Preliminary Feasibility and Acceptability Examination of Using a Novel Ergonomic Chinrest with a Low Shoulder Rest by a Viola Player: A Case Report.

BACKGROUND: High-string players, such as violinists and violists, are prone to neck problems. One factor can be their body posture, with often a rotated and flexed neck position with the jaw placed on a flat chinrest. The Kréddle chinrest (EC) was specifically designed to promote a more neutral neck position and prevent musculoskeletal problems among high-string players. This case report aims to evaluate the preliminary feasibility and acceptability of using the EC, with a low shoulder rest, in a pain-free professional high-string player. A secondary aim was to register newly developed pain and fatigue. METHODS: A 32-year-old professional viola player was instructed to use the EC for most of her playing time during a 6-week trial period. Outcome measures such as compliance (% of use out of total playing time over the last 7 days), performance, comfort and acceptability were assessed at baseline and at the end of each trial week. The Rapid Upper Limb Assessment (RULA) tool was used to evaluate the body posture at baseline when using the EC versus her own chinrest and shoulder rest. RESULTS: The initial trial period was interrupted after 2 days due to pain. A second 6-week period was completed. While compliance was high and there was positive feedback on how the EC affected her performance and comfort while holding the instrument, the case report identified a challenge with the complex instruction material, which made it difficult to install and adjust the product. The viola player was positive towards using EC in the end despite pain and fatigue during the trial period. CONCLUSION: This case report examined a professional viola player's 6-week experience with an EC. While positive outcomes were observed in posture, performance, and product acceptance, issues with complex instructions were noted. This study marks the first exploration of individual challenges with EC use.

The user experience of violinists playing with a novel ergonomic chinrest: An evaluation on motivation, usage behaviour, usability and acceptance.

BACKGROUND: This study focuses on the user experience of a novel developed ergonomic chinrest (EC), customised to accommodate the individual violinist's anthropometry and playing style. The EC was recently tested for biomechanical effect, but the violin player's motivation, usage behaviour, usability and acceptability may be equally important. OBJECTIVE: To explore the user experience of violinists who used the novel EC with a low shoulder rest for two weeks. Through that experience, we wanted to learn about the potential user barriers and facilitators related to their motivation, usage behaviour, usability, and acceptability, when trying a new product. METHODS: Thirty-eight professional violinists participated and evaluated motivation, user behaviour, usability and acceptance using a 5-point Likert scale and open-ended questions. RESULTS: Participants showed high motivation hoping to improve posture, reduce muscle tension and enhance performance. Usage behaviour was also high, while product appearance, adjustment time, and sound impact were negatively evaluated. However, 37% planned to continue to use EC after the study. CONCLUSION: Participants showed high motivation and usage behaviour but faced challenges with product appearance, adjustment time, and sound impact compared to their usual chinrest. Incorporating user feedback and addressing design and usability challenges can enhance the user experience.

Measuring the usability of a novel ergonomic chinrest during violin playing: A feasibility study.

BACKGROUND: Playing the violin often requires a rotated and lateral flexed neck, leading to potential neck and shoulder problems. An ergonomic chinrest (EC) with or without a shoulder rest (SR or WSR) may enhance neutral neck positioning, but the feasibility of the EC needs to be studied. OBJECTIVE: Our goal was to evaluate the usability of the EC for a two-week familiarisation period, including aspects such as playing performance, comfort level, and emotional response (e.g., feelings about using the product) among a group of violinists. METHODS: A one-arm feasibility study was conducted to assess the feasibility of violinists playing with EC every day for two weeks. Six violinists who usually played with SR were included and asked to divide their daily playing time equally between SR and WSR. Feasibility outcomes were measured as adherence (days), compliance (playing hours per day) and usability (5-point Likert scale and open-ended questions). Compliance was achieved with a minimum of 25% playing time. RESULTS: Daily violin playing with EC showed high adherence of 89.3%. Compliance with the 25% play time criterion was met for SR, but not for WSR. Low playing performance (median 45.8 points difference), long confidence time (two violinists failed to reach a confidence level) and mainly negative feedback (26 out of 33 comments) were found in WSR compared to SR. CONCLUSIONS: The feasibility of playing WSR was low and negatively impacted playing performance. As a result, a larger-scale study will only evaluate the EC with SR due to greater feasibility.

Rickettsiosis in Denmark: A nation-wide survey.

Rickettsia helvetica has been reported at varying prevalences in Danish and other European Ixodes ricinus populations. Though apparently widespread and with reported cases of human infection, the significance of the bacteria as a threat to public health remains unclear. We present a nation-wide survey of rickettsia in ticks, roe deer and humans in Denmark. Ticks were collected by flagging and screened for presence of rickettsial DNA by polymerase chain reaction. Sera from roe deer, hunters, neuroborreliosis patients and blood donors were analyzed for presence of anti-R. helvetica and Rickettsia felis antibodies by immunofluorescence microscopy. The Rickettsia minimum infection rate in ticks was 4.9 % (367/973 pools positive, 7510 ticks in total), with 3.9 % in nymphs and 9.3 % in adults. Rickettsia helvetica accounted for 4.17 % and Rickettsia monacensis for 0.03 %, 0.6 % comprised non-differentiable rickettsial DNA. The prevalence of antibodies against R. helvetica was 2.8 % (9/319) in roe deer, while no hunters (n = 536) or blood donors (n = 181) were positive. The prevalence of anti-R. helvetica antibodies among Lyme neuroborreliosis patients was 6 % (3/47), where it co-occurred with Anaplasma phagocytophilum. Based on our study autochthonous rickettsiosis is of limited concern to the public health in Denmark, but our finding of R. monacensis for the first time in Denmark illustrates the dynamic nature of tick-borne pathogens, emphasizing that continuous surveillance is necessary.

The effects of an ergonomic chinrest among professional violin players. A biomechanical investigation in a randomised crossover design.

This study aimed to compare violinists' upper body kinematics and muscle activity while playing with different supportive equipment: their usual chinrest (UC) or an ergonomic chinrest (EC), each mounted on the violin. Three-dimensional motion capture and electromyographic data were acquired from the upper body while 38 pain-free professional violinists performed an excerpt of a music piece. There were only minor differences between the two set-ups tested. The EC resulted in less left rotation of the head (3.3°), slightly more neck extension (1.3°) and less muscle activity (0.5-1.0 %MVE). However, the overall high static muscle activity (4-10 %MVE across all muscles) was maintained using EC. For both setups, the head posture was left-rotated >15°, ≤6° flexed and left-bent 90% of the time. The EC did not produce a substantial difference in biomechanical load. Instead, future studies may focus on aspects other than chinrest design to lower the static workload demands.

Effects of different violin playing techniques on workload in forearm and shoulder muscles.

Due to their working position, violinists are more prone to musculoskeletal pain than other instrumentalists. Playing the violin may cause increased activity in the shoulder and forearm muscles due to techniques such as vibrato (pitch variation), double-fingering (thirds), and changes in speed and volume (piano and forte). This study investigated how the different violin techniques affect muscle activity while playing scales and a music piece. Surface EMG was recorded bilaterally from the upper trapezius and forearm muscles in 18 violinists. Increased playing speed followed by playing with vibrato was the most demanding task affecting the left forearm muscles. Playing forte was the most demanding factor for the right forearm muscles. The music piece and the grand mean of all techniques showed similar workload demands. These results show that specific techniques require higher workload demands and should be considered when planning rehearsals with these techniques as a part of injury prevention.

Workplace Social Capital as Buffer for Emotional Demands and Perceived Stress in Symphony Orchestras: A Danish Cross-Sectional Survey.

INTRODUCTION: High workplace social capital (WSC) is associated with improved occupational health in the common occupational areas. However, little is known on WSC and its effect on the emotional demands and stress seen in the work of classical symphonic musicians. AIM: To investigate whether WSC moderates the associations between emotional demands and stress in the professional musicians working in Danish symphony orchestras. METHODS: This cross-sectional study builds on existing data collected on a sample of 341 Danish classical symphonic musicians. An interaction model based on multiple regression with bias corrected boot-strapping was used to assess the moderating effect of low, medium and high levels of WSC on the association between emotional demands and perceived stress. RESULTS: WSC had a significant moderating effect on the association between emotional demands and perceived stress: b = -0.01, t(212) = -2.40, p = 0.018. At low levels of WSC the effect of emotional demands on stress was strongest, declining at higher levels of WSC in a dose response pattern: low-WSC, b = 0.23, t(212) 3.20, p = 0.002, medium-WSC, b = 0.11, t(212) = 2.40, p = 0.017, and high-WSC, b = 0.04, t(212) = 0.75, p = 0.455. CONCLUSION: The study indicates a buffering effect of WSC on the association between emotional demands and stress in the work of orchestra musicians. Thus, enhancement of WSC could be a potential stress-preventing strategy in symphony orchestras and should be investigated in future studies on musicians' mental health.

A genome-wide meta-analysis yields 46 new loci associating with biomarkers of iron homeostasis.

Iron is essential for many biological functions and iron deficiency and overload have major health implications. We performed a meta-analysis of three genome-wide association studies from Iceland, the UK and Denmark of blood levels of ferritin (N = 246,139), total iron binding capacity (N = 135,430), iron (N = 163,511) and transferrin saturation (N = 131,471). We found 62 independent sequence variants associating with iron homeostasis parameters at 56 loci, including 46 novel loci. Variants at DUOX2, F5, SLC11A2 and TMPRSS6 associate with iron deficiency anemia, while variants at TF, HFE, TFR2 and TMPRSS6 associate with iron overload. A HBS1L-MYB intergenic region variant associates both with increased risk of iron overload and reduced risk of iron deficiency anemia. The DUOX2 missense variant is present in 14% of the population, associates with all iron homeostasis biomarkers, and increases the risk of iron deficiency anemia by 29%. The associations implicate proteins contributing to the main physiological processes involved in iron homeostasis: iron sensing and storage, inflammation, absorption of iron from the gut, iron recycling, erythropoiesis and bleeding/menstruation.

Surface electromyography of forearm and shoulder muscles during violin playing.

The aims of this study were to explore muscle activity levels during different violin repertoires, quantify the general levels bilaterally in upper extremity muscles, and evaluate associations between muscle activity and anthropometrics characteristics. In 18 skilled violin players surface EMG was recorded bilaterally from trapezius (UT), flexor digitorum superficialis (FDS), extensor carpi ulnaris (ECU), extensor digitorum cummunis (EDC), and extensor carpi radialis (ECR) during A and E major scales played in three octaves and Mozart's Violin Concerto no. 5. To compare side differences the static, median and peak levels of muscle activity were calculated from an amplitude probability distribution function (APDF). This study demonstrated that scales played as standardized tasks can be used to estimate the average muscle activity during violin playing. Comparing results from scales and the music piece revealed a similar muscle activity across all muscles in the music piece and E major scales. The static, median and peak EMG levels were higher in left than in right forearm muscles with left ECU presenting the highest peak load of 30 %MVE. Females demonstrated a higher muscle activity than males, but this was in accordance with differences in anthropometric measures.

Performance characteristics of thromboelastometry assays using incompletely filled and prolonged stored samples.

BACKGROUND: Thromboelastometry (TEM) is often used to guide transfusion therapy in patients with massive bleeding. The effect of testing incompletely filled samples and those stored for a prolonged time at 4°C was investigated. METHODS: Whole blood samples were collected from 15 healthy blood donors and were pooled according to ABO group. From these pools, aliquots were taken and diluted to produce final whole blood:citrate buffer ratios ranging from 90:10 (fully filled sample) to 40:60 (extremely under filled samples). These samples were then tested by EXTEM, INTEM, and FIBTEM on calibrated ROTEM delta machines. Separately, the four samples at 90:10 dilution were kept at 4°C for 16-20 hours and then retested on the ROTEM machines. RESULTS: All of the samples at the 90:10 and 80:20 (half-filled sample) whole blood:citrate buffer dilutions demonstrated ROTEM parameters within their respective reference ranges, although the samples from the 80:20 dilution tended to demonstrate slightly longer or slower times, depending on each ROTEM parameter, compared to the completely filled samples. All of the samples with more dilute whole blood to citrate buffer ratios (i.e., 70:30 to 40:60) yielded abnormal TEM results. The TEM results for the 90:10 dilution samples exposed to 16-20 hours of storage at 4°C were within the reference intervals. CONCLUSION: Completely and half-filled samples, and completely filled samples after prolonged cold storage, produced normal ROTEM results. Tubes that are less than half-filled should not be used for ROTEM testing.

Prevalence and socio-demographic characteristics of persons who have never had a headache among healthy voluntary blood donors - a population-based study.

INTRODUCTION: Headache is an extremely prevalent disorder with a lifetime prevalence of 90-99%. However, a small fraction of people never experiences a headache. Research on people without headache could uncover protective factors in headache, but to our knowledge no study on headache-free individuals has been published. We aim to estimate the prevalence of headache-free individuals among Danish blood donors, and to describe the socio-demographics and health factors of headache-free participants. MATERIALS AND METHODS: In all, 38,557 healthy volunteers were recruited as part of the Danish Blood Donor Study. Headache-free participants were identified based on the question "Have you ever experienced a headache of any kind?". Utilising the Danish registries and self-reported questionnaires, we analysed socio-demographic and lifestyle factors using logistic regression adjusted for age and sex. RESULTS: The prevalence of headache-free individuals was 4.1% (n = 1362) with a female-male ratio of 1:2.2. To be headache free was significantly associated with an employment status as a student, a low level of income and a regular alcohol consumption. DISCUSSION: The prevalence of headache-free individuals was comparable to population-wide studies of headache. To be headache free was not associated with a high socio-economic status. Further studies on people without headache will hopefully reveal protective factors in headache, and this novel approach might be useful in other very prevalent disorders.

Self-reported restless legs syndrome and involuntary leg movements during sleep are associated with symptoms of attention deficit hyperactivity disorder.

BACKGROUND: Restless legs syndrome (RLS) and attention-deficit hyperactivity disorder (ADHD) are disorders with virtually unknown etiologies. Several studies suggest that these disorders are comorbid. However, previous findings may have been influenced by study participants undergoing medical treatments. Thus, the association between RLS and ADHD needs to be investigated in a large population of individuals, not in continuous medical treatment. MATERIALS AND METHODS: This was a cross-sectional study of 25,336 participants enrolled in the Danish Blood Donor Study from May 1, 2015, to February 1, 2017. Study participants completed the Cambridge-Hopkins RLS questionnaire, reported experience of involuntary leg movements during sleep (ILMS), completed the Adult ADHD Self-Report Scale v.1.1 (ASRS), and provided information on sex, age, body mass index, smoking status, alcohol consumption, whole blood donation history, and self-appraised quality of sleep. Associations between RLS and ADHD symptoms, including subtypes, were examined using multivariate linear- and logistic regression analyses. RESULTS: Of the 25,336 participants with complete data, 1,322 (5.2%) were classified with RLS, and 653 (2.6%) experienced ADHD symptoms. RLS sufferers were more prone to classify with ADHD according to the full ASRS (OR = 3.57, 95% CI: 3.14-4.0), and they were also more likely to experience ADHD-subtype symptoms (inattention, OR = 1.66, 95% CI: 1.43-1.90; hyperactivity-impulsivity, OR = 1.90, 95% CI: 1.66-2.14). Finally, RLS sufferers with ILMS had increased odds for ADHD symptoms compared with RLS sufferers without (OR = 2.15, 95% CI: 1.30-3.55). This was also observed for the hyperactivity-impulsivity subtype (OR = 5.57, 95% CI: 2.14-14.5). CONCLUSIONS: RLS and ADHD are associated and may be comorbid disorders.

Tinnitus Severity Is Related to the Sound Exposure of Symphony Orchestra Musicians Independently of Hearing Impairment.

OBJECTIVES: Tinnitus can be debilitating and with great impact of musicians professional and private life. The objectives of the study were therefore to: (1) describe the epidemiology of tinnitus including its severity in classical orchestra musicians, (2) investigate the association between tinnitus severity in classical musicians and their cumulative lifetime sound exposure, and (3) the association between tinnitus and hearing thresholds. DESIGN: The study population included all musicians from five Danish symphony orchestras. Answers regarding their perception of tinnitus were received from 325 musicians, and 212 musicians were also tested with audiometry. Any tinnitus and severe tinnitus were two definitions of tinnitus used as outcomes and analyzed in relation to an estimation of the cumulative lifetime sound exposure from sound measurements and previously validated questionnaires and the average hearing threshold of 3, 4, and 6 kHz. RESULTS: Thirty-five percentage of all musicians (31% female and 38% of male musicians) reported having experienced at least one episode of tinnitus lasting for more than 5 minutes during their life. Severe tinnitus with a severe impact on daily life was reported by 19% of the musicians (18% of female and 21% of male musicians). The severity of tinnitus was associated with increased lifetime sound exposure but not to poorer high frequency hearing thresholds when the lifetime sound exposure was considered. The odds ratio for an increase in one unit of tinnitus severity was 1.25 (95% CI, 1.12-1.40) for every 1 dB increase in lifetime sound exposure. CONCLUSION: Musicians frequently report tinnitus. Any tinnitus and severe tinnitus are significantly associated with the cumulative lifetime sound exposure, which was shown to be the most important factor not only for the prevalence but also for the severity of tinnitus-even in musicians without hearing loss. High-frequency hearing thresholds and tinnitus severity were correlated only if the cumulative lifetime sound exposure was excluded from the analyses.

Comorbidity of migraine with ADHD in adults.

BACKGROUND: Migraine and Attention Deficit and Hyperactivity Disorder (ADHD) have been found to be associated in child and adolescent cohorts; however, the association has not been assessed in adults or otherwise healthy population. Assessing the comorbidity between ADHD and migraine may clarify the etiopathology of both diseases. Thus, the objective is to assess whether migraine (with and without visual disturbances) and ADHD are comorbid disorders. METHODS: Participants from the Danish Blood Donor Study (N = 26,456, age 18-65, 46% female) were assessed for migraine and ADHD using the ASRS ver 1.1 clinically validated questionnaire and self-reported migraine in a cross-sectional study. Logistic regression was used to examine the comorbidity between migraine and ADHD, and their associated endophenotypes. RESULTS: Migraine was strongly associated with ADHD (OR = 1.8, 95% CI = 1.5-2.1), (238/6152 vs 690/19,376). There was a significant interaction between age and gender, with comorbidity increasing with age and female sex. Post-hoc analysis showed that migraine with visual disturbance was generally associated with a marginally higher risk of ADHD and this was independent of ADHD endophenotypes. CONCLUSION: Migraine and ADHD were demonstrated to be comorbid disorders; the association with ADHD was most prominent for participants with migraine with visual disturbances. Future studies will elucidate which genetic and environmental factors contribute to migraine-ADHD comorbidity.

Reduced ferritin levels in individuals with non-O blood group: results from the Danish Blood Donor Study.

BACKGROUND: Genomewide association studies have reported alleles in the ABO locus to be associated with ferritin levels. These studies warrant the investigation of a possible association between the ABO blood group and ferritin levels. We aimed to explore if ABO blood group is associated with iron stores expressed as ferritin levels. STUDY DESIGN AND METHODS: Ferritin levels were measured at least once for 30,595 Danish Blood Donor Study participants. Linear regression analyses were performed with the ABO blood group as explanatory variable and adjusted for age, number of donations 3 years before the ferritin measurement, and time since latest donation. In addition, a subanalysis was performed on 15,280 individuals in which further adjustments for body mass index, smoking status, and C-reactive protein levels were possible. Furthermore, logistic regression analyses were performed to determine if ABO blood group was associated with a ferritin level of less than 15 ng/mL. RESULTS: Non-O blood group donors had lower ferritin levels than blood group O donors, regardless of sex. Accordingly, risk of ferritin level of less than 15 ng/mL was increased for individuals with non-O blood group compared with O blood group. In subanalyses similar associations were observed, albeit in women the association between blood group and risk of a ferritin level below 15 ng/mL was no longer significant. ABO blood group was not associated with red blood cell indices such as mean cell volume and mean cell hemoglobin content. CONCLUSION: Donors with non-O blood group have lower ferritin levels than donors with other blood groups.

Hearing loss in relation to sound exposure of professional symphony orchestra musicians.

OBJECTIVES: The objectives of this study were to: (1) estimate the hearing status of classical symphony orchestra musicians and (2) investigate the hypothesis that occupational sound exposure of symphony orchestra musicians leads to elevated hearing thresholds. DESIGN: The study population comprised all the musicians from five symphony orchestras. Questionnaires were filled in by 337 subjects, and 212 subjects performed an audiometric test. For a group of 182 musicians (363 ears) the results of the audiometry was analyzed in relation to the individual exposure, which was estimated on the basis of sound measurements and questionnaire data regarding the exposure time. The mean hearing threshold at the frequencies 3, 4, and 6 kHz, corrected for age and sex, was used as outcome. RESULTS: The musician ears with the highest exposure (29 of 363) had an additional threshold shift of 6.3 dB compared with the 238 ears with lowest exposure. The observed hearing loss of musicians was smaller compared with the noise-induced permanent threshold shift (NIPTS) predicted from ISO1999. A remaining confounding effect of age after ISO7029 age corrections could be observed to explain the difference in observed and predicted NIPTS. However, the observed hearing loss difference between the left and the right ear of musicians was 2.5 dB (95% confidence interval 1.5-3.6), which was similar to the NIPTS predicted from ISO1999. Most of the musicians had better hearing at 3, 4, and 6 kHz for age than expected, however, 29 ears with the highest exposure above 90.4 dBA with a mean exposure time of 41.7 years had significantly elevated hearing thresholds. Trumpet players and the left ear of first violinists had significantly elevated hearing thresholds compared with other musicians. CONCLUSION: Most of the symphony orchestra musicians had better hearing than expected but they had a work-related risk of developing additional noise-induced hearing loss. The additional NITPS of the left ear compared with the right ear was at the expected level based on the cumulated sound exposure and ISO1999, indicating that performing music may induce hearing loss to the same extent as industrial noise.

Occurrence and co-existence of localized musculoskeletal symptoms and findings in work-attending orchestra musicians - an exploratory cross-sectional study.

BACKGROUND: Due to ergonomic exposure musicians are at risk of work-related musculoskeletal disorders in the neck, back, and upper extremities. The literature confirms musculoskeletal problems in these anatomic regions among orchestra musicians. METHODS: An explorative cross-sectional study among 441 musicians from six Danish symphony orchestras; 216 underwent a clinical examination constructed for the purpose. Prior to the examination the musicians rated their maximally perceived trouble within the last week on a scheme blinded to the examiner. Accessibility to the clinical examination differed between orchestras.The aims were to assess the prevalence of 1) perceived symptoms within the previous week in the neck, back and limbs and of 2) clinical findings in the neck, back, and upper extremities, and 3) to investigate the co-existence of the perceived symptoms and clinical findings. RESULTS: Symptoms and findings were most common in the neck, back, and shoulders. Due to a poor co-existence between self-reported symptoms and clinical findings musicians experiencing bodily trouble could not be identified through this clinical examination. Free accessibility to the examination was of major importance to participation. CONCLUSIONS: In compliance with the purpose, perceived symptoms within the previous week and present clinical findings were assessed. Although both symptoms and findings were most frequent in the neck, back, and shoulders the co-existence of anatomically localized symptoms and findings was generally quite poor in this study.Discrepancy between symptoms and findings might be caused by the participants currently attending work and therefore being relatively healthy, and the fluctuating nature of musculoskeletal problems. Furthermore from a comparison of different measuring units - self-reported symptoms being period prevalence rates and clinical findings point prevalence rates; a bias which may also be inherent in similar studies combining self-reported questionnaire data and clinical findings.

A cross-sectional study of psychosocial work environment and stress in the Danish symphony orchestras.

PURPOSE: To investigate psychosocial work environment and stress in Danish symphony orchestra musicians. METHODS: This was a cross-sectional questionnaire survey of psychosocial work factors and stress symptoms among 441 musicians in six Danish symphony orchestras. The response rate was 78% (n = 342). The questions were from COPSOQ (Copenhagen Psychosocial Questionnaire). Mean values of 19 COPSOQ-scales were compared by gender and instrument group. The results for the musicians were compared with results for the general Danish work force (COPSOQ database). RESULTS: Female musicians reported higher work demands and higher stress symptoms than their male colleagues. Between instrument groups, 2nd violinists seemed to be of particular risk compared with the other instrumental groups in aspects of work pace, work organization, and content, whereas 1st violinists perceived higher emotional stress compared with 2nd violinists. The musicians' experience of increased work demands as well as deteriorated, work organization and job content, interpersonal relations and leadership, and work-individual interface was significantly associated with increasing stress symptoms. Compared to the general workforce independently of gender, Danish symphony orchestra musicians reported higher emotional demands, lower influence, lower social support, lower sense of community, and lower job satisfaction. However, the musicians reported a higher commitment to the workplace. CONCLUSIONS: The findings indicate a more demanding psychosocial work environment exposure among symphony orchestra musicians than among Danish workers in general. Critical results are the relatively high work demands, low influence, and low social support, females being of higher risk than males.

Prevalence and consequences of musculoskeletal symptoms in symphony orchestra musicians vary by gender: a cross-sectional study.

BACKGROUND: Musculoskeletal symptoms are common in the neck, back, and upper limbs amongst musicians. Playing-related musculoskeletal disorders have been found to range from 32% to 87% with a tendency for female musicians to have more problems than males. Studies of musculoskeletal problems in instrumentalists have generally involved pre-professional musicians or populations comprising musicians of different levels. The objective of this study was therefore to investigate the prevalence, duration and consequences of musculoskeletal symptoms in professional symphony orchestra musicians. METHODS: A cross-sectional questionnaire study. The study population comprised of 441 musicians from six Danish symphony orchestras; 342 (78%) completed the questionnaire. RESULTS: During the last year 97% of the women and 83% of the men experienced symptoms in at least one of nine anatomic regions (neck, upper and lower back, shoulders, elbows, and hands and wrists). 86% of the women and 67% of the men experienced symptoms for more than seven days, while 63% of the women and 49% of the men had symptoms for more than 30 days. Woodwind players had a lower risk for musculoskeletal symptoms and a lower risk for the consequences. Among consequences were changed way of playing, reported by 73% of the musicians, difficulty in daily activities at home, reported by 55%, and difficulty in sleeping, reported by 49%. Their health behaviour included taking paracetamol as the most used analgesic, while physiotherapists and general practitioners were reported as the most consulted health care professionals concerning musculoskeletal problems.Results regarding symptoms in six anatomic regions were compared to results for a sample of the general Danish workforce. Symptoms were more frequent in musicians and lasted longer than in the general workforce. This applied to both genders. CONCLUSIONS: Within the last year most symphony orchestra musicians experienced musculoskeletal symptoms in the neck, back or upper extremities. The symptoms impacted on their level of function in and outside work and were reflected in their health behaviour. Generally women had a higher risk than men and woodwind players a lower risk than other instrumentalists. Finally, symptoms were more frequent and lasted longer in the musicians than in the general workforce.