Employment status in cancer patients the first five years after diagnosis-a register-based study.

PURPOSE: Work is important for identity formation, social status, and economic independency. Although some evidence within the field of work and cancer survivorship exists, no study has so far investigated employment status across all cancer diagnoses. Thus, the aim of the present study was to investigate the impact of all cancer diagnoses on employment status. METHODS: Danish cancer patients aged 20-60 years, diagnosed between 2000 and 2015, were identified through Danish registers and matched 1:5 with cancer-free controls. Logistic and linear regression was performed separately in 11 cancer types to assess and compare work status and work participation between cancer patients and cancer-free controls one, three, and five years after diagnosis. RESULTS: A total of 111,770 cancer patients and 507,003 cancer-free controls were included. All cancer types had lower chances of working one year after diagnosis (ORs between 0.05 and 0.76), with lung, colorectal, upper gastrointestinal, and blood cancer patients having the lowest chances. After three years, 10 of 11 cancer types had lower chances (ORs between 0.39 and 0.84). After five years, there were minimal differences between cancer patients and controls among most cancer types (ORs between 0.75 and 1.36). CONCLUSION: Most cancer patients had lower chances of working compared with the general population until five years after diagnosis. However, patients with certain cancer types experienced lower chances of working all years, despite improvement over time. IMPLICATIONS FOR CANCER SURVIVORS: The knowledge will help increase awareness on challenges regarding work-life after cancer. Furthermore, the distinguishing between diagnoses can inform to more targeted vocational rehabilitation.

Danish translation and cultural adaptation of the Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) scale.

OBJECTIVES: Screening tools are needed to help to identify psoriatic arthritis in patients with psoriasis. The Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire was developed for this purpose and has been shown to perform very well. The aim of this study was to translate and culturally adapt the PURE-4 scale into the Danish language. METHOD: The translational process followed the guidelines provided by the Mapi Research Trust, which include the following steps: forward translation, backward translation, cognitive interviews, and proofreading. Following the guidelines helps to maintain the content validity of the questionnaire and secures a translation that is both literally and culturally appropriate for the target population. RESULTS: All four items were modified throughout the translation process, involving mainly minor changes such as the addition of more colloquial words in the Danish version. The new Danish version of PURE-4 was reviewed and approved by the original developers. CONCLUSIONS: A Danish version of the PURE-4 questionnaire was produced. The translation and cultural adaptation of PURE-4 constitute the first step in the validation of the questionnaire in Danish patients with psoriasis.

Do outpatients with cancer and their relatives want to use an online booking system to book the appointment and radiographer for their CT examination? A small-scale study in Denmark.

INTRODUCTION: Previous studies have found that online booking systems may be the preferred scheduling tool when booking appointments with healthcare providers. The aim of this study was to examine I) if outpatients with cancer and relatives of cancer patients wanted to use an online booking system to book appointments for the CT examinations, and II) if they wanted to book specific radiographers for the CT examinations. METHODS: An online questionnaire was distributed to outpatients with cancer and relatives of cancer patients registered in the user panel of the Danish Cancer Society. The questionnaires consisted of 13 questions for patients and eight questions for relatives. The study applied statistical analysis and qualitative content analysis with an inductive approach. RESULTS: In total, 555 patients out of 760 (73%) and 115 out of 341 (34%) relatives were included in the present study and 54% of the patients and 65% of the relatives responded that they wanted, "To a high degree" or "To some degree", to use an online system for booking the appointment of the CT examination. Furthermore, 49% of the patients and 60% of the relatives found it important, "To a high degree" or "To some degree", that the appointment of the CT examination also suited their relatives. Only 37% of the patients, in contrast to 56% of the relatives, were interested in the opportunity to book specific radiographers. Approximately half of the patients (48%) and relatives (58%) were interested in being scanned by the same radiographers. CONCLUSION: In this study, a majority of patients and relatives were interested in using an online booking system to book their CT examinations. Furthermore, while a majority of the relatives were more interested in booking specific radiographers for the CT examinations, only a few patients were interested in this function. IMPLICATIONS FOR PRACTICE: Using an online booking system to book the appointment could benefit the overall experience for cancer patients and relatives when attending a CT examination to ensure that the appointment also suits the relatives.

Oncology patients' experience of a routine surveillance CT examination: Relationships and communication.

INTRODUCTION: The question of radiographers' capacity to establish short time relationships as well as decoding patients' needs and expectations simultaneously with performing high technological examination frequently arises in the clinical practice. Additionally, the constant focus on technology and the fact that radiographers work in high productive departments accentuates the issue. Patients' experiences with radiology seem to be a neglected area of research and may help to identify areas for improvement in this highly technological and productive field. The purpose of the study was to explore oncology patients' experiences of a routine surveillance CT examination and their need for relationships and communication with the radiographer as part of the CT examination. METHODS: The study included patients diagnosed with cancer and in need of a CT examination as part of their course of treatment, and 21 semi-structured interviews were conducted. The interviews were analysed using qualitative content analysis. Themes were constructed and narratively reported. To increase validity, the themes were identified, discussed and formulated by the author group. RESULTS: Four themes were constructed based on the analysis: 1: The professional radiographer, 2. Disease and treatment, 3. The examination environment and 4: While waiting. CONCLUSION: The lack of focus on radiographers' capacity to establish relations, to consider each patient as an individual human being and being able to show sincere interest and empathy were highlighted. Findings illuminated the patient's need for relationship and communication with the radiographer as part of a CT examination.

Effectiveness of the "Cancer Home-Life Intervention" on everyday activities and quality of life in people with advanced cancer living at home: a randomised controlled trial and an economic evaluation.

BACKGROUND: During the past decade an increasing number of people live with advanced cancer mainly due to improved medical treatment. Research has shown that many people with advanced cancer have problems with everyday activities, which have negative impact on their quality of life, and that they spend a considerable part of their time at home. Still, research on interventions to support the performance of and participation in everyday activities is only scarcely available. Therefore, the occupational therapy-based "Cancer Home-Life Intervention" consisting of tailored adaptive interventions applied in the participant's home environment was developed. The objective of this study is to examine the effectiveness and cost-effectiveness of the Cancer Home-Life Intervention compared to usual care on the performance of and participation in everyday activities and quality of life in people with advanced cancer living at home. METHODS: The study is a randomised, controlled trial (RCT) including an economic evaluation. The required sample size of 272 adults living at home will be recruited from outpatient clinics at two Danish hospitals. They should be diagnosed with cancer; evaluated incurable by the responsible oncologist; and with a functional level 1-2 on the WHO performance scale. The primary outcome is the quality of performance of activities of daily living. Secondary outcomes are problems with prioritised everyday activities; autonomy and participation; and health-related quality of life. Participants are randomly assigned to: a) The Cancer Home-Life Intervention in addition to usual care, and b) Usual care alone. DISCUSSION: The trial will show whether the Cancer Home-Life Intervention provides better support for people with advanced cancer living at home in performing and participating in everyday activities, and whether it contributes to their health-related quality of life. The economic evaluation alongside the RCT will show if the Cancer Home-Life Intervention is cost-effective. The trial will also show the acceptability of the intervention to the target group, and whether subgroups of participants will benefit more than others. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02356627. Registered 02/02/2015.

An 18-month follow-up study on vibrotactile sense, muscle strength and symptoms in computer users with and without symptoms.

OBJECTIVES: The aim was to explore whether symptoms, sensory perception and muscle strength among computer users with and without symptoms in forearm or hand had changed after 18 months. METHODS: Twenty-six out of 30 females, experienced computer users, from a baseline study participated in the follow-up. In addition, five control subjects participated. The subjects completed a questionnaire regarding exposure to computer work, prevalence and severity of symptoms, health status and physical activity. Perceived thresholds for vibration were measured twice with 3 h in between on the right hand on four different sites innervated by the radial, median or ulnar nerve. Furthermore, sensory perception was measured on the left hand on two sites innervated by the median and ulnar nerve, respectively. Skin temperature was measured at each site prior to sensory perception measurements. Maximal handgrip strength and maximal pinch-grip strength were measured for both hands. RESULTS: Eighty-three percent of the subjects who had symptoms at baseline still had symptoms and 21% of the subjects who did not have symptoms at baseline experienced symptoms at follow-up. The first and the second sensory perception measurement were highly correlated. Vibrotactile sensory threshold representing the radial nerve was increased since baseline among the subjects who originally had symptoms. At follow-up, the vibrotactile sense for the computer users who reported symptoms in forearm or hand at baseline was deteriorated for the sites representing the median, ulnar and radial nerves compared to the control group. Among the original symptom free subjects with intensive computer work increases in vibrotactile perception thresholds were found for the sites representing the median and ulnar nerves. Handgrip muscle strength remained unchanged for all groups. CONCLUSIONS: The study indicates that sensory dysfunctions as well as symptoms in forearm and hand among computer users to a high degree are persistent. Muscle strength seems to be well maintained.

Physical workload during use of speech recognition and traditional computer input devices.

Musculoskeletal symptoms among computer users are frequently found. The aim was to investigate the musculoskeletal workload during computer work using speech recognition and traditional computer input devices (keyboard/mouse). Ten experienced computer users (nine female, one male) participated. They performed three different computer tasks: (1). text entry and (2). text editing of a standard text and (3). a self-selected work task. These tasks were performed twice using speech recognition and traditional computer input devices (keyboard/mouse). Additionally, a task consisting of reading aloud of the standard text was performed. Surface EMG from the forearm (m. extensor carpi ulnaris, m. extensor carpi radialis), the shoulder (m. trapezius) and the neck extensor muscles was recorded, in addition to the voice-related muscles (m. scalenii, m. cricothyroideus). Using speech recognition during text entry and text editing reduced the static muscle activity of the forearm, neck and to some extent the shoulder muscles. Furthermore, tendencies to longer periods of muscle activity pause (relative time with EMG gaps) in the forearm and shoulder muscles were found. This was seen at the expense of a tendency to an increased static activity and a decreased relative time with EMG gaps in m. cricothyroideus. Finally, during use of speech recognition the hand was tied to the keyboard/mouse for a shorter period of time, while the eyes were viewing the screen for a longer period of time compared to the condition with traditional computer input devices. It is recommended to use speech recognition as a supplementary tool to traditional computer input devices.

Vibrotactile sense and mechanical functional state of the arm and hand among computer users compared with a control group.

OBJECTIVES: To measure sensory perception and mechanical muscle function of the arm among experienced female computer users with (+sPC) and without (-sPC) symptoms compared with a control group (ctrl). METHODS: Group +sPC had severe symptoms in the hand/wrist and/or the forearm/elbow region. They worked with the computer 75% and used a computer mouse 50% of the working day. Group -sPC had no or minimal symptoms. They used the computer 80% and a computer mouse 58% of the working day. The control group had no symptoms and worked with the computer for 2 h or fewer per day. Sensory perception threshold was measured using vibrotactilometry at five sites on the right hand representing nn. medianus, ulnaris and radialis. Mechanical muscle function was assessed by measuring muscle strength, wrist extension endurance, hand-eye co-ordination, and range of motion. Furthermore, performance was measured during standardized computer work. RESULTS: The perception thresholds for +sPC were greater in the areas innervated by n. medianus and n. ulnaris than for non-symptomatic groups, indicating that nerve compression is involved. For n. radialis, no differences were found between groups. No difference in isometric muscle strength was found for hand-grip, wrist extension, vertical pinch-grip and knee extension. However, for horizontal pinch-grip (pronated forearm) lower values were obtained for the +sPC group than for non-symptomatic groups. At the end of the endurance task, the perceived exertion was highest for +sPC. Furthermore, slower recovery was found for +sPC. No differences in range of motion, hand-eye co-ordination, and error rate during computer work were found between groups. CONCLUSIONS: Increased perception threshold values indicating entrapment of n. medianus and n. ulnaris were found for +sPC. Only few differences in mechanical muscle performance were found among the groups. The +sPC group had lower pinch-grip strength when measured in the pronated hand position, and the results indicated shorter muscle endurance for +sPC than for -sPC and ctrl.

Motor unit recruitment and rate coding in response to fatiguing shoulder abductions and subsequent recovery.

The purpose of the present study was to investigate motor unit (MU) recruitment and firing rate, and the MU action potential (MUAP) characteristics of the human supraspinatus muscle during prolonged static contraction and subsequent recovery. Eight female subjects sustained a 30 degrees shoulder abduction, requiring 11-12% of maximal voluntary contraction (MVC), for 30 min. At 10 and 30 min into the recovery period, the shoulder abduction was repeated for 1 min. The rating of perceived exertion for the shoulder region increased to "close to exhaustion" during the prolonged contraction, and the surface electromyography (EMG) recorded from the deltoid and trapezius muscles showed signs of local muscle fatigue. From the supraspinatus muscle, a total of 23,830 MU firings from 265 MUs were identified using needle electrodes. Of the identified MUs, 95% were continuously active during the 8-s recordings, indicating a low degree of MU rotation. The mean (range) MU firing rate was 11.2 (5.7-14.5) Hz, indicating the relative force contribution of individual MUs to be larger than the overall mean shoulder muscle load. The average MU firing rate remained stable throughout the prolonged abduction, although firing rate variability increased in response to fatigue. The average concentric MUAP amplitude increased by 38% from the beginning (0-6 min) to the end (24-29 min) of the contraction period, indicating recruitment of larger MUs in response to fatigue. In contrast, after 10 min of recovery the average MU amplitude was smaller than seen initially in the prolonged contraction, but not different after 30 min, while the MU firing rate was higher during both tests. In conclusion, MU recruitment plays a significant role during fatigue, whereas rate coding has a major priority during recovery. Furthermore, a low degree of MU rotation in combination with a high relative load at the MU level may imply a risk of overloading certain MUs during prolonged contractions.

Consistency of motor-unit identification during force-varying static contractions.

Due to inter-operator variability, two operators were used to assess the consistency of motor unit (MU) identification during ramp contractions, by the comparison of semi-automatic decompositions of the same recordings. Static shoulder abduction was performed against a force transducer in a position with the upper arms vertical and elbows flexed to 90 degrees. The subjects followed an 8-s force trajectory: 30% maximum voluntary contraction (MVC, 2 s), a reduction in force from 30% to 0% MVC (2 s), 0% MVC (1 s), an increase in force from 0 to 30% MVC (2 s), and 30% MVC (1 s). Muscle activity was recorded from the supraspinatus muscle with a quadripolar needle. From six recordings of 8 s duration, a total of 2527 MU firings were identified by both operators, and 93% of these were identified identically into 31 MUs. Both operators identified 8 of these MUs as continuously firing, 5 as only being active either before or after the 1 s at 0% MVC, and 18 as being de-recruited during force decreases and recruited during force increases. Both operators agreed that 16 of these 18 MUs were de-recruited at a higher force level than that at which they were recruited, which may be due to the electromechanical delay. The coefficient of variation for double determination of the results obtained by operators A and B was 8.5% for the number of MU firings, 4.5% for the MU mean firing rate, and 8.4% for the MU action potential (MUAP) amplitude. Therefore, the operator interactive decomposition method was considered to be valid for studying recruitment and de-recruitment as well as firing rate and MUAP amplitude during static, force-varying ramp contractions.