Occupational exposures and complaints of neck, shoulder, arm, or hand

A systematic review

Reading time approx. 17 minutes Published: Publication type:

SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

Contact SBU
Published: Report no: 349 Registration no: SBU 2018/747 ISBN: 978-91-88437-93-8 https://www.sbu.se/349e

Introduction

This systematic review is a sequel to the report “Occupational exposures and neck and upper extremity disorder” published by SBU in 2012. The term complaint is used as a general description of all symptoms in a region and comprises pain, discomfort, and specific diseases.

Conclusions

This systematic literature review has uncovered a substantial body of evidence that supports an increased risk of complaints of neck, shoulder, arm, or hand are associated with a variety of occupational exposures. Conclusions are not formulated for the results evaluated as having a very low certainty of evidence. No results were evaluated as having a high certainty of evidence. The review evaluates longitudinal studies on the association between exposures in the workplace and complaints but cannot give a definite answer to whether occupational exposure is the only contributing factor to these complaints.

People with the following occupational exposures more often develop complaints of neck or neck/shoulders than people who are not subjected to the specified exposure to the same degree:

  • working with the neck bent forwards or backwards (moderate certainty)
  • working with arms elevated (low certainty)
  • working with repetitive arm movements (low certainty)
  • experiencing high quantitative demands (low certainty)
  • experiencing an imbalance between efforts and rewards (low certainty)

People with the following occupational exposures more often develop complaints of shoulders or impingement than people who are not subjected to the specified exposure to the same degree:

  • doing heavy lifting and forceful work with neck and/or shoulders (moderate certainty)
  • working with arms elevated (moderate certainty)
  • working with repetitive arm movements (moderate certainty for shoulder complaints and low certainty for impingement)

People with the following occupational exposures more often develop complaints of arms and/or forearms than people who are not subjected to the specified exposure to the same degree:

  • doing heavy lifting and forceful work with neck and/or shoulders (moderate certainty)
  • doing forceful work with wrist and/or hand (low certainty)
  • working with repetitive arm movements (low certainty)

People exposed to forceful work with neck and/or shoulders more often develop ulnar nerve entrapment than people who are not subjected to the specified exposure to the same degree.

People with the following occupational exposures more often develop complaints of wrists and/or hands than people who are not subjected to the specified exposure to the same degree:

  • doing forceful work with wrists and/or hands (moderate certainty)
  • doing forceful work combined with repetitive movements with hands (moderate certainty)
  • working with wrists in a bent or twisted position (low certainty)
  • working with repetitive wrist and/or hand movements (low certainty)
  • experiencing high job strain, that is a situation where one experiences high job demands combined with low control or decision latitude at work (low certainty)

People with the following occupational exposures more often develop carpal tunnel syndrome than people who are not subjected to the specified exposure to the same degree:

  • doing forceful work with wrist and/or hand (moderate certainty)
  • doing forceful work combined with repetitive movements with hands (moderate certainty)

Results regarding differences between men and women were inconclusive, so this report cannot conclude if women and men with similar occupational exposures develop complaints of neck, shoulders, arms, or hands to a different extent.

Background and Aim

The objective of this systematic review is to assess the scientific evidence describing the influence of occupational exposures on the development of complaints in the neck, shoulders, arms, or hands. A wide range of occupational exposures were investigated, for example, physical workload, and psychosocial and organisational factors.

Review questions

  1. Is there an association between exposures in the workplace and complaints of neck, shoulders, arms, or hands?
  2. To what extent do these associations differ between women and men?

Inclusion criteria

The inclusion criteria were structured according to PEOS (Population, Exposure, Outcome, and Study design).

PEO

Population: Workers in various occupations.

Exposure: Exposures in the workplace. Exposures only assessed by job title, and vibration exposures were excluded.

Outcome: Complaints of neck, shoulders, arms, or hands. Indirect assessments of complaints, such as sick leave, were excluded.

Study design: Prospective and retrospective cohort studies and case-control studies.

Language: English, Swedish, Norwegian, or Danish.

Search period: From 2010 to 2021. Final search august, 2021.

Databases searched: Embase via Elsevier, Ovid MEDLINE, PsycInfo via EBSCO, and Scopus via Elsevier.

Client/patient involvement: No

Method

A systematic review was undertaken following the PRISMA statement and standard methods used by SBU adapted to the context of occupational exposures. Studies that fulfilled the inclusion criteria were assessed for risk of bias by two experts independently, using pre-set protocols. After conducting independent assessments, the two experts had to agree on a mutual relevance and risk of bias classification. Only studies with low or moderate risk of bias were included in the assessment. The certainty of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results

A total of 19 451 abstracts were identified by the literature search (see Flow chart), 908 were read in full-text and 133 studies were eligible. Sixtyfive longitudinal or case-control studies were considered to have a low or moderate risk of bias and were included in the analyses.

Tables below. Summary of findings for the association between occupational exposure and complaints of neck, shoulders, arms, or hands. The results are based on longitudinal and case-controls studies.

Table 1 Neck or neck/shoulders.
⊕◯◯◯ = Insufficient scientific evidence; ⊕⊕◯◯ = Limited scientific evidence
Occupational exposureNumber of studies
Number of participants total (n)		Location of complaintsGRADEInterpretation
Force (push, pull, lift, or exert a force)
with neck and/or shoulders 7 studies
n=4677		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
with wrist and/or hand 1 study
n=1324		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
Posture
Neck posture 5 studies
n=47 918		 Neck or neck/shoulders ⊕◯◯◯ A positive association exists
Trunk posture 3 studies
n=40 557		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
Upper arm posture 8 studies
n=13 347		 Neck or neck/shoulders ⊕⊕◯◯ A positive associa­tion exists
Sitting 2 studies
n=2135		 Neck or neck/
shoulders		 ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Movements
Repetitive arm move­ments 4 studies
n=47 225		 Neck or neck/
shoulders		 ⊕⊕◯◯ A positive associa­tion exists
Repetitive wrist and/or hand move­ments 2 studies
n=1642		 Neck or neck/
shoulders		 ⊕◯◯◯ Cannot determine if an associa­tion exists
Combination of physical exposures
Force and trunk posture 1 study
n=317		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
Akward lifting 1 study
n=6745		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
Force and neck/shoulder posture 1 study
n=91		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
Psychosocial work demands
Quantitative demands 10 studies
n=17 788		 Neck or neck/shoulders ⊕⊕◯◯ A positive association exists
Qualitative demands 3 studies
n=3990		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
Job strain 3 studies
n=759		 Neck or neck/shoulders ⊕◯◯◯ Cannot determine if an associa­tion exists
Effort-reward imbalance 3 studies
n=3754		 Neck or neck/shoulders ⊕⊕◯◯ A positive associa­tion exists
Effort level 2 studies
n=1489		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job insecurity 1 study
n=245		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job stress 1 study
n=25 806		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Working with temporary workers 1 study
n=1510		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Role conflict 2 studies
n=9161		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Work pace 1 study
n=1510		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Psycho­social work resources
Job control 12 studies
n=39 101		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Social support 8 studies
n=5455		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Predictability 1 study
n=2416		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Rewards 2 studies
n=1489		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Advance­ment oppor­tunities 4 studies
n=5500		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Organisa­tional factors
Shift work 3 studies
n=4512		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Overtime work 1 study
n=1324		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Scope of work 2 studies
n=1532		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Temporary employ­ment 1 study
n=1510		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Accord system 1 study
n=245		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Destruc­tive leader ­1 study
n=951		 Neck or neck/shouldersy ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Fair leadership 3 studies
n=10 076		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Social factors
Bullying 1 study
n=5277		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Other exposures
Visual environ­ment 1 study
n=208		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Sensory demands 1 study
n=208		 Neck or neck/shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists

 

⊕◯◯◯ = Insufficient scientific evidence; ⊕⊕◯◯ = Limited scientific evidence; ⊕⊕⊕◯ = Moderately strong scientific evidence
Occupa­tional exposureNumber of studies
Number of partici­pants total (n)		Location of com­plaintsGRADEInter­pretation
Force (push, pull, lift, or exert a force)
with neck and/or shoulders 7 studies
n=83 203		 Shoulders ⊕⊕⊕◯ A positive associa­tion exists
with neck and/or shoulders 5 studies
n=44 233		 Impinge­ment ⊕⊕⊕◯ A positive associa­tion exists
with wrist and/or hand 1 study
n=167		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Posture
Trunk posture 1 study
n=317		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Upper arm posture 12 studies
n=87 676		 Shoulders ⊕⊕⊕◯ A positive associa­tion exists
Upper arm posture 6 studies
n=45 689		 Impingement ⊕⊕⊕◯ A positive associa­tion exists
Elbow and/or wrist posture 1 study
n=38 897		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Movements
Repetitive arm move­ments 7 studies
n=84 075		 Shoulders ⊕⊕⊕◯ A positive associa­tion exists
Repetitive arm move­ments 5 studies
n=44 739		 Impingement ⊕⊕◯◯ A positive associa­tion exists
Precise move­ments with arms 1 study
n=240		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Combina­tion of physical expo­sures
Force and posture 2 studies
n=2103		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Force, posture, and repetitive move­ments 2 studies
n=42 798		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Psychosocial work demands
Quantita­tive demands 6 studies
n=40 279		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Quantitative demands 3 studies
n=38 134		 Impingement ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Qualitative demands 2 studies
n=735		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job strain 3 studies
n=4533		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Effort-reward imbalance 1 study
n=106		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Effort level 1 study
n=1801		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Obstacles and interrup­tions 1 study
n=1801		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job insecurity 1 study
n=1801		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Working with tempo­rary workers 1 study
n=1655		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Work pace 1 study
n=1655		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Psychosocial work resources
Job control 8 studies
n=42 713		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job control 3 studies
n=38 134		 Impingement ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Social support 7 studies
n=47 306		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Social support 3 studies
n=43 283		 Impingement ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Predicta­bility 1 study
n=1655		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Advance­ment oppor­tunities 2 studies
n=6880		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Organisational factors
Shift work 2 studies
n=3111		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Overtime work 2 studies
n=3111		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Security climate 1 study
n=247		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Tempo­rary employ­ment 2 studies
n=3111		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Other exposures
Heat 1 study
n=1655		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Visually demanding work 1 study
n=1655		 Shoulders ⊕◯◯◯ Cannot deter­mine if an associa­tion exists

 

Table 3 Arms.
HAL TLV = Hand Activity Level – Threshold Limit Value
⊕◯◯◯ = Insufficient scientific evidence; ⊕⊕◯◯ = Limited scientific evidence; ⊕⊕⊕◯ = Moderately strong scientific evidence
Occupational exposureNumber of studies
Number of participants total (n)		Location of complaintsGRADEInterpre­tation
Force (push, pull, lift, or exert a force)
with neck and/or shoulders 5 studies
n=273 806		 Arms ⊕⊕⊕◯ A positive associa­tion exists
with neck and/or shoulders 3 studies
n=233 744		 Ulnar nerve entrapment ⊕⊕⊕◯ A positive associa­tion exists
with wrist and/or hand 4 studies
n=231 494		 Arms ⊕⊕◯◯ A positive associa­tion exists
with wrist and/or hand 3 studies
n=1805		 Epicondylalgia ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Posture
Trunk posture 1 study
n=699		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Upper arm posture 1 study
n=3833		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Elbow and wrist posture 5 studies
n=270 388		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Movements
Arm movements 1 study
n=229 689		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Repetitive arm movements 3 studie
n=272 252		 Arms ⊕⊕◯◯ A positive associa­tion exists
Wrist and/or hand movements 4 studies
n=231 414		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Wrist and/or hand movements 3 studies
n=1725		 Epicondylalgia ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Repetitive wrist and/or hand movements 4 studies
n=231 127		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Combination of physical exposures
Force and posture 1 study
n=611		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Strain Index 2 studies
n=1026		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Grip score 1 study
n=229 689		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
HAL TLV 1 study
n=495		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Psychosocial work demands
Quantitative demands 1 study
n=531		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job insecurity 1 study
n=531		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job stress 1 study
n=531		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Work pace 1 study
n=531		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Psychosocial work resources
Job control 1 study
n=531		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Social support 3 studies
n=1725		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Social support 3 studies
n=1725		 Epicondylalgia ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Other exposures
Heat 1 study
n=3833		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Cold 1 study
n=3833		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Temperature changes 1 study
n=3833		 Arms ⊕◯◯◯ Cannot deter­mine if an associa­tion exists

 

Table 4 Wrists and hands.
HAL TLV = Hand Activity Level – Threshold Limit Value
⊕◯◯◯ = Insufficient scientific evidence; ⊕⊕◯◯ = Limited scientific evidence; ⊕⊕⊕◯ = Moderately strong scientific evidence
Occupa­tional exposureNumber of studies
Number of participants total (n)		Location of com­plaintsGRADEInterpre­tation
Force (push, pull, lift, or exert a force)
with neck and/or shoulders 5 studies
n=46 994		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Heavy lifting 3 studies
n=44 947		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
with wrist and/or hands 8 studies
n=49 565		 Wrist and hand ⊕⊕⊕◯ A positive associa­tion exists
with wrist and/or hands 5 studies
n=9055		 Carpal tunnel syndrome ⊕⊕⊕◯ A positive associa­tion exists
Posture
Upper arm posture 1 study
n=3824		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Elbow and/or wrist posture 8 studies
n=1 066 050		 Wrist and hand ⊕⊕◯◯ A positive associa­tion exists
Movements
Wrist and/or hand movements 2 studies
n=1 019 616		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Repetitive wrist and/or hand move­ments 8 studies
n=52 671		 Wrist and hand ⊕⊕◯◯ A positive associa­tion exists
Repetitive wrist and/or hand movements 5 studies
n=12 169		 Carpal tunnel syndrome ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Combination of physical exposures
HAL TLV 4 studies
n=6469		 Wrist and hand ⊕⊕⊕◯ A positive associa­tion exists
HAL TLV 3 studies
n=6229		 Carpal tunnel syndrome ⊕⊕⊕◯ A positive associa­tion exists
Strain index 2 studies
n=2991		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Psychosocial work demands
Quantitative demands 3 studies
n=9775		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Job strain 3 studies
n=2288		 Wrist and hand ⊕⊕◯◯ A positive associa­tion exists
Job insecurity 1 study
n=6407		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Working with temporary workers 1 study
n=415		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Work pace 1 study
n=366		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Psycho­social work resources
Job control 3 studies
n=4828		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Social support 3 studies
n=7387		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Predictability 1 study
n=1532		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Advancement opportunities 1 study
n=1532		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Organisational factors
Shift work 2 studies
n=1937		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Overtime work 2 studies
n=3584		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Other exposures
Heat 1 study
n=3824		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Cold 2 studies
n=4239		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists
Temperature changes 1 study
n=3824		 Wrist and hand ⊕◯◯◯ Cannot deter­mine if an associa­tion exists

Conflicts of interest

According to SBU’s requirements, the experts and scientific reviewers participating in this project have submitted statements about conflicts of interest. These documents are available at SBU’s secretariat. SBU has determined that the conditions described in the submissions are compatible with SBU’s requirements for objectivity and impartiality.

The full report in Swedish

Arbetsmiljöns betydelse för besvär och sjukdom i nacke, axlar, armar och händer

Flow chart

Out of 19523 articles screened in full text, 133 were eligible. 45 had high risk of bias, 88 low or moderate risk of bias.

Project group

Experts

  • Svend Erik Mathiassen, Senior Professor at the Department of Occupational Health Science and Psychology, University of Gävle
  • Helena Sandén, MD and PhD at the Department of Public Health and Community Medicine, University of Gothenburg
  • Magnus Sverke, Professor of Work and Organisational Psychology at the Department of Psychology, Stockholm University
  • Jens Wahlström, Associate Professor at Department of Public Health and Clinical Medicine, University of Umeå

SBU

  • Margareta Hedner, PhD and Project Manager
  • Sara Fundell, Project Administrator
  • Jan Adolfsson, Assistant Project Manager(until December 2021)
  • Martin Norman, Assistant Project Manager (from January 2022)
  • Agneta Brolund, Information Specialist (until March 2020)
  • Hanna Olofsson, Information Specialist (from January 2021)
  • Jenny Odeberg, Head of Department

 External reviewers

  • Lars Adolfsson, Adjunct Professor at the Division of Surgery, Orthopedics and Oncology, University of Linköping
  • Jane Frølund Thomsen, MD at the Department of occupational and environmental medicine, Bispebjerg and Frederiksberg Hospital
  • Ulf Lundberg, Senior Professor, Professor at Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska institutet
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