (2012). Eye tracking during high speed naviation at sea: Field trial in search of navigational gaze behaviour. Journal of Transportation Technologies, 2, 277-283
Open this publication in new window or tab >>Eye tracking during high speed naviation at sea: Field trial in search of navigational gaze behaviour
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2012 (English)In: Journal of Transportation Technologies, ISSN 2160-0473, E-ISSN 2160-0481, Vol. 2, p. 277-283Article in journal (Refereed) Published
Abstract [en]

Purpose: Professional high speed sea navigational procedures are based on turn points, courses, dangers and steering cues in the environment. Since navigational aids have become less expensive and due to the fact that electronic sea charts can be integrated with both radar and transponder information, it may be assumed that traditional navigation by using paper based charts and radar will play a less significant role in the future, especially among less experienced navigators. Possible navigational differences between experienced and non-experienced boat drivers is thus of interest with regards to their use of navigational aids. It may be assumed that less experienced navigators rely too much on the information given by the electronic sea chart, despite the fact that it is based on GPS information that can be questioned, especially in littoral waters close to land.

Method: This eye tracking study investigates gaze behaviour from 16 experi- enced and novice boat drivers during high speed navigation at sea.

Results: The results show that the novice drivers look at objects that are close to themselves, like instrumentation, while the experienced look more at objects far away from the boat. This is in accordance with previous research on car drivers. Further, novice boat drivers used the elec-tronic navigational aids to a larger extent than the experienced, especially during high speed conditions. The experienced drivers focused much of their attention on objects outside the boat.

Conclusions: The findings verify that novice boat drivers tend to rely on electronic navigational aids. Experienced drivers presumably use the navigational aids to verify what they have observed in the surrounding environment and further use the paper based sea chart to a larger extent than the novice drivers.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2012
Keywords
Driving, Eye Tracking, Experience, Navigation, Vision
National Category
Engineering and Technology Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86440 (URN)10.4236/jtts.2012.23030 (DOI)
Available from: 2012-12-15 Created: 2012-12-15 Last updated: 2018-03-17Bibliographically approved
Sjörs, A., Ljung, T. & Jonsdottir, I. H. (2012). Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion. BMJ Open, 2(4)
Open this publication in new window or tab >>Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion
2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 4Article in journal (Refereed) Published
Abstract [en]

Objectives Studies on hypothalamus–pituitary–adrenal (HPA) axis activity in stress-related exhaustion and burnout have revealed incongruent results, and few longitudinal studies on clinical populations have been performed. This study was designed to investigate differences in HPA axis activity between patients with stress-related exhaustion and healthy controls and to investigate longitudinal changes in HPA axis activity in the patient group as they entered a multimodal treatment programme.

Design HPA axis activity was assessed through the cortisol awakening response (CAR). Salivary cortisol was sampled at awakening and after 15 min. Follow-up measurements were performed in the patient group after 3, 6, 12 and 18 months.

Setting An outpatient clinic specialising in stress-related illness.

Participants Patients with clinically diagnosed stress-related exhaustion (n=162) and healthy controls (n=79).

Primary and secondary outcome measures The primary measure was CAR measured as the difference between the two salivary cortisol samples. Changes in CAR during follow-up were related to changes in symptoms of burnout, depression and anxiety.

Results Patients showed similar CAR as the controls and their CAR did not change significantly during treatment. No association was found between CAR and symptom development during treatment.

Conclusions The authors conclude that CAR does not seem to discriminate clinically defined patients with exhaustion from healthy controls and it appears not to change during treatment. CAR, measured as salivary cortisol, at awakening and after 15 min, is thus not a valid marker for stress-related exhaustion.

Place, publisher, year, edition, pages
BMJ Publishing Group: BMJ Open / BMJ Journals, 2012
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-90216 (URN)10.1136/bmjopen-2012-001091 (DOI)000315049300053 ()
Available from: 2013-03-21 Created: 2013-03-21 Last updated: 2017-12-06
Sjörs, A., Larsson, B., Persson, A. L. & Gerdle, B. (2011). An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain. BMC Musculoskeletal Disorders, 12, 230-230
Open this publication in new window or tab >>An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain
2011 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 12, p. 230-230Article in journal (Refereed) Published
Abstract [en]

Background: Neck-shoulder pain conditions, e. g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance). less thanbrgreater than less thanbrgreater thanMethods: Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study. less thanbrgreater than less thanbrgreater thanResults: NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. less thanbrgreater than less thanbrgreater thanConclusion: These results indicate that central mechanisms e. g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.

Place, publisher, year, edition, pages
BioMed Central, 2011
Keywords
Quantitative sensory testing, trapezius myalgia, muscle, pain, hypersensitivity, centralization, pressure pain thresholds, pain drawing, pain intensity, questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72138 (URN)10.1186/1471-2474-12-230 (DOI)000296376400001 ()
Note

Funding Agencies|Swedish Council for Working life and Social Science|2004-02892007-0760|

Available from: 2011-11-18 Created: 2011-11-18 Last updated: 2017-12-08
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2530-4126

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