Scandinavian journal of work, environment & health最新文献

Objectives: Work-related musculoskeletal disorders (MSD) affect over 1.7 billion people globally with a huge economic burden. Despite decades with legislations, policies and risk-reduction interventions, we see no decreases in MSD prevalence. Current prevention models focus on eliminating workplace hazards, overlooking that physical and psychosocial work factors can also promote musculoskeletal health (MSH). We were commissioned through the Danish Working Environment Agreement to develop new approaches addressing this conceptual gap.

Methods: Through iterative stakeholder dialogue with Danish policymakers, social partners, and workplace practitioners, we developed and visualized the CoWork (Copenhagen work-related) MSH model to shift the focus from preventing MSD through risk reduction toward actively promoting work-related MSH. The model aims to bridge theory with workplace structure and implementation by addressing stakeholder requests for clear terminology, conceptual understanding in a workplace context, and actionable guidance.

Results: The CoWork MSH model provides a new definition of work-related MSH as "a state of physical, mental, and social well-being of the locomotor system in relation to work" as well as five integrated elements; (i) a health-oriented approach, (ii) a just-right work factor conceptualization, (iii) the Organizational, Management, Group, !ndividual (OMG!) workplace framework, (iv) an intervention guidance, and (v) health economics perspective. This approach recognizes that work factors can benefit rather than harm health when properly designed and implemented.

Conclusions: The CoWork MSH model represents a paradigm shift, extending from risk reduction to MSH promotion, providing researchers, policymakers, and practitioners with a framework for understanding, researching, and practice to promote workplace MSH.

Objective: The aim of this study was to explore the prospective association between compositions of accelerometry-measured occupational physical behaviors and the risk of knee pain among eldercare workers.

Methods: We performed a prospective study among 377 eldercare workers employed across 20 Danish nursing homes. Occupational physical behaviors were measured using thigh-worn accelerometers over 1-4 working days. Workers reported intensity of and days with knee pain in a questionnaire at baseline and after one year. We explored associations between compositions of occupational physical behaviors [ie, sedentary, standing, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)] and knee pain, adjusting for potential confounders.

Results: No significant associations were found. Trends were found for increased occupational time spent in MVPA and decreased risk of days with knee pain [relative risk (RR) 0.58, 95% confidence interval (CI) 0.32-1.05, P=0.07] in main analyses, and for decreased risk of knee pain intensity among non-knee pain cases (RR 0.36, 95% CI 0.12-1.13, P=0.08) in sensitivity analyses.

Conclusions: No significant associations were found between baseline occupational physical behaviors and knee pain at one-year follow-up. However, a non-significant trend suggested that increasing occupational MVPA might be associated with reduced risk of knee pain at follow-up, though studies with larger samples are needed to confirm this finding.

Objectives: In low- and middle-income countries (LMIC), there is mixed evidence on the effectiveness of interventions in improving workplace conditions among hazardous industries. In Thailand, a particularly hazardous industry with high injuries is informal electronic waste (e-waste) recycling. We investigated whether developing an optimized tool to dismantle e-waste would reduce injuries.

Methods: We conducted a quasi-randomized control trial to determine the perceptions and efficacy of the optimized tool in reducing worker injuries over three months among 89 workers. The optimized tool for dismantling e-waste was designed following employee and business owner input using conjoint analysis. Workers were quasi-randomized into an intervention (ie, receiving the tool) or control (ie, not receiving) group from an auction. We conducted differences-in-differences Poisson regression to examine differences in self-reported injuries and near misses over three months follow-up between the intervention and control groups.

Results: Among 44 workers who received the tool, workers self-reported that the tool created a safer work environment and reduced near misses, hammer danger, hand vibrations and hand pain. Among 42 workers (21 treatments, 21 controls) with complete information, the intervention reduced self-reported injuries over three months [difference-in-differences: -58%, 95% confidence interval (CI) -19- -79%]. Similar reductions in near misses were observed but not statistically significant (-53%, 95% CI -92-173%).

Conclusions: Our study suggests that meaningful reductions in injury risk for specific types of work can be achieved with co-designed tools optimized to consider inputs from multiple stakeholders. This approach can be especially useful in resource-constrained environments, including working conditions in LMIC.

Objectives: Emerging evidence suggests that low-dose ionizing radiation increases the risk of neurodegenerative diseases. Past studies have relied on death data to identify dementia, and these are prone to under-ascertainment and complicate the estimation of health risks as individuals tend to live with dementia for many years following onset. We present findings from the first occupational cohort to investigate dementia risk from low-dose radiation using incident outcomes.

Methods: This is a retrospective cohort of 60 874 Ontario Nuclear Power Plant workers from the Canadian National Dose Registry. Personal identifiers were linked to Ontario population-based administrative health data. Incident dementias between 1996 and 2022 were identified using a validated algorithm based on physician, hospital, and prescription drug data. Individual-level annual estimates of whole-body external ionizing radiation were derived from personal workplace monitoring. The incidence of dementia among these workers was compared to a random sample of Ontario residents matched by sex, age, and residential area. Internal cohort analysis using Poisson and linear excess relative risk (ERR) models, adjusted for sex, attained age, calendar period, and neighborhood income quintile, were used to characterize the shape of the exposure-response curve between low-dose cumulative radiation (lagged 10 years) and incident dementia.

Results: There were 476 incident dementias and 867 028 person-years of follow-up. The mean whole-body lifetime accumulated exposure at the end of follow-up was 11.7 millisieverts (mSv). Workers with cumulative exposure between 50-100 mSv had an increased risk of dementia [RR 1.50, 95% confidence interval (CI) 0.99-2.28] compared to those unexposed. Spline analysis suggested that the dose-response relationship was non-linear. The linear ERR per 100 mSv increase in exposure was 0.704 (95% CI 0.018-1.390).

Conclusion: Our findings suggest that low-dose exposure to ionizing radiation increases the risk of incident dementia.

Objectives: This study aimed to describe occupational, industrial, and temporal trends in relation to absence during pregnancy in the Danish workforce.

Methods: The register-based national cohort DOC*X-Generation was used to identify all pregnancies among women (18-50 years) engaged in regular employment in Denmark 1998-2018. The cohort holds individual-level data on occupations coded according to the Danish versions of the International Standard Classification of Occupations and of EU's nomenclature (NACE, revision 2). Data on absence from work was retrieved from the Danish Register for Evaluation and Marginalization. The study population comprised 884 616 pregnancies in 547 870 women.

Results: In 48% of the included pregnancies, the women had at least one week with registered absence with a median of 8 weeks (5-95% percentile; 1-27 weeks). The highest frequencies of absence were observed among painters (75%) and women in the meat products manufacturing industry (68%), whereas the lowest were seen among professionals in physics, mathematics, engineering, and architecture (30%) and in the research and university education industry (32%). The difference between the lowest and highest number of cumulated weeks with absence was 9 weeks. From 1998-2018, the proportion of pregnancies with registered absence decreased, whereas the extent of absence per pregnancy increased.

Conclusions: Absence during pregnancy was consistently high over time, but with vast differences across occupations and industries. A deeper understanding of underlying reasons for pregnancy-related absence is essential to develop targeted strategies for reducing absence, such as providing better opportunities for adjustments of work task early in pregnancy or other tailored interventions.

Objectives: This study aimed to investigate the impact of low job control on labor market participation expressed through working life expectancy (WLE) and working years lost (WYL) among men and women in Sweden.

Methods: A random sample of 100 000 individuals was drawn from the Swedish Work, Illness, and labor market Participation (SWIP) cohort of the registered Swedish population in 2005 born 1945 to 1975. The multi-state estimated labor market affiliation method was used to estimate WLE and WYL due to unemployment, sickness absence, other, disability pension, early old-age pension, and death over a 15-year period (2006-2020). Job control was assessed through a job exposure matrix.

Results: Men and women in high-control jobs had a longer WLE at each age. At age 30, the WLE for men in high-control jobs was 26.3 years while for men in low-control jobs this was 2.5 years shorter. For women, WLE at 30 was 25.8 years for high-control jobs but nearly five years shorter for low-control jobs. For both men and women, these differences were mostly due to disability pension and unemployment. Those in lower control jobs could expect to lose more working years according to nearly all other states besides active employment.

Conclusions: Higher job control is linked to longer WLE, while low job control is an important determinant of WYL in the Swedish workforce. Addressing low job control could extend working lives and reduce inequities in labor market outcomes.

Objectives: This study aimed to assess the associations between occupational biomechanical factors and occurrence of surgically treated lumbar disc herniation (LDH) and describe the consequences in terms of early exit from the labor market.

Methods: A cohort of 262 850 male construction workers participating in a national occupational health surveillance program was followed prospectively for 33 years (1987-2019). Occupational biomechanical exposures were assessed by a job exposure matrix (JEM) based on specific occupational groups. Workers who underwent surgical treatment for LDH were identified from the national patient register and data on disability pension from the Swedish Social Insurance Agency. Poisson regression models were used to estimate relative risks (RR) and 95% confidence intervals (CI) for biomechanical exposures, adjusted for age, body mass index, smoking status, height and time period.

Results: There were 2451 cases of surgical treatment for LDH and the incidence peaked at age 40-45 years. Increased risks were found for often lifting >25 kg (RR 1.77, 95% CI 1.06-2.94), extreme lumbar flexion/extension (RR 1.60, 95% CI 1.37-1.88) and high exposure to whole-body vibration (RR 1.32, 95% CI 1.05-1.65). Among cases, the mean age for exiting the labor market due to disability pension was 55.9 years for white-collar workers and 51.7 years for construction workers.

Conclusions: Occupational exposure to heavy lifting and working in non-neutral back postures was associated with increased risk of surgical treatment for LDH. Construction workers who have had surgery for LDH exited the labor market with disability pension earlier than white-collar workers.

Objectives: This study aimed to assess 12-month outcomes on return to work (RTW) and cost-effectiveness in adults on sick leave due to musculoskeletal disorders who were randomized to either usual case management (UC), UC+motivational interviewing (MI) or UC+stratified vocational advice intervention (SVAI).

Methods: The study was conducted in the Norwegian Labor and Welfare Administration (NAV). Workers on sick leave due to musculoskeletal disorders for ≥50% of their contracted work hours for ≥7 consecutive weeks were included. Trained caseworkers delivered MI in two face-to-face sessions, and physiotherapists provided SVAI and identified RTW obstacles. The main outcomes were sick leave days over 12 months and cost-effectiveness, cost-utility and cost-benefit.

Results: The trial included 509 workers with a mean age of 48 years. There were statistically significant differences between UC+MI versus UC [-15.6 days, 95% confidence interval (CI) -31.0- -0.2], and UC+SVAI versus UC (-17.6 days, 95% CI -33.0- -2.2). Compared to UC, odds ratios (OR) for receiving wage replacement benefits each month were lower for UC+MI (OR=0.73, 95% CI 0.64-0.84), and UC+SVAI (OR 0.74, 95% CI 0.64-0.84). The probabilities of cost-effectiveness were high for adding either MI or SVAI to UC (ceiling ratio 0.90), and the net benefit for MI was €5225 (95% CI -592-10 985) and for SVAI €7214 ((95% CI 1548-12 851) per person.

Conclusions: Adding MI or SVAI to UC significantly improved RTW outcomes and was cost-effective among people on sickness absence due to musculoskeletal disorders.

Objectives: There is increasing interest in the economic effects of improving working conditions, however, evidence is sparse. This study aims to estimate the economic effects of hypothetical improvements in the psychosocial work environment (PSWE) experienced by Danish workers.

Methods: We included 71 207 workers, reporting information on their psychosocial working conditions in the "Work Environment and Health in Denmark" survey and linked these workers to population-based register data. We used the parametric g-formula method to estimate the economic effects of hypothetical improvements of the general PSWE, in terms of costs related to sickness absence and healthcare use. We further examined which PSWE factors contributed most to the economic effects.

Results: A hypothetical improvement of the PSWE - from the least to the most desirable situation - resulted in an annual gain of €1685 [95% confidence interval (CI) €1234-2135] per worker. When analyzing an improvement from the observed to the most desirable situation, the gain became weaker (€305, 95% CI €134-476). Gains were largely driven by reductions in sickness absence and were larger for women than men and for public sector workers than private sector workers. The PSWE factors with the largest contribution were eliminations of threats of violence and improvements in quality of leadership and social support from colleagues (least to most desirable) and improvements in social support from colleagues, influence at work and quality of leadership (observed to most desirable), respectively.

Conclusions: Hypothetical improvements in the PSWE resulted in substantial economic gains, mostly driven by savings related to sickness absence.