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  • 1.
    Bakker, Roel H.
    et al.
    Department of Applied Research in Care, University Medical Center Groningen, University of Groningen, The Netherlands.
    Pedersen, Eja
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    van den Berg, Godefridus Petrus
    GGD Amsterdam Public Health Service, Amsterdam, The Netherlands.
    Stewart, R.E.
    Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, The Netherlands.
    Lok, W.
    Department of Applied Research in Care, University Medical Center Groningen, University of Groningen, The Netherlands.
    Bouma, J.
    Department of Health Care, Science shop, University Medical Center Groningen, University of Groningen, The Netherlands.
    Impact of wind turbine sound on annoyance, self-reported sleep disturbance and psychological distress2012In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 425, p. 42-51Article in journal (Refereed)
    Abstract [en]

    Purpose of the research: The present government in the Netherlands intends to realize a substantial growth ofwind energy before 2020, both onshore and offshore. Wind turbines, when positioned in the neighborhood ofresidents may cause visual annoyance and noise annoyance. Studies on other environmental sound sources,such as railway, road traffic, industry and aircraft noise show that (long-term) exposure to sound can havenegative effects other than annoyance from noise. This study aims to elucidate the relation between exposureto the sound of wind turbines and annoyance, self-reported sleep disturbance and psychological distress ofpeople that live in their vicinity. Data were gathered by questionnaire that was sent by mail to a representativesample of residents of the Netherlands living in the vicinity of wind turbinesPrincipal results: A dose–response relationship was found between immission levels of wind turbine soundand selfreported noise annoyance. Sound exposure was also related to sleep disturbance and psychologicaldistress among those who reported that they could hear the sound, however not directly but with noiseannoyance acting as a mediator. Respondents living in areas with other background sounds were less affectedthan respondents in quiet areas.Major conclusions: People living in the vicinity of wind turbines are at risk of being annoyed by the noise, anadverse effect in itself. Noise annoyance in turn could lead to sleep disturbance and psychological distress. Nodirect effects of wind turbine noise on sleep disturbance or psychological stress has been demonstrated,which means that residents, who do not hear the sound, or do not feel disturbed, are not adversely affected.

  • 2.
    Janssen, Sabine A.
    et al.
    TNO Department of Environment and Health, P.O. Box 49, 2600 AA Delft, Netherlands.
    Vos, Henk
    TNO Department of Environment and Health, P.O. Box 49, 2600 AA Delft, Netherlands.
    Eisses, Arno R.
    TNO Monitoring Systems - Acoustics, P.O. Box 55, 2600 AD Delft, Netherlands.
    Pedersen, Eja
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS).
    Exposure-response relationships for annoyance by wind turbine noise: a comparison with other stationary sources2009In: 8th European Conference on Noise Control 2009 (EURONOISE 2009): Proceedings of the Institute of Acoustics, Volume 31, Pt 3, St. Albans Hertfordshire, UK: Institute of Acoustics , 2009, p. 1472-1478Conference paper (Refereed)
    Abstract [en]

    There are indications that, given a certain level of noise exposure, the expected annoyance by wind turbine noise is higher than that by noise from other sources such as industrial noise or transportation noise. The aim of the present study was to establish the exposure-response relationship between wind turbine noise exposure and the expected percentage annoyed residents on the basis of available data. Data from two surveys in Sweden (N=341, N=754) and one survey in the Netherlands (N=725) were combined to achieve relationships between Lden and annoyance indoors as well as annoyance outdoors at the dwelling. In addition, the influence of several individual and situational factors was assessed. In particular, annoyance was lower in residents who received economical benefit from wind turbines, and higher in residents for whom the wind turbine was visible from the dwelling. Age and noise sensitivity had similar effects on annoyance to those found in research on annoyance by other sources. The exposure-response relationship for wind turbine noise is compared to previously established relationships for industrial noise.

  • 3.
    Johansen, Alexandra
    et al.
    Halmstad University, School of Health and Welfare.
    Basic, Ena
    Halmstad University, School of Health and Welfare.
    Nilsson, Josefin
    Halmstad University, School of Health and Welfare.
    Hur ledare inom vård- och omsorg bedriver hälsoarbete utifrån Organisatorisk och social arbetsmiljö2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Svårigheter som anträffas inom vård- och omsorg är den arbetsmiljö som bedöms vara en stor risk för medarbetarna. Arbetsmiljöverket belyser organisatorisk och social arbetsmiljö i sin föreskrift AFS (2015:4), de påpekar att det är arbetsgivarens ansvar att ha kunskap om föreskriften innehåll. Det är viktigt för ledare inom vård- och omsorg att arbeta förebyggande och främjande för att bevara och utveckla medarbetarnas hälsa.

    Syftet med denna uppsats är att utifrån ett pedagogiskt perspektiv belysa hur ledare inom vård- och omsorg förebygger ohälsa och främjar hälsa med fokus på organisatorisk och social arbetsmiljö.

    För att kunna ta fram empiri har sju individuella intervjuer genomförts. Empirin transkriberades och en innehållsanalys utförde för att tydliggöra resultatets innehåll.

    Resultatet som synliggjordes är att ledarna upplever att deras resurser för att förebygga ohälsa och främja hälsa hos sina medarbetare är betydande för den organisatoriska och sociala arbetsmiljön. Ledarna använder sig av bland annat handledning, medarbetarsamtal, riskbedömningar tillsammans med skyddsombud och tar även hjälp av andra aktörer i syfte för att bemöta medarbetarnas behov. Det kompetensbehov ledarna ansåg medarbetarna behöva för att förebygga ohälsa och främja hälsa var genom olika utbildningar. Hinder ledare påpekar står emot att föreskriften följs är bland annat, budget, tidsbrist samt bristande kunskap.

    Slutsatsen är att ledarna bör fördjupa sig i föreskriften AFS (2015:4) om organisatorisk och social arbetsmiljö i stöd för att de inte kunde redogöra för dess innehåll och hur det implementeras i arbetsmiljön. Vi vill med hjälp av studien belysa samt inspirera ledare till att utveckla större engagemang till föreskriftens betydelse för medarbetarnas hälsa.

  • 4.
    Panosyan, Luiza
    Halmstad University, School of Business and Engineering (SET).
      Impact of vehicle exhaust emitted by the combustion of biofuels on human health2010Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

     

    Introduction: Significant changes in the global ecosystem, together with a potential shortfall in oil resources, have stimulated intense interest in the development of other sources of energy, and most particularly biofuels since these are basically considered to be less harmful to human health than petroleum-based fuels. However, information about the impact of biofuel-derived vehicle emissions on human health is limited and incomplete.

     

    Aim of the study: To identify those biofuels that are less detrimental to human health on the basis of published results from toxicological and chemical studies of vehicle emission products.

     

    Tasks of the study: To review systematically all conventional and alternative fuels used in internal combustion engines, to identify all known toxic emission products formed by such fuels, to review their toxic effects on human health, and to analyse the data collected in order to develop conclusions concerning the possible health benefits deriving from the use of alternative fuels.

     

    Materials and methods: In order to fulfil the requirements of a complete, comprehensive and up-to-date review of the toxic effects of automotive exhaust, an extensive search of official scientific data sources has been performed. Relevant publications were retrieved from public domain databases with a toxicological focus such as Toxcenter and CAplus, as well as from the websites of the US Environmental Protection Agency and the US Agency for Toxic Substances and Disease Registry. Keywords employed in the literature search were: petrol, gasoline, diesel exhaust, emission, biofuel, biogas, biodiesel, bioethanol, bioalcohol, toxicity, methanol and ethanol. A total of 295 references were initially selected relating to the period 1962 to 2008, and 142 of these presented titles and abstracts that met the main inclusion criteria, i.e. describing toxicological and epidemiological studies in humans. In cases where eligible studies relating to the goals and tasks of the review were limited or not available, some in vitro or in vivo toxicological studies involving animal models were included.

     

    Results: In comparison with petroleum diesel, the emissions derived from biodiesel contain less particulate matter, carbon monoxide, total hydrocarbons and other toxic compounds including vapour-phase C1-C12 hydrocarbons, aldehydes and ketones (up to C8), selected semi-volatile and particle-phase polycyclic aromatic hydrocarbons (PAHs). Whilst sulphur-containing compounds appear to be undetectable in biodiesel, nitrogen oxide and a soluble organic fraction comprising unregulated pollutants including the “aggregated toxics” (i.e., formaldehyde, acetaldehyde, acrolein, benzene, 1,3-butadiene, ethylbenzene, n-hexane, naphthalene, styrene, toluene and xylene) are present at elevated levels. Toxicological studies have shown that the mutagenicity of exhaust particles from biodiesel is normally lower than those obtained from petroleum diesel, however, rapeseed oil-derived biodiesel exhibits toxic effects that are 4-fold greater than petroleum diesel. Such enhanced toxicity is probably caused by the presence of carbonyl compounds and unburnt fuel. The toxicity of highly volatile components of biofuel exhaust has not yet been evaluated accurately. A substantial portion of these compounds was apparently lost in the process of preparing the test samples used for the assays (during the evaporation). The overall recoveries of these compounds have not been evaluated and the accuracy of the sample preparation method has not been validated. Hence, it could be that the cytotoxic effect of biodiesel exhaust is higher than that reported. Moreover, compared with fossil diesel, fuel derived from rapeseed oil emits particulate matter with increased mutagenic effects. Epidemiological investigations of the effects of biofuels on humans are very sparse but have revealed dose-dependent respiratory symptoms following exposure to rapeseed oil biodiesel, although the observed differences between this fuel and petroleum diesel are not significant. Such data, however, give rise to serious concerns about the future usage of this plant material as a replacement for established diesel fuels. Combustion of alcohol-based fuels leads to a reduced formation of photochemical smog in comparison with gasoline or diesel, however, the emission of aldehydes (officially classified as carcinogenic or potentially carcinogenic) is several times higher. The toxicity of the exhaust emissions of gasoline-fuelled engines is generally significantly greater than that of alcohol-burning engines. However, some harmful effects from ethanol blends might be expected, such as enhanced emissions of carcinogenic PAHs and increased ozone-related toxicity associated with the high level of aldehydes emitted. The use of ethanol–diesel fuel blends gives rise to increases in regulated exhaust emissions and, possibly, to greater emissions of aldehydes and unburnt hydrocarbons. The most promising fuels, in terms of reduced toxicity and genotoxicity of exhaust emissions, are methanol-containing blends. However, the emission from these fuels still contains formaldehyde, which is a carcinogen. The use of biogas can significantly reduce emissions of total PAHs and formaldehyde and, consequently, the risk of lung toxicity. On the other hand, the emissions of particulate matter by compressed natural gas, and the mutagenic potencies of the exhaust, are similar to those associated with gasoline and diesel fuels.

     

    Conclusions: The use of biofuel is currently viewed very favourably and there are suggestions that the exhaust emissions from such fuel are less likely to present risks to human health in comparison with gasoline and diesel emissions. However, the expectation of a reduction in health effects based on the chemical composition of biodiesel exhaust is far from reality. Thus, although toxicological evidence relating to the effects of biofuels on humans is sparse, it is already apparent that emissions from the combustion of biofuel and blends thereof with petroleum-based fuels are toxic. In addition to the regulated toxic compounds, such as total hydrocarbons, carbon monoxide, nitrogen oxides, particulate matter and polycyclic aromatic hydrocarbons, biofuel emissions contain significant amounts of various other harmful substances that are not regulated, e.g. carbonyls (including formaldehyde, acetaldehyde, benzene, 3-butadiene, acrolein, etc.). Whilst biofuels may be potentially less damaging to human health than petroleum fuels, considerable harmful effects must still be expected. Substitution of conventional fuel by biofuel decreases the concentration of regulated toxic pollutants in vehicle exhaust, but increases the concentration of some unregulated toxic pollutants emitted from on-road engines. Generally, the toxicity of biofuels decreases in the order biodiesel>biogas>ethanol>=methanol. In this respect, methanol produced by the oxidation of biogas appears to represent an alternative fuel that exhibits the least potential for damage to human health, however, this alcohol represents a source of formaldehyde pollution and is carcinogenic.

    .

     

  • 5.
    Pedersen, Eja
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Persson Waye, K.
    Department of Acoustics, Aalborg University, Aalborg, Denmark.
    Audio-visual reactions to wind turbines2003In: Acta Acoustica united with Acustica, ISSN 1610-1928, E-ISSN 1861-9959, Vol. 89, no Suppl.Article in journal (Refereed)
    Abstract [en]

    A cross sectional study with the aim of evaluating dose response relationships between noise exposure from wind turbines and subjective reactions was performed in a flat landscape in Sweden. The study area comprised 16 turbines. Subjective reactions were obtained by a questionnaire, which purpose was masked. The response rate was 69% (356 respondents). Outdoor noise levels (dBA) were calculated for each dwelling at 2.5 dB intervals. The results showed a significant dose response relationship between noise level and annoyance. The prevalence of noise annoyance was comparatively high. In the categories of greatest noise exposure 37.5-40 dBA and >40 dBA, 20% (95%Cl: ±12.4) and 36% (95%Cl: ±18.4) were very annoyed. The noise only explained part of the annoyance. Noise annoyance was also correlated to visual factors such as the respondents’ opinion of the turbines’ impact on the landscape. To further study interactions between noise annoyance and visual disturbance, the shadows from wind turbines (hours/year) were calculated for each respondent and used as dose for annoyance of shadows, but also as a variable when trying to explain noise annoyance. The results of the analysis and the possible interactions between audio and visual annoyance will be presented at the conference.

  • 6.
    Pedersen, Eja
    et al.
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS).
    Persson Waye, Kerstin
    Arbets- och miljömedicin, Göteborgs universitet.
    Wind turbine sound – how often is it heard by residents living nearby?2009In: Proceedings of EURONOISE, 8th European conference on noise control, Edinburgh, 26 – 28 October 2009, St Albans: Institute of Acoustics , 2009Conference paper (Refereed)
    Abstract [en]

    Sound power levels of wind turbines and consequently also the immission sound pressure levels at nearby residents vary with the wind speed. A standard meteorological situation is therefore commonly used when the immission levels are discussed; wind speed 8 m/s at 10 m height downwind. There is a need for a more comprehensive description of the sound that could be included in the Environmental Impact Assessment. The objectives of this study were to explore if it is possible to measure how often the sound is heard, and if the occurrence could be related to the standardized immission levels or the performance of the wind turbine. Twenty four people living in three wind turbine areas (A-weighted sound pressure levels 29.6 – 45.9 dB) filled in diaries for three weeks, noting when they were at home, when they were outdoors, and when they could hear sound from wind turbines. The incidents when the wind turbines were heard varied largely from 0% to 100% of the times spent outdoors. The percentage increased with increasing standardized immission levels (r = 0.56, p < 0.01). In two of the areas it was possible to get data from the nearest turbines for the study period. The sound was more easily heard at wind speeds above 5 m/s than at lower wind speeds. No indication of a decreased possibility to hear the sound when the wind increased further was found. Possibility to hear the sound was most closely related to the electrical power generation

  • 7.
    Pedersen, Eja
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Persson Waye, Kerstin
    Occupational and Environmental Medicine, Sahlgrenska Academy, Göteborg University.
    Bengtsson Ryberg, Johanna
    The National Board of Health and Welfare, Socialstyrelsen.
    Response to occupational noise of medium levels at four types of work places2010In: Proceedings of INTERNOISE, 39th International congress of noise control engineering, Lisbon, 13 – 16 June 2010, 2010Conference paper (Refereed)
    Abstract [en]

    Occupational noise exposure at levels below those recognized as causing hearing impairment can cause annoyance and tiredness, and impair work performance. Few studies have addressed these and other responses to occupational noise of medium levels. Furthermore, studies typically explore one type of work place due to the hypothesized influence of situational factors. Our interest was to explore if a dose-response relationship between annoyance and measurements of sound levels in different work places could be derived.  Four categories of occupational environments were studied; education, health care, offices and control rooms, including in total 26 work places. An average sound pressure level for each work place was derived from measurements at different positions in the rooms (range: 28.7 – 59.5 LpAeq dB). A global dose-response relationship between average A-weighted sound pressure levels and proportion of employees annoyed was found, despite disparity in conditions for the different categories of work places. Alternative descriptors of the sound pressure levels did not significantly improve the relationship. The result will be discussed in the view of impact of sound versus that of moderating factors.

  • 8.
    Pedersen, Eja
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    van den Berg, Frits
    GGD Amsterdam.
    Why is wind turbine noise poorly masked by road traffic noise?2010In: Proceedings of INTERNOISE, 39th International congress of noise control engineering, Lisbon, 13 – 16 June 2010, 2010Conference paper (Refereed)
    Abstract [en]

    The possibility of road traffic noise masking noise from wind turbines was explored among residents living close to wind turbines in the Netherlands (n = 725) with different levels of  road traffic noise present. No general masking effect was found, except when levels of wind turbine sound were moderate (35 – 40 dB(A) Lden) and road traffic sound level exceeded that level with at least 20 dB(A). This low masking capacity may be due to the different time patterns of these noise sources, both on a small time scale (car passages/regular blade passing) and a larger time scale (diurnal and weekly patterns). Also, wind turbine sound is relatively easy audible and may be heard upwind more often than road traffic.

  • 9.
    Sjöholm, Therese
    Halmstad University, School of Business, Engineering and Science.
    Changes in Running Technique At Shod and Barefoot Running Condition: - An analysis of Muay Thai Fighters2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: everal studies mean that individuals accustomed to running barefoot and habitually barefoot individuals choose a fore foot or mid foot strike rather than a rear foot strike when running. This is partly to do with the proprioceptive feedback given from the soles of the feet. The common denominator of the barefoot runner and the Muay Thai fighter would be this proprioceptive feedback due to general bare foot training. A contributing factor to a non heal strike pattern could perhaps also be found in the sport specific movement pattern of Muay Thai where the athlete is trained to execute several actions from the fore foot. Aim: The first aim was to analyse differences in angles of the knee, ankle and foot at initial contact while running shod compared to barefoot in Muay Thai fighters accustomed to training barefoot. A second aim was to investigate if there was a difference in running technique regarding foot strike pattern when running shod compared to bare foot. The foot strike pattern is defined as heal strike, mid foot strike or forefoot strike. Method: Seventeen Muay Thai fighters (13 male 4 female) volunteered to participate in the test of the cross- sectional experimental study. The study took place at PT-Studion Halmstad. The participants performed 2x3minutes of running shod and barefoot respectively at a subjective speed equal to a 12 on the Borg scale. Both conditions were video recorded from a sagittal plane using an iPhone 6. The dominant leg defined as the non-weight bearing leg at the preferred boxing stance was analysed. Data was collected two-dimensionally of the angels of the knee, ankle and foot position to horizontal. Foot strike pattern was also determined. Landmarks were marked to ease the analysis. T-tests of paired samples were used to examine whether there were any differences between the angle of the knee, ankle and foot at barefoot and shod conditions. The significance level for this study was set to be statistically significant if p ≤ 0.05. Foot strike frequency distributions were compared between shod and barefoot runners using chi-square (X2) analysis. Result: A significant difference at the angle of the foot (p=0,034) at initial contact with the ground while running between shod (12 ± 9) and barefoot (17 ± 9) was found. No significant difference in the angle of the knee (p=0,076) or ankle (p=0,081) was found. Changes in foot strike pattern were observed. At shod condition 88% used a rear foot strike, 6% used a mid foot strike and 6% used a forefoot strike. At barefoot condition 41% used a rear foot strike, 0% used a mid foot strike and 59% a fore foot strike. Conclusion: This study shows that the there is a significant difference in foot strike pattern when running shod and barefoot which confirms previous studies. The test group have in common that they train Muay Thai although; their sport specific training doesn’t appear to in this case have any impact on the foot strike pattern.

  • 10.
    Wikström, Ingegerd
    et al.
    Department of Rheumatology, Malmö University Hospital, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Nilsson, Käth
    Department of Rheumatology, Malmö University Hospital, Sweden.
    Roos, Ewa
    Department of Orthopaedics, Clinical Sciences, Lund University, Sweden.
    Jacobsson, Lennart
    Department of Rheumatology, Malmö University Hospital, Sweden.
    Reliability, validity and responsiveness of a new leisure index: The Patient-Specific Leisure Scale (PSLS)2009In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 7, no 3, p. 178-193Article in journal (Refereed)
    Abstract [en]

    Objectives:

    To investigate the reliability, validity and responsiveness of a new Patient-Specific Leisure Scale (PSLS), constructed to identify goals and outcomes for individual patients with rheumatoid arthritis (RA).

    Methods:

    Forty-nine patients with RA were used to evaluate test-retest reliability, and 100 consecutive RA patients were used for construct validity. Twenty-five RA patients, commencing with treatment on tumour necrosis factor (TNF) inhibitors, were evaluated before the start and after three months of therapy, to test responsiveness. The most important leisure activity (as judged by the patients) was used when evaluating reliability and validity. The perceived difficulty with each activity was scored from 0 to 10 (0 = able to perform activity without difficulty, 10 = unable to perform activity).

    Results:

    Test-retest reliability indicated a good agreement (0.62-0.87) using weighted kappa. Construct validity was demonstrated by modest positive correlation between leisure activity and Health Assessment Questionnaire (HAQ) (rs = 0.27, p = 0.005) visual analogue scale (VAS) pain (rs = 0.28, p = 0.004) VAS global (rs = 0.22, p = 0.027), VAS fatigue (rs = 0.24, p = 0.013), joint index of 28 swollen joints (rs = 0.22, p = 0.027) and negative correlations with short-form-36 (SF-36) physical functioning (rs = -0.18, p = 0.008), bodily pain (rs = -0.31, p < 0.001), general health (rs = -0.23, p = 0.019), vitality (rs = -0.31, p < 0.001), social function (rs = -0.24, p = 0.016) and role-emotional (rs = -0.28, p = 0.005). Mean improvement for the most important leisure activity was 1.36, (p = 0.036, 95% confidence interval 0.10-2.62). Standardized response mean and effect size for the most important activity in PSLS was 1.05 and 0.72, respectively, and for HAQ 0.34 and 0.28, respectively.

    Conclusions:

    PSLS appears to be feasible, reliable, valid and responsive for measuring leisure activities in RA. It provides both an individual result which is useful in clinical work, and results at a group level.

  • 11.
    Wikström, Ingegerd
    et al.
    Department of Rheumatology, Malmö University Hospital, Sweden.
    Jacobsson, Lennart
    Department of Rheumatology, Malmö University Hospital, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    How people with rheumatoid arthritis perceive leisure activities: A qualitative study2005In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 3, no 2, p. 74-84Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore how people with rheumatoid arthritis (RA) perceive leisure activities. METHOD: A phenomenographic approach using semi-structured interviews to explore the impact of RA on leisure pursuits was used. RESULTS: Three descriptive categories containing 11 conceptions emerged: (1) Experiencing constraints included four conceptions: seeing limitations, needing time, finding balance, being dependent. (2) Experiencing coherence included four conceptions: accepting feelings participating in a social context, being active, having insight. (3) Finding solutions included three conceptions: choosing, planning, and adapting. CONCLUSIONS: This study emphasizes the limited choices and problems people with RA had participating in leisure activities, as well as its impact on self-esteem.

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