Introduction:Musculoskeletal and mental health conditions are common, often coexist and may lead to disability among young adults. We aimed to: (1) estimate the 3-month incidence of coexisting function-limiting musculoskeletal problems and psychological distress among university students in Sweden, (2) estimate recovery from coexisting conditions (resolution of one or both conditions) and (3) determine whether incidence and recovery vary by sociodemographic factors. Methods:We followed 4262 university students in Sweden (17-65 years; 62% women) over 3 months, assessing function-limiting musculoskeletal problems and psychological distress (moderate or worse depression and/or anxiety) using the Nordic Musculoskeletal Questionnaire and the Depression Anxiety Stress Scales-21. The 3-month incidence of coexisting conditions was estimated among 3642 students without coexisting conditions at baseline. We used risk ratios (RRs) to describe the variation of coexisting conditions across sociodemographic strata, comparing categories within each variable. Recovery at 3 months was estimated among 620 students with both conditions at baseline. Results:The 3-month incidence of coexisting function-limiting musculoskeletal problems and psychological distress was 8% (n=302, 95% CI 7% to 9%), higher among women (RR: 1.51, 95% CI 1.19 to 1.92), non-Europeans (RR: 1.55, 95% CI 1.17 to 2.06) and students whose parents lacked a university degree (RR: 1.31, 95% CI 1.04 to 1.64). Among students with coexisting conditions at baseline, 42% (n=258, 95% CI 38% to 46%) recovered from at least one condition at 3 months. Recovery did not clearly vary by age group, civil or socioeconomic status, country of origin or parental education. Conclusion:The 3-month incidence of coexisting function-limiting musculoskeletal problems and psychological distress was 8%, higher in women, non-Europeans and those whose parents had no university degree. Just under half of those with coexisting conditions recovered from at least one condition within 3 months, with no meaningful variation across sociodemographic groups. These findings underscore the need for targeted prevention, integrated student health support and further research.

The aim of this study was to assess the one-year trajectories of psychological distress and of spinal pain intensity in manual therapists during the COVID-19 pandemic in Sweden, and to assess characteristics’ association with trajectory membership. In this cohort study, 816 clinically active licensed manual therapists answered four web-based surveys during a year of the COVID-19 pandemic in Sweden, measuring psychological distress and spinal pain intensity. Trajectory modelling was conducted to cluster individual trajectories over time. Association between baseline characteristics and cluster membership of psychological distress, and spinal pain intensity trajectories were analyzed using multinomial logistic regression models, adjusted for posterior probability, age, and sex. Five clusters of psychological distress and five of spinal pain intensity were identified. A majority of participants’ psychological distress (89%), and spinal pain intensity (75%) were clustered into low/mild levels. One cluster of increasing psychological distress (2%) were identified. Two fluctuating clusters of moderate/mild (14%), as well as one cluster of stable moderate (11%) spinal pain intensity were identified. Impaired sleep, and not meeting physical activity recommendations were associated with worse trajectories of spinal pain. In conclusion, most manual therapists had favorable trajectories of psychological distress and spinal pain intensity during a year of the COVID-19 pandemic in Sweden.

Objective This study aims to investigate how authors attribute causality in case reports and case series describing ischaemic stroke following cervical manual therapy. Methods This qualitative, document-based study is nested within a larger epidemiological investigation evaluating the association between cervical manual therapy and ischaemic stroke (PROSPERO ID: CRD42024602659). Eligible case reports and case series will be identified through a systematic review of biomedical databases. A software-assisted qualitative content analysis will be undertaken in MAXQDA, combining deductive coding, guided by counterfactual theory and the concept of hypothesis generation, with inductive coding to capture linguistic patterns. Conclusion This research protocol presents a novel approach to examining how causality is attributed in case reports and case series, addressing the relationship between ischemic stroke following cervical manual therapy for headaches or neck pain. The anticipated findings have implications for improving the clarity and responsibility of scientific communication and informing the interpretive boundaries and appropriate use of descriptive research designs in clinical and policy contexts.

Abstract Background The prevalence of back pain and neck/shoulder pain among nurses is high. This study reports a detailed description of health related characteristics of experienced nurses with and without severe back pain or severe neck/shoulder pain in Sweden. Methods Cross-sectional data was collected in a national investigation of nursing graduates from 26 Swedish universities to identify three groups of nurses 11–15 years after graduation: nurses with severe back pain (n = 212), nurses with severe neck/shoulder pain (n = 277), and nurses with no or little such pain (n = 1525). Severe pain was defined as much discomfort from pain the preceding four weeks. Descriptive statistics were used to summarise general health and pain characteristics, use of health resources and impact of pain on work. Results Nurses with severe back or neck/shoulder pain described worse general state of health and lifestyle, such as personal or mental health problems, fatigue, dizziness and pain in other body regions, less physical activity and lower sleep quality, than those with no or little pain. They used more health resources as over-the-counter and prescription painkillers and care seeking for physical ailments. The course of the severe pain was often persistent, and those nurses commonly reduced their working hours, changed work tasks, and had days off work. Conclusions This study describes variations of nurses’ health related characteristics by pain levels. Experienced nurses with severe back or neck/shoulder pain describe worse states of general health and lifestyle, and more use of health resources than experienced nurses with no or little such pain. The course of the severe pain is often persistent and affects work capacity. Clinical trial number Not applicable.

BACKGROUND:In Sweden, almost 60% of patients seeking care at primary healthcare centers do so due to musculoskeletal disorders. These patients constitute a strain on the healthcare system. Manual therapists are experts in diagnosing patients with these conditions but are usually not part of healthcare centers in Sweden. Further, there is a significant societal problem with overuse of medications, injections, medical imaging, and unnecessary surgeries, so-called low-value care, for back and neck pain. We aimed to explore the current management of patients with back and neck pain in primary healthcare centers, staff's perceptions regarding the need for improvement, and incentives and concerns about having licensed chiropractors and naprapaths (manual therapists) triage these patients as part of the primary healthcare center team. METHODS:In this qualitative study, we conducted semi-structured focus group interviews with 20 participants employed at three primary healthcare centers in the Stockholm region, chosen based on location, organization, and exposure to manual therapists. Participants were purposefully selected from different professions. Data were analyzed using inductive qualitative manifest and latent content analysis. RESULTS:The current management of patients with back and neck pain was described in terms of long waiting times and patients' expectations of seeing a medical doctor and receiving imaging. Thus, there was room for improvement by reducing low-value care. Participants had limited knowledge about the competence of chiropractors and naprapaths and were concerned about the boundaries of professional identity. Decreased physician workload and more choices for patients were mentioned as incentives for manual therapists to take on a triaging role. CONCLUSIONS:Staff at three primary healthcare centers in the Stockholm area described the current management of patients with back and neck pain as navigating the expectations of patients and their overreliance on seeing their physician, not other caregivers, resulting in long waiting times. Alongside patients expecting imaging, these were incentives for chiropractors and naprapaths triaging these patients as an opportunity to improve care. A lack of knowledge about the competence of manual therapists was a concern, and assigning manual therapists to the primary healthcare team would necessitate a reconfiguration of the care process, potentially challenging the boundaries of professional identity.

BACKGROUND:The Swedish governmental strategy during the COVID-19-pandemic was to impose voluntary recommendations to limit viral spread, but to keep health care and important societal functions running. The objective of this study was to describe the work environment and practice of manual therapists, who were challenged by this strategy, in Sweden during a year of the pandemic. METHODS:The cohort study Corona And Manual Professions (CAMP) was studying chiropractors and naprapaths, registered in the public register of licensed manual therapists in Sweden, during the pandemic. Mixed methods were used to answer the research aims. Surveys were distributed in November 2020, during the second wave, and in February, May and November of 2021. The quantitative data were presented descriptively, with the development over time illustrated in graphs. The qualitative data from the free-text answers were analyzed using content analysis. RESULTS:In total, 816 manual therapists (47% of the invited sample) were included in the study, of which between 275 and 662 participants answered the free-text questions. At baseline, most (60-65%) rated their knowledge of viral infections and their spread, of vulnerable patient groups, and of protective gear as fairly good or good. Most (68-70%) were able to follow the official recommendations, but decreased numbers of patients and changes in clinic routines were reported. There was a positive trend in caring adequately for patients and having access to protective gear. Manual therapists reported that they were unable to care for vulnerable patient groups, had to adhere to routines perceived as onerous, and found care to be less personalized. CONCLUSION:At the time of the outbreak of the COVID-19 pandemic, manual therapists in Sweden encountered challenges regarding knowledge about pandemics and availability of protective equipment. Sweden's official recommendations were possible to implement by the manual therapists, but had adverse impacts on clinic activities and patient care. Despite this, over 50% were able to deliver adequate care for their patients.

BACKGROUND:For competitive adolescent athletes, injury avoidance is a challenge, and causes of injury are complex and multifactorial. Despite an incidence of 8.2 shoulder injuries per 1,000 hours of tennis played, few studies have investigated the association between shoulder strength, range of motion (ROM), and injury. HYPOTHESIS:Eccentric and isometric shoulder muscle strength and/or shoulder ROM are associated with new shoulder complaints and/or injuries. STUDY DESIGN:Cohort study. LEVEL OF EVIDENCE:Level 3. METHODS:At baseline 301 adolescent competitive tennis players aged 13 to 19 years completed a questionnaire, were assessed with a shoulder protocol for strength and ROM and followed weekly (for shoulder complaint/injury) for 52 consecutive weeks. Outcomes were a first incidence of a tennis-related shoulder complaint or injury in the dominant arm, defined as a sum score of ≥20 or ≥40, respectively, on the Oslo Overuse Injury Questionnaire. Two cohorts were created for Cox regression analyses, adjusted for age, sex, and playing level: (1) shoulder complaints (n = 204), and (2) shoulder injuries (n = 252). RESULTS:The most definitive adjusted associations were a hazard rate ratio (HRR) of 1.3 (95% CI 1.0-1.8) for a shoulder complaint in eccentric external rotation (eccER) strength, and a HRR for shoulder injuries of 1.4 (95% CI 1.0-1.9) in isometric internal rotation (IIR) strength in the 90-90 position, and 1.5 (95% CI 1.1-2.0) in eccER normalized to body mass. CONCLUSION:Higher values of eccER shoulder strength, IIR strength at the 90-90 position, and eccER shoulder strength normalized to body mass, were associated with shoulder complaints/injuries in adolescent competitive tennis players. CLINICAL RELEVANCE:Incorporating a training program that takes volume and intensity into account in the daily oncourt sessions, to build resilience through a well-planned, long-term training and competition plan to minimize shoulder injury risk may be of importance.

BACKGROUND:There is growing awareness that back pain in adolescent soccer (European football) players is not always related to local tissue damage. Approaches taking into consideration lifestyle factors are needed. This study aimed to investigate the association between psychological distress, skipped meals, and insufficient sleep, and the occurrence of back pain among adolescent female soccer players. HYPOTHESIS:Psychological distress, skipped meals, and insufficient sleep are associated with the occurrence of back pain. STUDY DESIGN:Cohort study. LEVEL OF EVIDENCE:Level 3. METHODS:Swedish adolescent female soccer players aged 12 to 17 years, without back pain at baseline, were included. The exposures psychological distress, skipped meals, and insufficient sleep were assessed at baseline. The players were followed for 1 year with a weekly web-based survey, where back pain intensity was measured on a numeric rating scale (NRS) ranging from 0 to 10. The outcome back pain was defined as reporting low back pain and/or upper back/neck pain intensity of ≥4 on the NRS. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard rate ratio (HRR) with 95% CI for the association between each exposure and the outcome back pain, adjusted for age at baseline and parents' education. RESULTS:In total, 351 players were included, and 141 players reported back pain at some point during the 1-year follow-up. The adjusted HRR for back pain was 1.79 (95% CI, 1.11-2.91) for insufficient sleep, 1.45 (95% CI, 0.97-2.17) for psychological distress, and 0.98 (95% CI, 0.61-1.59) for skipped meals. CONCLUSION:Insufficient sleep and psychological distress are associated with the occurrence of back pain among female adolescent soccer players. CLINICAL RELEVANCE:Our results contribute to the understanding of what may influence the occurrence of back pain in adolescence, offering potential strategies for the prevention of back pain in adolescent female soccer players.

Neck and back pain are common musculoskeletal conditions in university students and associated with unhealthy lifestyle behaviors such as physical inactivity, unhealthy dietary habits, smoking and risky alcohol use. Cohort studies have investigated the effect of a healthy lifestyle including several lifestyle behaviors on the risk and prognosis for neck and back pain. Studies of an association between an unhealthy lifestyle and musculoskeletal conditions in university students are lacking. This study aimed to assess the association between an unhealthy lifestyle and incident activity-limiting neck/back problems (ALNBP) in university students. Participants enrolled in the Sustainable UNiversity Life (SUN) study who did not report baseline ALNBP in the past three months were included (n = 3492). The baseline web-survey assessed unhealthy lifestyle behaviors (physical inactivity, high sitting time, meal skipping and risky use of alcohol, tobacco, and illicit drugs) with valid instruments and single-item questions. Participants with ≥ 3 unhealthy lifestyle behaviors were categorized as exposed to an unhealthy lifestyle. Responses to web-based follow-up surveys every third month until first reporting ALNBP or to the end of the one-year follow-up were used. The outcome ALNBP was defined as reporting limitations in daily activities due to a neck, low back and/or midback problem the past three months, assessed with a modified version of the Nordic Musculoskeletal Questionnaire. Crude and adjusted Cox regression models were built to assess the association between an unhealthy lifestyle and incident ALNBP, reported as a hazard rate ratio (HRR) with a 95

BACKGROUND:This study assessed health and change in lifestyle factors in Swedish manual therapists during one year of the COVID-19 pandemic, and potential differences with regards to age, sex, and business constellation. Further, therapists' strategies for health promotion during the pandemic were explored. METHODS:In this cohort study, 816 clinically active manual therapists were followed with web-based surveys during a year of the COVID-19 pandemic in Sweden, measuring physical activity, sedentary time, COVID-19-related worries, maladaptive coping, alcohol and tobacco consumption. Health promotion and impact of the pandemic on physical and mental health were explored in free text questions. Generalized estimating equations were conducted to assess changes in sample averages over time, and qualitative content analysis was used to code and categorize free-text answers. RESULTS:There was a decrease in physical activity and sedentary time increased as well as subjective mental health impact by the pandemic over one year. Maladaptive coping decreased during follow-up, and alcohol and tobacco consumption decreased in younger participants, and women, respectively. Participants stated that the pandemic affected their physical and mental health and reported using health promoting activities primarily targeting physical activity, nutrition, and sleep. CONCLUSION:Swedish manual therapists maintained good lifestyle habits except for a small decrease in physical activity and slight increase in sedentary behavior and subjective mental health impact by the pandemic over time. There were small differences in terms of maladaptive coping, alcohol consumption, and tobacco consumption, however, these differences were not likely clinically relevant. The therapists seemed conscientious regarding health promotion measures during one year of the COVID-19 pandemic.

BACKGROUND:It is unclear whether lifestyle behaviours influence use of healthcare for musculoskeletal pain in young adults. This study examined if lifestyle behaviours among college/university students were associated with future healthcare utilisation for musculoskeletal pain. METHODS:Data from the Students' Health and Wellbeing Study (SHoT2018) were linked with the Norwegian Registry for Primary Health Care, comprising 31,358 college/university students. We analysed associations of physical activity level, sleep duration, alcohol consumption, smoking, illicit drug use and cumulative adverse lifestyle behaviours with healthcare utilisation for musculoskeletal pain over the following three years, including 'any use', 'high use' and for back and neck pain specifically. RESULTS:High physical activity levels, compared to recommended levels, were associated with a higher risk of 'any' healthcare utilisation for musculoskeletal pain (females: RR 1.14, 99% CI [1.04-1.25]; males: RR 1.20, 99% CI [1.07-1.36]); below recommended physical activity levels were associated with a lower risk (females: RR 0.90, 99% CI [0.85-0.96]; males: RR 0.84, 99% CI [0.76-0.93]). Illicit drug use was associated with a lower risk of healthcare utilisation for neck pain in females (RR 0.77, 99% CI [0.62-0.97]). Four or more adverse lifestyle behaviours, compared to ≤ 1, were associated with a lower risk of high healthcare utilisation for musculoskeletal pain (females: RR 0.66, 99% CI [0.48-0.90]; males: RR 0.68, 99% CI [0.48-0.97]) and a lower risk of healthcare utilisation for neck pain in females (RR 0.63, 99% CI [0.41-0.97]). CONCLUSIONS:Associations between college/university students' lifestyle behaviours and healthcare utilisation for musculoskeletal pain were identified, but with some unexpected patterns. Future research should explore long-term effects of these behaviours on healthcare utilisation for musculoskeletal pain. SIGNIFICANCE:High levels of physical activity among college and university students were associated with a greater risk of seeking healthcare for musculoskeletal pain within the following three years. Illicit drug use was associated with a lower risk of seeking healthcare for neck pain in females. Surprisingly, the presence of many adverse lifestyle behaviours appeared to be associated with a lower risk of healthcare utilisation for musculoskeletal pain, particularly healthcare contacts for neck pain in females and repeated healthcare contacts for musculoskeletal pain in general.

Objectives To assess the association between (1) dietary habits and knee/shoulder injury incidence in male and female adolescent handball players and (2) menstrual dysfunction and injury incidence in females.Methods This study is based on seasons 2020–2022 of the Swedish Handball Cohort including 1144 participants (1703 player seasons) free from a substantial knee and shoulder injury. Participants self-reported meal frequency, meal timing, nutritional intake and menstrual function (season 2022/2023) at baseline. Weekly follow-ups throughout the season assessed training and matches, and substantial knee/shoulder injuries. Cox regression analyses estimated a hazard rate ratio (HRR) with the first event of a knee/shoulder injury (combined), with minutes of handball training and matches as the timescale.Results In females, adjusted analyses generated an HRR for knee/shoulder injuries of 1.46 (95% CI 1.08, 1.98) for moderate-high nutritional quality compared with low quality and an HRR of 1.38 (95% CI 1.02, 1.86) for ≥2 unfavourable dietary habits compared with 1 unfavourable dietary habit. For poor meal timing, adjusted analyses generated an HRR of 1.20 (95% CI 0.90, 1.61) compared with adequate timing in females. In males, adjusted analyses generated an HRR of 1.23 (95% CI 0.69, 2.17) for low meal frequency and an HRR of 0.83 (95% CI 0.60, 1.15) for poor meal timing.Conclusions In adolescent female handball players, moderate-high nutritional quality and ≥2 unfavourable dietary habits are associated with higher knee/shoulder injury incidence; whereas, no or unprecise associations were found for other dietary habits in females and males and for menstrual dysfunction in females.

PURPOSE:To determine the gender-specific impact of recent exposure to different forms of sexual harassment and sexual violence (SHV) on depression and anxiety symptoms three, six, and nine months later. METHODS:We recruited 2229 women and 1274 men studying at Swedish universities and followed them with web-surveys every three months over one year. We estimated mean differences (MDs) of depression and anxiety symptoms between exposed and unexposed at each follow-up, adjusting for prior SHV, prior depression and anxiety symptoms and potential confounders. RESULTS:For women, sexual harassment (wide subjective definition) was associated with higher symptom levels of depression (MD 1.0 [95% CI: 0.3; 1.7]) and anxiety (MD 0.8 [95% CI: 0.3; 1.4]) three months later. Unwanted sexual attention was associated with higher symptom levels of anxiety three (MD 0.5 [95% CI: 0.1; 0.8]) and six months later (MD 0.4 [95% CI: 0.0; 0.7]). Exposure to sex against ones will was associated with higher depression symptoms three (MD 1.7 [95% CI: 0.1;3.4]), and six months later (MD 3.1 [95% CI: 1.0; 5.2]). Trends indicated that associations with subsequent mental health differed between forms of SHV among women, and that most associations were more pronounced in temporal proximity to the exposures. For men, we refrain from interpreting the results since they showed high variability and were not robust to sensitivity analyses using multiple imputation to account for missing outcome data. CONCLUSIONS:Among women, several forms of SHV were associated with higher subsequent depression and anxiety symptoms.

BACKGROUND:This study examined manual therapy business owners' perception of official recommendations during the COVID-19 pandemic and the impact on their clinics' economic performance, including clinic activity hours and business turnover. MATERIALS AND METHODS:In a longitudinal study design, data were collected in November 2021 (baseline), and after three months, six months, and 12 months. Participants were manual therapists who were business owners. A growth curve model was used to analyze differences in clinical activity trajectories. Multinomial logistic regression analysis was used to assess the relationship between perceived disruptions in business and turnover. Qualitative text analysis was used to examine participants' responses to open-ended questions concerning economic measures taken to sustain their business during the pandemic. RESULTS:This study of 443 manual therapy business owners found that clinics were initially active with minimal variation, but activity changed following COVID-19 recommendations. Business owners perceived that the disruptions had no significant impact on turnover during the initial stages of the official recommendations. Economic support and the previous decrease in turnover increased the likelihood of experiencing a decreased turnover at 12 months. Business owners implemented cost-cutting measures and diversified income sources to navigate COVID-19 challenges and sustain their businesses. CONCLUSION:The official recommendations in Sweden had an impact on manual therapists' businesses as the COVID-19 pandemic lingered. Some business owners were concerned at the early stages about lower turnover but showed financial resilience by cutting costs and finding new revenue sources to overcome COVID-19 challenges.

PURPOSE:To investigate the association between common measures of trunk and lower extremity range of motion (ROM), strength, the results of one-leg jump tests at baseline and the incidence of subsequent substantial knee injuries in adolescent female football players. METHODS:Players were assessed at baseline regarding (1) ROM of trunk, hip, and ankle; (2) trunk, hip, and knee strength; and (3) one-leg jump tests. Players were prospectively monitored weekly for 1 year regarding knee injuries and the volume of matches and training. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated with Cox regression for the association between the baseline tests and the incidence of substantial knee injury (moderate/severe reduction in training volume or performance, or complete inability to participate in football). Exposures were categorized in tertiles (high, medium and low values). The highest tertile was used as reference. RESULTS:376 players were included without substantial knee injury at baseline (mean age, 13.9 ± 1.1 years), and 71 (19%) reported at least one substantial knee injury during the follow-up. Several associations were found; the strongest was that players in the lowest tertile of knee extension strength had a higher incidence of knee injuries than players in the highest tertile (HRR, 2.28; 95% CI, 1.20-4.38). Players in the lowest tertile of trunk rotation ROM in lunge position half-kneeling (HRR, 0.50; 95% CI, 0.27-0.94) had lower incidence of knee injuries than players in the highest tertile. CONCLUSIONS:Poor knee strength and high trunk ROM were associated with an increased incidence of substantial knee injury in adolescent female football players. Therefore, knee-strengthening exercises during season may be recommended. LEVEL OF EVIDENCE:Level II.

Background Research waste is defined as research outcomes with no or minimal societal benefits. It is a widespread problem in the healthcare field. Four primary sources of research waste have been defined: (1) irrelevant or low priority research questions, (2) poor design or methodology, (3) lack of publication, and (4) biased or inadequate reporting. This commentary, which was developed by a multidisciplinary group of researchers with spinal manipulative therapy (SMT) research expertise, discusses waste in SMT research and provides suggestions to improve future research. Main text This commentary examines common sources of waste in SMT research, focusing on design and methodological issues, by drawing on prior research and examples from clinical and mechanistic SMT studies. Clinical research is dominated by small studies and studies with a high risk of bias. This problem is compounded by systematic reviews that pool heterogenous data from varying populations, settings, and application of SMT. Research focusing on the mechanisms of SMT often fails to address the clinical relevance of mechanisms, relies on very short follow-up periods, and has inadequate control for contextual factors. Conclusions This call to action is directed to researchers in the field of SMT. It is critical that the SMT research community act to improve the way research is designed, conducted, and disseminated. We present specific key action points and resources, which should enhance the quality and usefulness of future SMT research.

Aims: Back pain and neck/shoulder pain are common among nurses. The aim of this study was to investigate the association between nurses' exposure to a demanding psychosocial work environment during the first three years after graduation and the occurrence of severe back pain and neck/shoulder pain in the longer term, 11-15 years later. Methods: The Longitudinal Analysis of Nursing Education (LANE) study (nursing graduates from 26 Swedish universities in the years 2002, 2004 and 2006) was used to create two risk cohorts of nurses not reporting severe back pain (n=1764) or neck/shoulder pain (n=1707). Nurses exposed to a demanding psychosocial work environment for one, two or three of the first three years in their career were compared to nurses not having a demanding psychosocial work environment for any of these three years regarding the incidence of severe back pain or neck/shoulder pain at follow-up, 11-15 years later. Relative risks (RR) with 95% confidence intervals (CI) were calculated using binomial regression. Results: The RR (95% CI) of having severe back pain for nurses who had a demanding psychosocial work environment for one of the three years was 1.36 (0.82-2.28) and 2.08 (1.21-3.57) for two of the three years and 2.82 (1.43-5.55) for all three years. Corresponding RRs (95% CIs) for severe neck/shoulder pain were 1.35 (0.87-2.10), 1.49 (0.88-2.51) and 1.41 (0.62-3.20), respectively. Conclusions: Nurses who were repeatedly exposed to a demanding psychosocial work environment early in their career reported severe back pain to a higher extent in the longer term.

Background Studies indicate that inadequate dietary habits such as low meal frequency and intake of low-energy-dense foods are associated with injuries in adolescent athletes from weight-sensitive sports. This association has been less studied in team sports. Objective To investigate the association between meal frequency, meal timing and nutritional quality, respectively, and incident knee- and shoulder injuries in adolescent handball players. Design Prospective study based on the Swedish Handball Cohort. Setting Swedish handball-profiled secondary schools. Participants Players free from knee and shoulder injuries at baseline, followed 1–3 seasons 2020–2023, including 1149 participants (53% male, mean age 16.7 ± 0.9 years) and 1717 player seasons. Assessment of Risk Factors Meal frequency, meal timing in relation to training/games and intake frequency of foods (i.e., fruits/vegetables, wholegrain etc.), generating a nutritional quality score of 0–12 according to national dietary guidelines, were assessed in a baseline web-survey. Main Outcome Measurements The Oslo Sports Trauma Research Center Overuse Injury Questionnaire was used to assess a substantial injury through weekly follow-ups. An event was registered when the first substantial knee and/or shoulder injury occurred. Cox proportional hazard regression analyses (adjusted for previous injury, dietary supplements, playing position, sleep, sex, and school) including cumulative exposure time-to-event of minutes of playing handball were performed, generating adjusted hazard rate ratios (HRR) with 95% confidence intervals (CI). Results Each increase in nutritional score was associated with a HRR of 1.07 (95% CI 1.01–1.14). Each increase in daily meals generated a HRR of 1.01 (95% CI 0.91–1.11) and each additional meal timed with training/games generated a HRR of 1.00 (95% CI 0.92–1.08). Conclusions Higher nutritional score was associated with incident injuries in adolescent handball players, but not meal frequency or meal timing. These results suggest that sports nutrition recommendations rather than national dietary guidelines may be of clinical importance in adolescent handball.

Abstract Background Procrastination is common among university students and associated with adverse outcomes such as physical and mental health problems. According to the Temporal motivation theory procrastination may vary over time depending on the temporal proximity to goals and deadlines. Aims To determine if mean procrastination levels among university students varies over an academic year, and if trajectories of procrastination are moderated by gender identity, perfectionistic strivings, and/or perfectionistic concerns. Sample Swedish university students (n = 1410). Methods The cohort was followed with web-surveys at four time-points over one academic year (Late semester, Mid semester, After semester, and Early semester). Generalized Estimating Equations were used to estimate mean levels of self-rated procrastination at the different time-points. Results We found only small fluctuations in mean procrastination levels over the academic year. Participants with high perfectionistic concerns demonstrated higher mean procrastination levels at all time-points, but neither gender identity, perfectionistic concerns nor perfectionistic strivings affected the slope of the mean procrastination trajectories. Conclusions In this cohort of Swedish university students, self-rated procrastination levels were stable over the academic year. Perfectionistic concerns, but not gender identity or perfectionistic strivings, was associated with higher levels of procrastination.