Anne Møller

Does a history of physical exposures at work affect hand-grip strength in midlife? A retrospective cohort study in Denmark.

OBJECTIVE The aim of this cohort study was to examine associations between physical exposures throughout working life and hand-grip strength (HGS) in midlife. METHODS The Copenhagen Aging and Midlife Biobank (CAMB) provided data about employment and HGS for 3843 Danes. Individual job histories, including duration of employment in specific jobs, were assigned exposures from a job exposure matrix. Exposures were standardized to ton-years (lifting 1000 kg each day in one year), stand-years (standing/walking for six hours each day in one year) and kneel-years (kneeling for one hour each day in one year). The effects of exposure-years on HGS were analyzed as linear effects and cubic splines in multivariate regression models, adjusted for potential confounders. RESULTS Mean age was 59 years among both genders and HGS was 49.19 kg [standard deviation (SD) 8.42] and 30.61 kg (SD 5.49) among men and women, respectively. Among men, exposure to kneel-years was associated with higher HGS [>0.030 kg (P=0.007) per exposure-year]. Ton- and stand-years were not associated with HGS among either men or women in linear analyses. In spline regression analyses, associations between ton- and stand-years and HGS were non-linear and primarily positive among men. Among women, the associations were non-linear and, according to ton-years, primarily negatively associated with HGS but statistically insignificant. CONCLUSION A history of physical exposures at work explained only a minor part of the variation in HGS, though exposure to kneeling throughout working life was associated with a slightly higher HGS among men. Exposure to lifting and standing/walking was not associated with HGS.

Lifetime Occupational Physical Activity and Musculoskeletal Aging in Middle-Aged Men and Women in Denmark: Retrospective Cohort Study Protocol and Methods

Background Physical function is essential for performing most aspects of daily life and musculoskeletal aging leads to a decline in physical function. The onset and rate of this process vary and are influenced by environmental, genetic, and hormonal factors. Although everyone eventually experiences musculoskeletal aging, it is beneficial to study the factors that influence the aging process in order to prevent disability. The role of occupational physical activity in the musculoskeletal aging process is unclear. In the past, hard physical work was thought to strengthen the worker, but current studies in this field fail to find a training effect in jobs with a high level of occupational physical activity. Objective The aim of this study is to examine the influence of lifetime occupational physical activity on physical function in midlife. The study follows the “occupational life-course perspective,” emphasizing the importance of occupational exposures accumulated throughout life on the musculoskeletal aging process taking socioeconomic and lifestyle factors into consideration. Methods This study is a retrospective cohort study including a cross-sectional measurement of physical function in 5000 middle-aged Danes. Data was obtained from the Copenhagen Aging and Midlife Biobank (CAMB) which is based on three existing Danish cohorts. Using questionnaire information about the five longest-held occupations, the job history was coded from the Danish version of the International Standard Classification of Occupations (D-ISCO 88) and a job exposure matrix containing information about occupational physical activity in Danish jobs was applied to the dataset. The primary outcomes are three tests of physical function: handgrip strength, balance, and chair rise. In the analyses, we will compare physical function in midlife according to accumulated exposure to high levels of occupational physical activity. Conclusions We have a unique opportunity to study the influence of work on early musculoskeletal aging taking other factors into account. In this study, the “healthy worker effect” is reduced due to inclusion of people from the working population and people who are already retired or have been excluded from the labor market. However, low participation in the physical tests can lead to selection bias.

Validity of Workers' Self-Reports. Evaluation of a Question Assessing Lifetime Exposure to Occupational Physical Activity

Aims: In epidemiological studies exposure assessment based on questionnaires is the most cost-effective method. A question about lifetime exposure to occupational physical

Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension: prospective cohort study

Objectives The aim of this study was to determine the prospective association of cumulative mechanical exposure during working life with health-related labor market outcomes. Methods This prospective cohort study combines data from 5076 older workers (age 49-63 years) from the Copenhagen Aging and Midlife Biobank with a job exposure matrix and a national register containing information on social transfer payment. By coding individual job histories from the Danish version of ISCO-codes (International Standard Classification of Occupations), we calculated cumulative occupational mechanical exposures from a JEM for ton-years (lifting 1000 kg each day in one year), lifting-years (lifting loads weighing ≥20 kg >10 times each day in one year), kneeling-years (kneeling for one hour each day in one year) and vibration-years (whole-body vibration for one hour each day in one year). Cox-regression analyses estimated the relative risk of register-based long-term sickness absence (LTSA) and disability pension with cumulative occupational mechanical exposures throughout working life. Analyses were censored for competing events and adjusted for multiple confounders. Results During the follow-up period, 970 persons (19.3%) had ≥1 episode of LTSA and 85 persons (1.7%) were granted a disability pension. Number of ton-, lifting- and kneeling-years showed an exposure-response association with increased risk of LTSA (P<0.0001). In addition, both long term [≥20 years; hazard ratio (HR) 1.76 95% CI 1.39-2.22] and short term (<10 years; HR 1.20 95% CI 1.02-1.41) exposure to kneeling work increased the risk of LTSA. Lifting-years, but not the other mechanical exposures, were associated with risk of disability pension (HR 1.75 95% CI 1.01-3.04). Conclusions Cumulative occupational mechanical exposures during working life - such as lifting and kneeling work - increased the risk of LTSA. Importantly, being exposed to lifting increased the risk of disability pension.

Does physical exposure throughout working life influence chair-rise performance in midlife? A retrospective cohort study of associations between work and physical function in Denmark

Objectives Our aim was to study associations between physical exposures throughout working life and physical function measured as chair-rise performance in midlife. Methods The Copenhagen Aging and Midlife Biobank (CAMB) provided data about employment and measures of physical function. Individual job histories were assigned exposures from a job exposure matrix. Exposures were standardised to ton-years (lifting 1000 kg each day in 1 year), stand-years (standing/walking for 6 h each day in 1 year) and kneel-years (kneeling for 1 h each day in 1 year). The associations between exposure-years and chair-rise performance (number of chair-rises in 30 s) were analysed in multivariate linear and non-linear regression models adjusted for covariates. Results Mean age among the 5095 participants was 59 years in both genders, and, on average, men achieved 21.58 (SD=5.60) and women 20.38 (SD=5.33) chair-rises in 30 s. Physical exposures were associated with poorer chair-rise performance in both men and women, however, only associations between lifting and standing/walking and chair-rise remained statistically significant among men in the final model. Spline regression analyses showed non-linear associations and confirmed the findings. Conclusions Higher physical exposure throughout working life is associated with slightly poorer chair-rise performance. The associations between exposure and outcome were non-linear.

Association of physical workload and leisure time physical activity with incident mobility limitations: a follow-up study.

Objectives To examine individual as well as joint associations of physical workload and leisure time physical activity with incident mobility limitations in initially well-functioning middle-aged workers. Methods This study is based on 6-year follow-up data of the Danish Longitudinal Study on Work, Unemployment and Health. Physical workload was reported at baseline and categorised as light, moderate or heavy. Baseline leisure time physical activity level was categorised as sedentary or active following the current recommendations on physical activity. Incidence of mobility limitations in climbing stairs and running among initially well-functioning workers (n=3202 and n=2821, respectively) was assessed during follow-up. Results Higher workload increased whereas active leisure time decreased the risk of developing mobility limitations. The incidence of limitations increased progressively with higher workload regardless of level of leisure time physical activity, although the risks tended to be higher among those with sedentary leisure time compared with their active counterparts. All in all, the risk for onset of mobility limitations was highest among those with heavy workload combined with sedentary leisure time and lowest among those with light workload combined with active leisure time. Conclusions Although leisure time physical activity prevents development of mobility decline, high workload seems to accelerate the progression of mobility limitations among both those with active and sedentary leisure time. Therefore, efforts should be made to recommend people to engage in physical activity regardless of their physical workload.

From knowledge to action: the potentials of knowledge portals

Abstract In recent years, focus has been on the utilisation of research-based knowledge and evidence in social work policy and practice in order to make it more effective. A part of this process has been the launch of knowledge portals to make use of knowledge from research. In this article, we investigate how knowledge portals about vulnerable children and youth present knowledge and evidence, and how they try to work as ‘knowledge brokers’ or intermediaries of evidence. We argue that knowledge portals are not merely channels for dissemination of knowledge. Knowledge portals could be considered as part of a greater process of bringing knowledge to action, encompassing the social and organisational contexts of research utilisation. The article concludes by stating that knowledge portals have the potential to be effective instruments in knowledge-to-action processes. The two main challenges, however, are to define and communicate more clearly what is meant by ‘knowledge’, and to view knowledge portals as part of a broader strategy of knowledge use.

Retrospectively assessed psychosocial working conditions as predictors of prospectively assessed sickness absence and disability pension among older workers

BackgroundThe aim was to explore the association between retrospectively assessed psychosocial working conditions during working life and prospectively assessed risk of sickness absence and disability pension among older workers.MethodsThe prospective risk of register-based long-term sickness absence (LTSA) and disability pension was estimated from exposure to 12 different psychosocial work characteristics during working life among 5076 older workers from the CAMB cohort (Copenhagen Aging and Midlife Biobank). Analyses were censored for competing events and adjusted for age, gender, physical work environment, lifestyle, education, and prior LTSA.ResultsLTSA was predicted by high levels of cognitive demands (HR 1.31 (95% CI 1.10–1.56)), high levels of emotional demands (HR 1.26 (95% CI 1.07–1.48)), low levels of influence at work (HR 1.30 (95% CI 1.03–1.64)), and high levels of role conflicts (HR 1.34 (95% CI 1.09–1.65)). Disability pension was predicted by low levels of influence at work (HR 2.73 (95% CI 1.49–5.00)) and low levels of recognition from management (HR 2.04 (95% CI 1.14–3.67)).ConclusionsThis exploratory study found that retrospectively assessed high cognitive demands, high and medium emotional demands, low influence at work, low recognition from management, medium role clarity, and high role conflicts predicted LTSA and/or disability pension.

Retrospectively assessed physical work environment during working life and risk of sickness absence and labour market exit among older workers

Objective To determine the prospective association between retrospectively assessed physical work environment during working life and prospectively assessed sickness absence and labour market exit among older workers. Methods Using Cox regression analyses we estimated the 4-year to 6-year prospective risk of register-based long-term sickness absence (LTSA), disability pension, early retirement and unemployment from exposure to different physical work environmental factors during working life among 5076 older workers (age 49–63 at baseline) from the Copenhagen Aging and Midlife Biobank cohort. Results Very hard physical work throughout working life was a risk factor for LTSA (HR 1.66,95% CI 1.32 to 2.07), disability pension (HR 2.21,95% CI 1.04 to 4.72) and early retirement (HR 1.57,95% CI 1.13 to 2.17). Both short-term (<10 years) and long-term (≥20 years) exposures to lifting or carrying of heavy burdens predicted the risk of LTSA (HRs 1.49–1.56) and disability pension (HRs 2.26–3.29). In contrast, exposure to dust was associated with LTSA and disability pension only following 20 or more exposure years. Conclusions Retrospectively assessed hard physical work during working life and exposure to several factors in the physical work environment, especially heavy lifting, were important for labour market exit and sickness absence. This study underscores the importance of reducing physical work exposures throughout the working life course for preventing sickness absence and premature exit from the labour market.

0032 Physical capacity in midlife and labour market attachment among older workers: prospective cohort study with register follow-up

Introduction We aim to determine the prospective association of different physical capacity tests with health related labour market outcomes among older workers. Methods The prospective risk of register-based long-term sickness absence (LTSA) and disability pension from measured musculoskeletal capacity (jump performance, postural balance, sit-to-stand, explosive muscle strength, and maximal strength of the hand, back and abdominal muscles) and cardiovascular capacity (lung function and aerobic fitness) were estimated among 5076 older workers from the Copenhagen Ageing and Midlife Biobank. Time-to-event analyses were censored for competing events and adjusted for age, gender, physical and psychosocial work environment, lifestyle, socioeconomic position and previous LTSA. Results Low physical capacity in many of the tests (less than 1SD below mean) predicted risk of LTSA and disability pension. Specifically, low aerobic fitness (HR 5.9), low jump performance (HR 2.7) and low abdominal muscle strength (HR 3.3) predicted risk of disability pension. A dose-response association was observed between number of musculoskeletal capacity tests with low performance and disability pension and LTSA - with the risk-estimate for disability pension being 7.6 when low capacity was present in ≥5 musculoskeletal capacity tests. Population attributable risks for disability pension and LTSA from poor musculoskeletal capacity were 33% and 8%, respectively. Conclusions Poor musculoskeletal and cardiovascular capacity in midlife increased the risk for LTSA and disability pension. Promoting physical capability to a normal level among older workers with low capacity may have the opportunity to prevent premature exit from the labour market.