Publisher: Finnish Institute of Occupational Health   (Total: 1 journals)   [Sort by number of followers]

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Scandinavian J. of Work, Environment & Health     Partially Free   (Followers: 13, SJR: 1.596, CiteScore: 3)
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  • Suicide among transport industry workers: A systematic review and
           meta-analysis

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      Abstract: Objectives Working in high-stress and male-dominated occupations is associated with an elevated risk of suicide. The current study sought to conduct the first systematic literature review and meta-analysis aimed at determining suicide risk across the diverse, high pressure and male-dominated transport industry (commercial aviation, merchant seafaring, transit/driving) as compared to the general/employed population.Methods Searches of PubMed/Medline, Scopus and PsycINFO databases were conducted without date restriction until March 2021. Studies were included if they were written in English, were peer reviewed, and presented primary observational research data. Studies referring exclusively to suicidal ideation, suicide attempts, self-harm, and/or accidents were excluded.Results Following deletion of duplicates and non-English titles, a total of 4201 titles/abstracts were screened and 92 full-texts were read against inclusion/exclusion criteria. The final included sample consisted of 23 articles (16 used for meta-analysis). Results from the meta-analysis indicated that transport workers had a significantly elevated risk for suicide as compared to the general/employed population. Results were consistent across sensitivity analyses, and there was some variation across subgroup analyses.Conclusions Overall, we found transport workers had a significantly higher risk for suicide than the general/employed population, and this appeared to be driven by the association for those working in merchant seafaring/maritime occupations. The findings are discussed in relation to an identified need for the development, implementation, and evaluation of tailored workplace suicide prevention strategies for transport industry workers. by Mathieu S, Ross V, Wardhani R, Brough P, Wishart D, Chan XW, Kõlves K. doi:10.5271/sjweh.4061
      PubDate: Sun, 25 Sep 2022 18:37:25 +020
      DOI: 10.5271/sjweh.4061
       
  • Author response: Occupation and SARS-CoV-2 infection risk among workers
           during the first pandemic wave in Germany: potential for bias

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      Abstract: We thank van Tongeren et al for responding to our study on occupational disparities in SARS-CoV-2 infection risks during the first pandemic wave in Germany (1). The authors address the potential for bias resulting from differential testing between occupational groups and propose an alternative analytical strategy for dealing with selective testing. In the following, we want to discuss two aspects of this issue, namely (i) the extent and reasons of differential testing in our cohort and (ii) the advantages and disadvantages of different analytical approaches to study risk factors for SARS-CoV-2 infection. Our study relied on nationwide prospective cohort data including more than 100 000 workers in order to compare the incidence of infections between different occupations and occupational status positions. We found elevated infection risks in personal services and business administration, in essential occupations (including health care) and among people in higher occupational status positions (ie, managers and highly skilled workers) during the first pandemic wave in Germany (2). Van Tongeren’s et al main concern is that the correlations found could be affected by a systematic bias because people in healthcare professions get tested more often than employees in other professions. A second argument is that better-off people could be more likely to use testing as they are less affected by direct costs (prices for testing) and the economic hardship associated with a positive test result (eg, loss of earnings in the event of sick leave). We share the authors’ view that differential testing must be considered when analysing and interpreting the data. Thus, in our study, we examined the proportion of tests conducted in each occupational group as part of the sensitivity analyses (see supplementary figure S1, accessible at www.sjweh.fi/article/4037). As expected, testing proportions were exceptionally high in medical occupations (due to employer requirements). However, we did not observe systematic differences among non-medical occupations or when categorising by skill-level or managerial responsibility. This might be explained by several reasons. First, SARS-CoV-2 testing was free of charge during the first pandemic wave in Germany, but reporting a risk contact or having symptoms was a necessary condition for testing ( https://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus.html (accessed 5 September 2022). The newspaper article cited by van Tongeren et al is misleading as it refers to a calendar date after our study period. Second, different motivation for testing due to economic hardship in case of a positive test result is an unlikely explanation, because Germany has a universal healthcare system, including paid sick leave and sickness benefits for all workers (3). Self-employed people carry greater financial risks in case of sickness. We therefore included self-employment in the multivariable analyses to address this potential source of bias. While the observed inverse social gradient may be surprising, it actually matches with findings of ecological studies from Germany (4, 5), the United States (6, 7) as well as Spain, Portugal, Sweden, The Netherlands, Israel, and Hong Kong (8), all of which observed higher infection rates in wealthier neighbourhoods during the initial outbreak phase of the pandemic. One possible explanation is the higher mobility of managers and better educated workers, who are more likely to participate in meetings and engage in business travel and holiday trips like skiing. Given the increasing number of studies providing evidence for this hypothesis, we conclude that the inverse social gradient in our study likely reflects different exposure probabilities and is not a result of systematic bias. This also holds true for the elevated infection risks in essential workers, which is actually corroborated by a large body of research (9–11).Regarding differential likelihood of testing, van Tongeren et al state that “[i]t is relatively simple to address this problem by using a test-negative design” (1). As van Tongeren et al describe, this is a case–control approach only including individuals who were tested (without considering those who were not tested). However, the proposed analytical strategy can lead to another (more serious) selection bias if testing proportions and/or testing criteria differ between groups (12). This can be easily illustrated when comparing the results based on a time-incidence design with those obtained by a test-negative design as shown in table 1 (see PDF).Both approaches show similar results in terms of vertical occupational differences. Infection was more common if individuals had a high skill level or had a managerial position, but associations were stronger in the time-incidence design and did not reach statistical significance in the test-negative design (as indicated by the confidence intervals overlapping “1”). Unfortunately, the test-negative approach relies on a strongly reduced sample size and thus results in greater statistical uncertainty and loss of statistical power (13). In contrast, the test-negative design yields a different picture when estimating the association between essential occupation and infection risk: In this analysis, essential workers did not differ from non-essential workers in their chance of being infected with SARS-CoV-2 (the test-negative design even exhibits a lower chance for essential workers). This is rather counter-intuitive and is not in accordance with what we know about the occupational hazards of healthcare workers during the pandemic (14). The main problem is that proportions of positive tests are highly unreliable when testing proportions and/or testing criteria differ between groups. As essential workers were tested more often without being symptomatic (due to employer requirements), a lower proportion of positive tests in thi...
      PubDate: Sun, 25 Sep 2022 17:52:41 +020
      DOI: 10.5271/sjweh.4056
       
  • Occupational risk of COVID-19 across pandemic waves: a two-year national
           follow-up study of hospital admissions

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      Abstract: Objective Assuming that preventive measures to mitigate viral transmission of SARS-CoV-2 at the workplace may have been improved in the course of the COVID-19 pandemic, we examined the occupational risk of COVID-19 related hospital admission across the four pandemic waves in Denmark between week 8, 2020, and week 50, 2021.Methods The study included 4416 cases of COVID-19 related hospital admissions among 2.4 million Danish employees aged 20–69 with follow-up in 2020 through 2021. At-risk industrial sectors and a reference population were defined a priory by a job-exposure matrix on occupational risk for COVID-19. Incidence rate ratios (IRR) and potential effect modification by pandemic wave were computed with Poisson regression adjusted for demographic, social and health factors including completed COVID-19 vaccination.Results We observed an overall elevated relative risk in four of six at-risk industrial sectors, but the pandemic wave only modified the risk among healthcare employees, where the excess risk from a high initial level declined to background levels during the latest waves in models not adjusting for COVID-19 vaccination. In social care, education and transport, the elevated risk was not modified by pandemic wave.Conclusion Danish healthcare employees were to some extent protected against occupational transmission of SARS-CoV-2 during the two last pandemic waves even though the absolute risk conferred by occupation may not have been eliminated. Early vaccination of this group seems not to be the only explanation. The risk in other sectors remained elevated indicating a need to revisit preventive measures. by Bonde JPE, Sell L, Jensen JH, Begtrup LM, Flachs EM, Jakobsson K, Nielsen C, Nilsson K, Rylander L, Petersen KU, Tøttenborg SS. doi:10.5271/sjweh.4058
      PubDate: Thu, 15 Sep 2022 18:56:36 +020
      DOI: 10.5271/sjweh.4058
       
  • Scientific challenges of studying shift schedule design

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      Abstract: The study of shift schedule design, and its impact on the health, safety and the performance of shiftworkers, has seen considerable advances in methodology in the last decade. Much of the early research that helped identify shift schedule design principals was based on observational studies. Quite many featured cross-sectional designs that were subject to residual confounding from unadjusted potential confounders (eg, socioeconomic status, health-driven selection bias). Moreover, the early studies were almost universally based on self-reported exposure and many relied upon self-reported outcomes, making them subject to information bias (1). Researchers have since built on the findings of earlier research with more sophisticated and robust designs and metrics, many of which are exemplified in studies that have been published in this journal. These provide a firmer evidence base on which to develop recommendations for the design of shift schedules. The fundamental aim of research is to optimise the balance between precision (internal validity), achieved through having control over variables and the study setting; existential realism, achieved through the collection of data in realistic situations; and generalisability of results, from the study sample to the target population (2). In their attempts to achieve this optimal balance, shiftwork researchers have adopted various methodological approaches that try to combine the existential realism (and, in some cases, the generalisability) of the field study with the precision of the laboratory simulation. The randomised control trial (RCT) is widely regarded as the gold standard of methodological design because confounders are balanced across comparison groups, giving statistical independence between the confounders and the treatment assignment. However, true randomisation to a treatment condition can be impractical, expensive or unethical in field studies that are conducted in the workplace. Hence, true RCT with randomisation at participant level are rare in comparisons of working time arrangements. One of the very few of these types of studies examined the impact of compressed work weeks among police officers who were randomly allocated to either 8-, 10- or 12-hour shifts (3). The results were favourable towards compressing the working week from 8- to 10-hour shifts but somewhat less favourable towards 12-hour shifts. When the fully experimental approach is not feasible in field settings, another approach to controlling confounders is to use participants as their own control. This approach was adopted in a ‘quasi-experimental’ study (also of police officers), examining the impact of night shift intensity on sleep (4). Each participant undertook three conditions: (i) 2 nights followed by 2 rest days; (ii) 4 nights + 4 rests; and (iii) 7 nights + 7 rests. The order of conditions was allocated individually on a non-random basis that was determined according to the convenience of the rota planner. It was found that sleep was impaired on night shifts and did not improve with an increasing number of consecutive nights, leading to an accumulation of sleep debt with more consecutive nights. Another form of quasi-experimental study is the group intervention study, where researchers follow the implementation of a change in predictor (eg, working time arrangements) among one group of workers and compare them with a no-change group (a ‘difference-in-difference’ design). Such changes often take place at the instigation of, or are largely guided by, the managers of the organisation in which the study takes place. Thus, potential biases may creep in, such as the way in which groups of participants (eg, departments within the organisation) are allocated to conditions. Moreover, the success of an intervention is likely to be influenced by the process of implementation (eg, the way in which the change is introduced and communicated to the workforce, and the actions of the organisation’s management during implementation). Successful high-quality intervention studies are relatively rare in the study of shift schedule design. Nevertheless, the approach remains a potentially fruitful one, especially in light of the recent publication of a framework for the development of high-quality interventions (5). While the framework’s authors acknowledge the importance of obtaining unbiased estimates (ie, adequately controlling for confounders), they also emphasise the need to understand how an intervention contributes to change and the ways in which it interacts with wider dynamic systems within the operational setting. While intervention studies conducted at the group level remain relatively rare in the study of shift schedule design, recent years have seen an increasing number of observational studies examining the impact of changes in working time arrangements at the individual level. One of the more robust forms of this approach is the non-randomised pseudo trial, in which data from observational studies are analysed in a way that mimics an RCT design (6). This approach was exemplified in a study of night work and the risk of developing common mental disorders (CMD; 7). From baseline, participants were followed up on two occasions, four years apart. At the first follow up, participants were divided into those who had changed schedule since baseline (eg, from non-night to night work) and those who had not, while excluding participants who experienced a change in CMD status in that same initial four-year period (eg, if they had developed a CMD since baseline). At the second follow up, the two groups were compared with respect to their change in CMD status between the first and second follow up. Analyses were also included which adjusted for selection bias, namely the tendency for night workers who develop CMD to transfer to daywork. This bias is a form of the ‘healthy worker effect’ (8), which has long been identif...
      PubDate: Wed, 07 Sep 2022 11:53:29 +020
      DOI: 10.5271/sjweh.4055
       
  • Overqualification at work and risk of hospitalization for psychiatric and
           somatic diseases among immigrants in Sweden – a prospective
           register-based study

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      Abstract: Objectives This study aimed to (i) describe the prevalence of overqualification at work among immigrants in Sweden and (ii) analyze any association between overqualification and the risk of hospitalization for somatic and psychiatric disease among refugees and labor immigrants.Methods We performed a prospective register study in a cohort of 120 339 adults who immigrated to Sweden in 1991–2005 and were employed in 2006. Education-occupation status was defined as the combination of an individual’s highest level of education and their occupation skill level. Individuals were followed from 2007 to 2016 with regard to hospitalization for a psychiatric, cardiovascular, respiratory or musculoskeletal disease or diabetes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated in a multivariate Cox regression analysis adjusted for age, gender, reason for residence and duration of residence.Results The overall prevalence of overqualification among immigrants with an academic education was 39%. Overqualified individuals had an increased risk of hospitalization for any disease (HR 1.33, 95% CI 1.21–1.46) compared to "job-matched with an academic education". However, the risk estimates were lower than that of "job-matched with no academic education" (HR 1.56, 1.46–1.68). The increased risk of hospitalization for a psychiatric disease of overqualified individuals did not differ from that of job-matched with no academic education.Conclusion Our study showed that being overqualified was associated with poorer health outcomes than job-matched individuals with an academic education. Considering the high prevalence of overqualification in immigrants, this constitutes a concern, for both society and individuals. by Brendler-Lindqvist M, Tondel M, Helgesson M, Nordqvist T, Svartengren M. doi:10.5271/sjweh.4054
      PubDate: Fri, 02 Sep 2022 13:25:50 +020
      DOI: 10.5271/sjweh.4054
       
  • Working life expectancy and working years lost among users of part- and
           full-time sickness absence in Finland

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      Abstract: Objectives The use of part-time sickness absence (pSA) instead of full-time sickness absence (fSA) is known to increase work participation. Yet, its effect on the total length of working lives remains unclear. We carried out a quasi-experiment to assess the impact of using pSA versus fSA on the length of working lives.Methods We used a register-based 70% random sample of the working-age population living in Finland on 31 December 2007 to (i) form propensity-score-matched groups of users of pSA and fSA and (ii) calculate their working life expectancy (WLE) and working years lost (WYL). We applied the Sullivan method based on daily measured time spent at work and other labor market statuses, followed up over a four-year period until the end of year 2017. The study population consisted of private and public sector employees with SA due to mental and musculoskeletal disorders, ie, the diagnostic groups where pSA has been primarily used.Results Among both genders, the pSA group had a significantly higher WLE at age 30 than the fSA group, with larger differences seen in mental disorders compared to musculoskeletal diseases and in the private versus public sector. Overall, the pSA group had fewer WYL due to unemployment and disability retirement but more expected years working with partial disability benefits than the fSA group.Conclusions Based on beneficial working career effects, the use of pSA instead of fSA should always be recommended for persons with mental or musculoskeletal disorders where feasible. by Hartikainen E, Solovieva S, Viikari-Juntura E, Leinonen T. doi:10.5271/sjweh.4053
      PubDate: Fri, 26 Aug 2022 17:40:41 +020
      DOI: 10.5271/sjweh.4053
       
  • Does a change to an occupation with a lower physical workload reduce the
           risk of disability pension' A cohort study of employed men and women
           in Sweden

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      Abstract: Objective This study aimed to examine if a change to an occupation with a lower physical workload reduces the risk of all-cause disability pension (DP) and musculoskeletal DP (MDP).Methods This study used a sample of 359 453 workers who were registered as living in Sweden in 2005 and aged 44–63 in 2010. Exposure to physical workload was measured from 2005–2010 by linking a mean value from a job exposure matrix to occupational codes. The mean values were then split into quartiles. All included participants had high exposure to physical workload (top quartile) from 2005–2007. A change in physical workload was measured as a change to (i) any lower quartile or (ii) medium-high or low quartiles from 2008–2010. DP cases were taken from register data from 2011–2016. Crude and multivariate Cox proportional-hazards regression models estimated sex-specific hazard ratios (HR) with 95% confidence intervals (CI).Results Compared to workers with consistently high physical workload, a change to any lower quartile of physical workload was associated with a decreased risk of all-cause DP (men: HR 0.59, 95% CI 0.46–0.77, women: HR 0.63, 95% CI 0.52–0.76) and MDP (men: HR 0.52, 95% CI 0.31–0.89, women: HR 0.61, 95% CI 0.44–0.84). Older workers had the largest decreased risk for MDP. Generally, changing from high to low physical workload was associated with a greater reduced risk of DP than changing from high to medium-high physical workload.Conclusions Changing to an occupation with lower exposure to physical workload was associated with reduced risks of DP and MDP among both sexes. by Badarin K, Hemmingsson T, Almroth M, Falkstedt D, Hillert L, Kjellberg K. doi:10.5271/sjweh.4052
      PubDate: Tue, 23 Aug 2022 14:35:57 +020
      DOI: 10.5271/sjweh.4052
       
  • Occupation and SARS-CoV-2 infection risk among workers during the first
           pandemic wave in Germany: potential for bias

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      Abstract: We read with great interest the paper by Reuter et al (1) on the differences in risk of SARS-CoV2 infection by occupation during the first pandemic wave in Germany. Occupation has been linked with differential risks of infection (2, 3) as well as severe disease and death (4, 5). Hence, this is a potentially very important paper, advancing the evidence in relation to occupational risk factors for infection. This study makes use of an existing cohort (the German National Cohort – NAKO), with data from over 100 000 workers who were employed or self-employed and completed a COVID-19 questionnaire. SARS-CoV2 infection was assessed through a self-reported positive PCR test carried out in a doctor’s practice, test centre or in a hospital. The main analyses used a Poisson regression model to obtain incidence rates of infection by occupation, both crude and analyses adjusted for potential confounding factors (sociodemographic and employment related factors) were carried out. Based on the results of the analyses, the authors conclude that (i) there were relatively high infection rates in healthcare and personal services but also in business management and business services, (ii) there were relatively low infection rates in manufacturing and production related occupations, and (iii) there was an inverse social gradient between occupational position and risk of infection, with higher risk in occupations with advanced tertiary degrees/managers.Like other studies, these analyses found relatively high infection rates in essential occupations. However, important differences with other studies included the inverse social gradient and the relatively high infection rates in occupations with management responsibility and requiring higher degrees. The authors postulated a possible explanation for this finding, stating that managers in Germany may be at higher risk due to recreational ski trips. Although this may well be a partial explanation, we argue that there is a more likely explanation for the high rates in higher educated people and those working in the healthcare sector. These groups are more likely to have been tested, particularly during the early stage of the pandemic, compared to other occupations such as those working in manufacturing and production-related occupations. This could be due to differential access to testing due to employer requirements or financial restraints (especially at times when tests were not free for all in Germany, https://www.reuters.com/business/healthcare-pharmaceuticals/germany-offer-free-covid-19-tests-saturday-2021-11-12/) or different motivations for testing (due to lack of sick pay or self-employment). The authors estimate the infection rates using these positive tests as the numerator and the total cohort population (many of whom have never been tested) as the denominator. Therefore, if there is a differential likelihood of testing between different occupations, this would lead to bias in the results. It is relatively simple to address this problem by using a test-negative design (6, 7), which is a type of case–control approach where those with a positive test are compared to those who have tested negative (ie, excluding those who have never been tested). This has been widely used as the gold standard method for studying vaccine effectiveness (8) and is increasingly being used to study risk factors for COVID-19 infection. We would encourage the authors to carry out such analyses and present the results in their response to this letter. If, as we expect, the high relative risks in those with higher education and/or managers are reduced in these analyses, this would strongly indicate that the reported findings are primarily due to selection bias.References1. Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S et al. Occupation and SARS-CoV-2 infection risk in 108 960 workers during the first pandemic wave in Germany. Scand J Work Environ Health – online first. https://doi.org/10.5271/sjweh.40372. Rhodes S, Wilkinson J, Pearce N, Mueller W, Cherrie M, Stocking K, et al. Occupational differences in SARS-CoV-2 infection: Analysis of the UK ONS Coronavirus (COVID-19) Infection Survey. medRxiv. 2022 https://doi.org/10.1101/2022.04.28.222731773. Beale S, Patel P, Rodger A, Braithwaite I, Byrne T, Fong WLE, et al. Occupation, work-related contact and SARS-CoV-2 anti-nucleocapsid serological status: findings from the Virus Watch prospective cohort study. Occup Environ Med. 2022. https://doi.org/10.1136/oemed-2021-107920 4. Nafilyan V, Pawelek P, Ayoubkhani D, Rhodes S, Pembrey L, Matz M, et al. Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults. Occup Environ Med. 2022;79(7):433-41. https://doi.org/10.1136/oemed-2021-1078185. Mutambudzi M, Niedzwiedz C, Macdonald EB, Leyland A, Mair F, Anderson J, et al. Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occup Environ Med. 2021;78(5):307-14. https://doi.org/10.1136/oemed-2020-106731 6. Vandenbroucke JP, Brickley EB, Pearce N, Vandenbroucke-Grauls CMJE. The Evolving Usefulness of the Test-negative Design in Studying Risk Factors for COVID-19. Epidemiology. 2022;33(2):e7-e8. https://doi.org/10.1097/EDE.00000000000014387. Vandenbroucke JP, Brickley EB, Vandenbroucke-Grauls CMJE, Pearce N. A Test-Negative Design with Additional Population Controls Can Be Used to Rapidly Study Causes of the SARS-CoV-2 Epidemic. Epidemiology. 2020;31(6):836-43.https://doi.org/10.1097/EDE.00000000000012518. Cerqueira-Silva T, Katikireddi SV, de Araujo Oliveira V, Flores-Ortiz R, Júnior JB, Paixão ES, et al. Vaccine effectiveness of heterologous CoronaVac plus BNT162b2 in Brazil. Nature Med. 2022;28(4):838-43. https://doi.org/10.1038/s41591-022-01701-w by van Tongeren M, Rhodes S, Pearce N. doi:10.5271/sjweh.4051
      PubDate: Mon, 08 Aug 2022 12:16:20 +020
      DOI: 10.5271/sjweh.4051
       
  • Does occupational forward bending of the back increase long-term sickness
           absence risk' A 4-year prospective register-based study using
           device-measured compositional data analysis

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      Abstract: Objective Forward bending of the back is common in many jobs and a risk factor for sickness absence. However, this knowledge is based on self-reported forward bending that is generally imprecise. Thus, we aimed to investigate the dose–response relation between device-measured forward bending at work and prospective register-based risk of long-term sickness absence (LTSA).Methods At baseline, 944 workers (93% from blue-collar jobs) wore accelerometers on their upper back and thigh over 1–6 workdays to measure worktime with forward bending (>30˚ and>60˚) and body positions. The first event of LTSA (≥6 consecutive weeks) over a 4-year follow-up were retrieved from a national register. Compositional Cox proportional hazard analyses were used to model the association between worktime with forward bending of the back in an upright body position and LTSA adjusted for age, sex, body mass index (BMI), occupational lifting/carrying, type of work, and, in an additional step, for leisure time physical activity (PA) on workdays.Results During a mean worktime of 457 minutes/day, the workers on average spent 40 and 10 minutes on forward bending>30˚ and>60˚ in the upright position, respectively. Five more minutes forward bending>30˚ and>60˚ at work were associated with a 4% [95% confidence interval (CI) 1.01–1.07] and 8% (95% CI 1.01–1.16) higher LTSA risk, respectively. Adjustment for leisure-time PA did not influence the results.Conclusion We found a dose–response association between device-measured forward bending of the back and prospective LTSA risk. This knowledge can be integrated into available feasible methods to measure forward bending of the back for improved workplace risk assessment and prevention. by Gupta N, Bjerregaard SS, Yang L, Forsman M, Rasmussen CL, Rasmussen CDN, Clays E, Holtermann A. doi:10.5271/sjweh.4050
      PubDate: Wed, 27 Jul 2022 16:58:15 +020
      DOI: 10.5271/sjweh.4050
       
  • Physical work demands and expected labor market affiliation (ELMA):
           Prospective cohort with register-follow-up among 46 169 employees

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      Abstract: Objective This study aimed to estimate the impact of high physical work demands on expected labor market affiliation (ELMA) among men and women of different ages in the general working population. Methods After participating in the Danish Work Environment and Health study (2012, 2014, and/or 2016), 46 169 employees were followed for two years in national registers. Using multi-state modeling, taking all day-to-day transition probabilities of labor market affiliation into account (work, unemployment, sickness absence, temporary out, and permanently out), and performing multilevel adjustment, we estimated the prospective association between physical work demands (ergonomic index including 7 factors) and ELMA. Results During 104 896 person-years of follow-up, we identified of 439 045 transitions. Using low physical work demands as reference, higher physical work demands were associated with fewer days of active work (2–35 days) during 730 days of follow-up, and more days of sickness absence (4–26 days) and unemployment (ranging 1-9 days) among men and women of aged 40–49 and 50–64 years. Among men and women aged 18–39 years, high physical work demands only had minor and inconsistent impact on ELMA. Conclusions Analyzing multiple and highly detailed patterns of transition probabilities concerning labor market affiliation we showed that reducing physical work demands is likely to increase the active working time and prevent high societal cost of sickness absence and unemployment, especially among middle-aged and older workers. by Pedersen J, Bjorner JB, Andersen LL. doi:10.5271/sjweh.4049
      PubDate: Tue, 05 Jul 2022 17:43:37 +020
      DOI: 10.5271/sjweh.4049
       
  • Healthcare workers’ SARS-CoV-2 infection rates during the second wave of
           the pandemic: follow-up study

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      Abstract: Objectives This study aimed to assess if, during the second wave of the COVID-19 pandemic, healthcare workers had increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates, following close contact with patients, co-workers and persons outside work with COVID-19.Methods A follow-up study of 5985 healthcare workers from Denmark was conducted between November 2020 and April 2021 and provided day-to-day information on COVID-19 contacts. SARS-CoV-2 infection was defined by the first positive polymerase chain reaction (PCR) test ever. Data was analyzed in multivariable Poisson regression models.Results The SARS-CoV-2 infection rates following close contact 3–7 days earlier with patients, co-workers and persons outside work with COVID-19 were 153.7, 240.8, and 728.1 per 100 000 person-days, respectively. This corresponded with age, sex, month, number of PCR tests and mutually adjusted incidence rate ratios of 3.17 [40 cases, 95% confidence interval (CI) 2.15–4.66], 2.54 (10 cases, 95% CI 1.30–4.96) and 17.79 (35 cases, 95% CI 12.05–26.28). The risk of SARS-CoV-2 infection was thus lower, but the absolute numbers affected was higher following COVID-19 contact at work than COVID-19 contact off work.Conclusions Despite strong focus on preventive measures during the second wave of the pandemic, healthcare workers were still at increased risk of SARS-CoV-2 infection when in close contact with patients or co-workers with COVID-19. There is a need for increased focus on infection control measures in order to secure healthcare workers’ health and reduce transmission into the community during ongoing and future waves of SARS-CoV-2 and other infections. by Würtz AM, Kinnerup MB, Pugdahl K, Schlünssen V, Vestergaard JM, Nielsen K, Cramer C, Bonde JP, Biering K, Carstensen O, Hansen KK, Dalbøge A, Flachs EM, Hansen ML, Thulstrup AM, Würtz ET, Kjærsgaard M, Christensen MW, Kolstad HA. doi:10.5271/sjweh.4048
      PubDate: Sun, 03 Jul 2022 13:06:09 +020
      DOI: 10.5271/sjweh.4048
       
  • Longitudinal changes in proportionate mortality due to COVID-19 by
           occupation in England and Wales

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      Abstract: Objective This study aimed to understand whether the proportionate mortality of COVID-19 for various occupational groups has varied over the pandemic.Methods We used the Office for National Statistics (ONS) mortality data for England and Wales. The deaths (20–64 years) were classified as either COVID-19-related using ICD-10 codes (U07.1, U07.2), or from other causes. Occupational data recorded at the time of death was coded using the SOC10 coding system into 13 groups. Three time periods (TP) were used: (i) January 2020 to September 2020; (ii) October 2020–May 2021; and (iii) June 2021–October 2021. We analyzed the data with logistic regression and compared odds of death by COVID-19 to other causes, adjusting for age, sex, deprivation, region, urban/rural and population density. Results Healthcare professionals and associates had a higher proportionate odds of COVID-19 death in TP1 compared to non-essential workers but were not observed to have increased odds thereafter. Medical support staff had increased odds of death from COVID-19 during both TP1 and TP2, but this had reduced by TP3. This latter pattern was also seen for social care, food retail and distribution, and bus and coach drivers. Taxi and cab drivers were the only group that had higher odds of death from COVID-19 compared to other causes throughout the whole period under study [TP1: odds ratio (OR) 2.42, 95% confidence interval (CI) 1.99–2.93; TP2: OR 3.15, 95% CI 2.63–3.78; TP3: OR 1.7, 95% CI 1.26–2.29]. Conclusion Differences in the odds of death from COVID-19 between occupational groups has declined over the course of the pandemic, although some occupations have remained relatively high throughout. by Cherrie M, Rhodes S, Wilkinson J, Mueller W, Nafilyan V, Van Tongeren M, Pearce N. doi:10.5271/sjweh.4041
      PubDate: Thu, 30 Jun 2022 15:08:53 +020
      DOI: 10.5271/sjweh.4041
       
  • Predicting long-term sickness absence among retail workers after four days
           of sick-listing

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      Abstract: Objective This study tested and validated an existing tool for its ability to predict the risk of long-term (ie, ≥6 weeks) sickness absence (LTSA) after four days of sick-listing.Methods A 9-item tool is completed online on the fourth day of sick-listing. The tool was tested in a sample (N=13 597) of food retail workers who reported sick between March and May 2017. It was validated in a new sample (N=104 698) of workers (83% retail) who reported sick between January 2020 and April 2021. LTSA risk predictions were calibrated with the Hosmer-Lemeshow (H-L) test; non-significant H-L P-values indicated adequate calibration. Discrimination between workers with and without LTSA was investigated with the area (AUC) under the receiver operating characteristic (ROC) curve.Results The data of 2203 (16%) workers in the test sample and 14 226 (13%) workers in the validation sample was available for analysis. In the test sample, the tool together with age and sex predicted LTSA (H-L test P=0.59) and discriminated between workers with and without LTSA [AUC 0.85, 95% confidence interval (CI) 0.83–0.87]. In the validation sample, LTSA risk predictions were adequate (H-L test P=0.13) and discrimination was excellent (AUC 0.91, 95% CI 0.90–0.92). The ROC curve had an optimal cut-off at a predicted 36% LTSA risk, with sensitivity 0.85 and specificity 0.83.Conclusion The existing 9-item tool can be used to invite sick-listed retail workers with a ≥36% LTSA risk for expedited consultations. Further studies are needed to determine LTSA cut-off risks for other economic sectors. by Roelen CAM, Speklé M, Lissenberg-Witte BI, Heymans MW, van Rhenen W, Schaafsma FG. doi:10.5271/sjweh.4046
      PubDate: Sun, 26 Jun 2022 17:17:29 +020
      DOI: 10.5271/sjweh.4046
       
  • Lung cancer incidence among workers biologically monitored for
           occupational exposure to lead: a cohort study

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      Abstract: Objective Earlier studies have reported increased risks of lung, kidney and brain cancers for exposure to lead. The International Agency for Research on Cancer (IARC) Working Group evaluated inorganic lead and its compounds probably carcinogenic to humans. This study aimed to assess the association between blood lead level in occupational exposure and risk of lung cancer.Methods The study was based on the follow-up of lung cancer incidence during 1973–2014 among 20 729 employees biologically monitored for their occupational lead exposure in 1973–1983. Duration of employment in the monitored work was assessed using records from the Finnish Centre for Pensions; and potential confounding by other occupational carcinogens using longitudinal information on the occupation in censuses and the Finnish National Job-Exposure Matrix (FINJEM). Occupation- and gender-specific prevalence of regular tobacco smoking and the socioeconomic status were also utilized in the adjustments for potential confounding.Results Positive trends were found for the elevated blood lead levels on the lung cancer risk. Among employees with the duration of employment of ≥60 months, the relative risk (RR) of lung cancer was 1.72 [95% confidence interval (CI) 1.28–2.31] for mean blood lead 1.0–1.9 µmol/L and RR 2.63 (95% CI 1.71–4.05) for mean blood lead ≥2.0 µmol/L, compared with mean lead
      PubDate: Sun, 26 Jun 2022 16:55:48 +020
      DOI: 10.5271/sjweh.4042
       
  • Workplace psychosocial resources and risk of cardiovascular disease among
           employees: a multi-cohort study of 135 669 participants

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      Abstract: Objective In terms of prevention, it is important to determine effects on cardiovascular disease (CVD) when some workplace psychosocial resources are high while others are low. The aim of the study was to assess the prospective relationship between clustering of workplace psychosocial resources and risk of CVD among employees.Methods We pooled data from three cohort studies of 135 669 employees (65% women, age 18–65 years and free of CVD) from Denmark, Finland and Sweden. Baseline horizontal resources (culture of collaboration and support from colleagues) and vertical resources (leadership quality and procedural justice) were measured using standard questionnaire items. Incident CVD, including coronary heart and cerebrovascular disease, was ascertained using linked electronic health records. We used latent class analysis to assess clustering (latent classes) of workplace psychosocial resources. Cox proportional hazard models were used to examine the association between these clusters and risk of CVD, adjusting for demographic and employment-related factors and pre-existing physical and mental disorders.Results We identified five clusters of workplace psychosocial resources from low on both vertical and horizontal resources (13%) to generally high resources (28%). High horizontal resources were combined with either intermediate [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.95] or high (HR 0.88, 95% CI 0.78–1.00) vertical resources were associated with lower risks of CVD compared to those with generally low resources. The association was most prominent for cerebrovascular disease (eg, general high resources: HR 0.80, 95% CI 0.67–0.96).Conclusions Individuals with high levels of workplace psychosocial resources across horizontal and vertical dimensions have a lower risk of CVD, particularly cerebrovascular disease. by Xu T, Rugulies R, Vahtera J, Pentti J, Mathisen J, Lange T, Clark AJ, Magnusson Hanson LL, Westerlund H, Ervasti J, Virtanen M. doi:10.5271/sjweh.4045
      PubDate: Sun, 26 Jun 2022 16:03:06 +020
      DOI: 10.5271/sjweh.4045
       
  • Night and shift work characteristics and incident ischemic heart disease
           and atrial fibrillation among healthcare employees – a prospective
           cohort study

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      Abstract: Objective This study aimed to examine the effects of various aspects of night and shift work on the risk of incident ischemic heart disease (IHD) and atrial fibrillation (AF) using detailed and registry-based exposure data.Methods This prospective cohort study included>30 300 healthcare employees (eg, nurses, nursing assistants) employed for at least one year in Region Stockholm 2008–2016. Information on daily working hours was obtained from a computerized administrative employee register and outcomes from national and regional registers. Using discrete-time proportional hazard models, we analyzed the outcomes as functions of working hour characteristics the preceding year, adjusted for sex, age, country of birth, education, and profession.Results We observed 223 cases of IHD and 281 cases of AF during follow-up 2009–2016. The risk of IHD was increased among employees who the preceding year had permanent night shifts compared to those with permanent day work [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.06–2.43] and among employees working night shifts>120 times per year compared to those who never worked night (HR 1.53, 95% CI 1.05–2.21). When restricted to non-night workers, the risk of IHD was increased for employees having frequent quick returns from afternoon shifts. No increased risks were observed for AF.Conclusions Night work, especially working permanent night shifts and frequent night shifts, is associated with an increased risk of incident IHD but not AF. Moreover, frequent quick returns from afternoon shifts (among non-night workers) increased IHD risk. Organizing work schedules to minimize these exposures may reduce IHD risk. by Kader M, Selander J, Andersson T, Albin M, Bodin T, Härmä M, Ljungman P, Bigert C. doi:10.5271/sjweh.4043
      PubDate: Mon, 20 Jun 2022 18:43:04 +020
      DOI: 10.5271/sjweh.4043
       
  • Social inequalities in early exit from employment in Germany: a causal
           mediation analysis on the role of work, health, and work ability

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      Abstract: Objective The aim of this study was to investigate the contribution of work factors, health, and work ability to social inequalities in early exit from employment among older employees in Germany.Methods Longitudinal data from the representative German lidA Cohort study was linked with employment register data to obtain maximum information on exit routes out of paid employment. Information of N=2438 respondents, aged 46 and 52 at baseline, were obtained for a follow-up of six years (2011–2017). Causal mediation analysis with inverse odds weighting was conducted using discrete-time survival outcomes and baseline measurements of the socioeconomic status (SES: education), work factors, health, and work ability.Results Older employees with low SES were at an increased risk of exiting employment early by receiving disability pension and through long-term unemployment but not through an unspecified labor market exit when compared to those with high and moderate SES. Low work ability accounted for up to 38% of the social inequalities in work exits into disability pension. Less-than-good physical health accounted for up to 59% of inequalities in work exits into long-term unemployment. Work factors contributed considerably to inequalities in exits through unemployment but not disability pension.Conclusions This study finds social inequalities in early exits through disability pension and long-term unemployment among older employees in Germany, predominantly attributable to differences in work ability (disability pension) and physical health (unemployment). Investments in work ability and promotion of physical health may constitute promising approaches to counteract an increase of these inequalities. by Rohrbacher M, Hasselhorn HM. doi:10.5271/sjweh.4036
      PubDate: Thu, 16 Jun 2022 17:53:27 +020
      DOI: 10.5271/sjweh.4036
       
  • Chronic disorders, work-unit leadership quality and long-term sickness
           absence among 33 025 public hospital employees

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      Abstract: Objective This study aimed to examine the association between work-unit level leadership quality and individual-level long-term sickness absence (LTSA) in the hospital sector and effect modification by chronic disorders.Methods This longitudinal analysis included 33 025 Danish public hospital employees who were followed-up for one year after baseline in March 2014. Leadership quality was assessed by questionnaire with mean responses aggregated by work-unit and characterized in tertiles. LTSA during follow-up was determined from employer records. Chronic disorders at baseline was assessed from the Danish hospital and prescription registers. We performed multilevel logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusting for potential confounders. We evaluated interaction between chronic illness and low leadership quality on multiplicative and additive scales.Results We identified employees as healthy (60.8%) or with somatic (31.6%), mental (3.3%), or both somatic and mental (4.3%) disorders. During follow-up, 6% of employees registered a LTSA. Medium and high leadership quality were associated with lower risk of LTSA with OR of 0.84 (95% CI 0.76–0.94) and 0.73 (95% CI 0.65–0.82) respectively, compared to low leadership quality. Associations were similar for healthy employees and employees with only somatic disorders, whereas no association was observed for employees with mental disorders (in presence or absence of somatic disorders). No statistically significant (α=0.05) interactions between leadership quality and chronic disorders on LTSA were observed.Conclusion The findings suggest that the quality of leadership in work units is associated with risk of long-term sick leave in the Danish public hospital sector and that strong leadership protects employees against LTSA. by Mehta AJ, Mathisen J, Nguyen T-L, Rugulies R, Hulvej Rod N. doi:10.5271/sjweh.4040
      PubDate: Tue, 14 Jun 2022 21:29:57 +020
      DOI: 10.5271/sjweh.4040
       
  • Association between rotating night shift work and carotid intima-media
           thickness among Chinese steelworkers: a cross-sectional survey

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      Abstract: Objective This study aimed to examine the association between rotating night shift work and subclinical athero­sclerosis among Chinese steelworkers.Methods We evaluated 3582 steelworkers who participated in the legally required health examination in 2017. Carotid intima-media thickness (CIMT) was measured using ultrasonography. Different exposure metrics of night shifts collected by face-to-face personal interviews were used to examine the relationship between night shift work and the mean CIMT.Results The mean CIMT values were 0.66 (standard deviation 0.22) mm in the study population. Current shift workers shown higher mean CIMT compared to day workers. There were no significant associations between the current shift status, the duration of night shifts, the cumulative number of night shifts, the average frequency of night shifts, and the mean CIMT after all confounding factors adjusted both in male and female.Conclusions Rotating night shift work is not associated with subclinical atherosclerosis among steelworkers. Further large-scale prospective longitudinal studies are warranted to confirm our findings. by Wang L, Zhang S, Yu M, Wu J, Li X, Yuan J. doi:10.5271/sjweh.4038
      PubDate: Mon, 13 Jun 2022 21:28:00 +020
      DOI: 10.5271/sjweh.4038
       
  • Combined psychosocial work factors and risk of long-term sickness absence
           in the general working population: Prospective cohort with register
           follow-up among 69 371 workers

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      Abstract: Objective This study aimed to investigate the importance of combined psychosocial work factors for the risk of long-term sickness absence (LTSA).Methods We followed 69 371 employees in the general working population (Work Environment and Health in Denmark study 2012–2018), without LTSA during the preceding year, for up to two years in the Danish Register for Evaluation of Marginalization. Using k-means cluster analyses and weighted Cox-regression controlling for age, gender, survey year, education, health-behaviors, and physical work demands, we determined the prospective association of 11 identified clusters – based on the combination of nine psychosocial work factors (recognition, quantitative demands, work pace, emotional demands, influence, justice, role clarity, role conflicts, and support from colleagues) – with the risk of LTSA.Results During 124 045 person-years of follow-up, 6197 employees developed LTSA (weighted 8.5%). Using the cluster with the most favorable psychosocial scores as reference, clusters scoring poorly on several combined psychosocial factors had increased risk of LTSA. The cluster scoring poor on all nine psychosocial factors exhibited the highest risk [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.45–1.94]. Scoring poorly on one or two psychosocial factors did not increase the risk of LTSA when combined with favorable scores on the other psychosocial factors. Interaction analyses showed that gender, but not age and education, modified the association between cluster and LTSA.Conclusion Scoring poorly on several combined psychosocial work factors plays an important role in the risk of LTSA. Scoring favorably on several psychosocial factors outweighed the potentially adverse effects of scoring poorly on one or two factors. by Andersen LL, Vinstrup J, Thorsen SV, Pedersen J, Sundstrup E, Rugulies R. doi:10.5271/sjweh.4030
      PubDate: Wed, 01 Jun 2022 15:42:16 +020
      DOI: 10.5271/sjweh.4030
       
 
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