Eva Vingård

Sports and osteoarthrosis of the hip An epidemiologic study

To investigate if participation in sports increases the risk of developing osteoarthrosis of the hip, we did a case-control study on the sports activities of 233 men (up to age 49) who were recent recipients of a prosthe sis because of severe idiopathic osteoarthrosis of the hip and 302 men randomly selected from the general population. Assessments of sports, job history, and health status were made by an interview. Men with high exposure to sports of all kinds com bined (in hours) had a relative risk to develop osteoar throsis of the hip of 4.5 compared to those with low exposure. Track and field sports and racket sports seemed to be the most hazardous to the hip joint. Men who had been exposed to high physical loads both from their occupation and sports had a relative risk of 8.5 to develop osteoarthrosis of the hip compared to those with low physical load in both activities. Potential confounding factors, such as age, body mass index, and smoking, were considered. Long-term exposure to sports among men seems to be a risk factor for developing severe osteoarthrosis of the hip; this is increased when combined with heavy load from occupation.

Comparisons of self-reported and register data on sickness absence among public employees in Sweden

Aim: Self-reported assessments of sickness absence are often performed in epidemiological studies. The objective of this study was to compare the number of sick-leave days according to self-reported data over 12 months with data from the employer’s register for the same period. An additional aim was to ascertain whether the self-reported information and the recorded data would show equivalent associations with self-reported general health. Methods: The study was based on a cohort of 4869 municipal employees in Sweden, about 80% women, who answered a questionnaire in 2001–2. The responses provided by the employees included information on number of sick-leave days and self-rated health. Data on sick-leave days, occupation and age were derived from the employers’ computerised registers. The questionnaire information on sick-leave days was compared with the corresponding information retrieved from the employer register by means of calculating sensitivity and specificity, using the employers’ data as the “gold standard”. Results: The annual number of sick-leave days was lower according to the self-reported information than to the register data. For women the agreement between the two sickness absence measures for no sick-leave days, 1–7 days and ≥28 days were 74%, 72% and 67%, respectively. The sensitivity of questionnaire versus register information regarding any self-reported sick-leave day was 91% and the specificity was 74%. Sensitivity and specificity for sickness absence ⩾28 days were 67% and 98%, respectively. The results for men were similar to those for women. Self-reported and recorded sickness absence were both associated with self-rated health. The odds ratios were 7.27 and 8.25, for subjects with ≥28 recorded and self-reported number of sick-leave days respectively, compared to subjects with no sickness absence. Conclusions: Good agreement was found between self-reported and register information on sickness absence. Self-reported data on sickness absence may be useful in common epidemiological applications.

Osteoarthrosis of the knee in men and women in association with overweight, smoking, and hormone therapy

OBJECTIVES The aim was to examine the relation between osteoarthrosis of the knee leading to prosthetic surgery among men and women and overweight, smoking, and hormone therapy. METHODS A case-referent study was performed with a study base of all men and women, born 1921–1938, living in 14 counties in Sweden during 1991–95. The cases (n=625) were identified through the Swedish Knee Arthroplasty Register. The referents (n=548) were randomly selected through the central population register from the same counties. Detailed information on general health status, height, weight, smoking habits, medication, use of hormones, specific physical loads from occupation and housework, and sports activities was collected by a telephone interview and a postal questionnaire. The cases were classified in terms of high, medium or low/non-exposure to the factors studied, according to the distribution of variables among the referents. RESULTS Women with high body mass index (BMI) at the age of 40 had a relative risk of 9.2 (95%CI 5.3, 16.0) of developing severe knee osteoarthrosis later in life, and for men at the same age the relative risk was 3.9 (95%CI 2.3, 6.4). Smokers were less likely to develop severe knee osteoarthrosis compared with non-smokers. Oestrogen therapy for women over 50 showed an increased relative risk of 1.8 (95%CI 1.2, 2.6), while use of oral contraceptives did not influence the risk . CONCLUSION Overweight is a risk factor for knee osteoarthrosis leading to prosthetic surgery in men and women, with the strongest relation for women. Oestrogen therapy after 50 increased the relative risk, while smoking decreased it.

Excessive body weight and smoking associates with a high risk of onset of plaque psoriasis.

Accumulating evidence indicates that body weight, alcohol and smoking are associated with psoriasis. However, these factors have scarcely been investigated in relation to onset and disease activity at onset of psoriasis. A population-based case-control study was performed including 373 cases with onset of first-time plaque psoriasis within 12 months and matched healthy controls. Psoriasis activity was measured using the Psoriasis Area and Severity Index (PASI). Analyses were performed using conditional logistic regression. In multivariable analyses for each unit increment in body mass index, there was statistically significant 9% increased risk for psoriasis onset and 7% higher risk for increased PASI. Obesity (body mass index > or =30) compared with normal body weight was associated with a two-fold increased risk for psoriasis onset. Smoking was associated with a 70% increased risk for onset, but was not related to PASI. A positive association with alcohol drinking was observed among men, but not among women. No associations were observed for weight gain and use of smokeless tobacco. Our results indicate that excessive body weight and smoking are risk factors for onset of psoriasis and that higher body mass index increases the PASI of plaque psoriasis at onset.

Chapter 9. Consequences of being on sick leave

The possible consequences of sick leave can be measured at different levels in society. This chapter focuses on the consequences from the perspective of the sick-listed individual. Sick leave may have both positive and negative consequences for the individual, e.g. regarding disease, health, working life, social life, lifestyle, and emotional aspects. Some of these factors have been investigated in different studies. However, scientific evidence is insufficient since there are too few studies on the consequences of sickness absence and disability pension. The lack of relevant studies is the most striking observation from the review of studies on the consequences of being sick listed.

Long-term sick-listing among women in the public sector and its associations with age, social situation, lifestyle, and work factors: A three-year follow-up study

Background: Since 1997 the number of long-term sick-listed people in Sweden has increased dramatically, especially among women employed in the public sector. Aims: The aim of this study was to investigate associations between age, social situation, lifestyle, work factors, and long-term sick-listing (≥28 days), regardless of diagnosis, during a period of three years among women employed in the public sector. Methods: Exposure information at baseline was recorded by a questionnaire. All new spells of sick-listing ≥28 days were consecutively reported from the employer for three years from baseline. In total 6,246 women from the public sector in Sweden answered the questionnaire (85% response rate); 5,224 were classified as having good or rather good health for working and were included. Of these, 918 persons had spells of sick-listing ≥28 days during follow-up. Results: Univariate and multivariate analyses for calculating relative risks (RR) were carried out. In the Cox regression model age (RR 1.4), strained financial situation (RR 1.3), obesity (RR 1.3), bullying (RR 1.5), physical demands at work higher than own capacity (RR 1.5), and mental demands at work higher than own capacity (1.2) remained risk indicators for long-term sick-listing. Conclusion: This study suggests prevention of some work and lifestyle factors as general measures to reduce long-term sick-listing among women in the public sector.

Psychosocial and physical risk factors associated with low back pain: a 24 year follow up among women and men in a broad range of occupations.

OBJECTIVES: To investigate the relation between psychosocial and physical factors at work, as well as conditions during leisure time, and low back pain (LBP) over 24 years. METHODS: The study group consisted of 252 women and 232 men. From a previous study conducted in 1969, data on psychosocial and physical conditions and LBP were available. Data on LBP for 1971-93 were obtained retrospectively in 1993. RESULTS: The prevalence of LBP in 1969 among women and men were 34% and 24%, the cumulative incidences of LBP during 1970-92 were 38% and 43%, and the prevalences in 1993 of having had LBP during the past 12 months were 44% and 39%, respectively. Monotonous work and few or unsatisfactory social contacts outside work were risk factors for LBP in 1969 among women. LBP in 1969 and dissatisfaction with leisure time were risk factors among both sexes for LBP in 1970-92. LBP in 1969 was a risk factor for LBP in 1993 among women and dissatisfaction with leisure time a risk factor among men. Interactions between few or unsatisfactory social contacts outside work, as well as dissatisfaction with leisure time, and several factors related to work were found to increase the risk of LBP among both sexes during the studied periods. CONCLUSIONS: Conditions in leisure time exert a long term influence on LBP. In this study factors related to work had a long term effect only in interaction with leisure time factors.

Work environment and neck and shoulder pain: the influence of exposure time. Results from a population based case-control study

Objectives: To study associations between long term and short term exposure to different work environmental conditions and the incidence of neck or shoulder pain. The results were obtained as part of the MUSIC-Norrtälje study, which is a population based case-control study conducted in Sweden in 1993–7. Methods: The cases were people from the study base who sought medical care or treatment for neck or shoulder pain. Information on physical and psychosocial conditions in the work environment, currently and 5 years ago, and lifestyle factors, was obtained by self administered questionnaires from 310 cases and 1277 randomly selected referents. Results: Associations between both physical and psychosocial exposures in the work environment and seeking care for neck or shoulder pain were found. The risk patterns differed for the sexes, and risk ratios exceeding 1.5 were more often found among women than among men. Generally, subjects who had experienced a recent increase of exposure were more likely (relative risk (RR) 2.1–3.7) to seek care than those who had been exposed long term (RR 1.5–1.8). Among women, an increased amount of visual display terminal (VDT) work, work above shoulder level, and reduced opportunities to acquire new knowledge, and among men, an increased amount of seated work were associated with neck or shoulder pain. This might indicate short induction periods for neck or shoulder pain for these exposures. However, for repetitive work with the hands and hindrance at work among women, and possibly also local vibrations among men, the induction periods seem to be longer. Interactive effects between factors, both at work and in the family, were found, but only among women. Conclusions: Associations between some exposures in the work environment and seeking care for neck or shoulder pain were found. The high RRs for short term exposure might indicate that for many factors the induction period for neck or shoulder pain is short.

Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: Prospective study with clinical implications

Study Design: Prospective cohort study with 18-month follow-up. Objective: To investigate if long-term sick listed persons’ own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. Method: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. Results: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons’ own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31–20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19–3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21–5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10–3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07–5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82–4.20). Conclusion: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.

Osteoarthrosis of the Hip in Women and Its Relationship to Physical Load from Sports Activities

In a case-control study, the relationship between sporting activities and osteoarthrosis of the hip in women was investigated. The study base comprised Swedish women 50 to 70 years of age between 1991 and 1994. Case subjects (N 230) had had total hip replacements because of primary osteoarthrosis of the hip, and control subjects (N 273) were randomly selected women without hip problems from the study base. All women were interviewed about sports activities to the age of 50, health status, smoking habits, occupational history, and work in the home. Three exposure classes were defined based on total hours of sports activities aggregated to the age of 50. The relative risks of developing osteoarthrosis of the hip leading to total hip replacement was 2.3 (confidence interval, 1.5 to 3.7) for those with high sports exposure and 1.5 (0.9 to 2.5) for those with medium sports exposure compared with those with low exposure. The relative risks were adjusted for age, occupational physical load, body mass index, hormone therapy, and smoking. Physical load from sporting activities seems to be a moderate risk factor for women for the development of severe osteoarthrosis of the hip. Participation in sports was low, and therefore individual risk estimates for different sports activities were not possible to obtain.