Françoise Leynen

The impact of psychosocial factors on low back pain : Longitudinal results from the belstress study

Study Design. An epidemiological cohort study. Objective. To describe the impact of psychosocial factors, both work and nonwork-related, on the prevalence of low back pain (LBP) after 6.6 years on average. Summary of Background Data. There is growing consensus that psychosocial factors play a role in the development of LBP, although results are not consistent across studies. Methods. Within a sample of 2556 middle-aged men and women from the Belstress study, baseline psychosocial factors were measured through self-administered questionnaires and related to prevalent cases of LBP after a mean time interval of 6.6 years through Cox regression analysis. Results. After adjustment for individual and physical risks, including occasional back pain at baseline, the prevalence rate of LBP in men is significantly related to baseline low decision latitude and low social support at work, and nonsignificantly to high job strain, low wage and job satisfaction, feeling stressed at work, and feeling depressed. High job insecurity, feeling stressed at work, and feeling depressed nonsignificantly increase the relative risks for LBP in women. Conclusions. Based on the results of this study, psychosocial factors (both work and nonwork-related) constitute nonnegligible risks for the development of LBP.

High job strain and ambulatory blood pressure in middle-aged men and women from the belgian job stress study

Objective: The aim of this study was to assess whether job strain is associated with 24-hour ambulatory blood pressure measurements within a subsample of the Belgian Job Stress Project (BELSTRESS) population. Methods: A group of 89 middle-aged male and female workers perceiving high job strain and an equally large group of workers perceiving no high job strain wore an ambulatory blood pressure monitor for 24 hours on a regular working day. Results: Mean ambulatory blood pressure at work, at home, and while asleep was significantly higher in workers with job strain as compared with others. The associations between job strain and ambulatory blood pressure were independent from the covariates. Conclusions: Within this study, high job strain was an important independent risk factor for higher ambulatory blood pressure at work, at home, and during sleep in a group of men and women.

Increased absenteeism from work among aware and treated hypertensive and hypercholesterolaemic patients

Aim The ‘labelling hypothesis’ was introduced on the basis of the observation that labelling subjects with blood pressure elevation as hypertensive was associated with an increase in sickness absence. In the Belstress I study this hypothesis was analysed in the same way for the possible influence on sick leave of labelling persons with elevated cholesterol as hypercholesterolaemic. Methods and results The Belstress I cohort concerns a sample of more than 16000 men and 5000 women at work in 24 Belgian industries in various sectors. Baseline data were collected by questionnaire and clinical examination. Awareness was defined as answering positively to the question ‘did a physician ever tell you that your blood pressure/serum cholesterol was too high?’ Sick leave data were independently and objectively recorded during 1 year following the screening. Sick leave was treated in a dichotomous way whereby the event was defined as being in the highest quartile of the annual number of days of sick leave (10 days or more for men and 15 days or more for women) or as being in the highest quartile of the annual number of spells of sick leave (two spells or more for both sexes). Gender-specific logistic regression analyses were performed, with adjustment for a large set of covariates. A positive association was observed between both awareness of hypertension and awareness of hypercholesterolaemia and the various definitions of sick leave, in both sexes and after adjustment for different covariates. When dividing up aware subjects into treated versus untreated, we observed in men the highest sick leave incidence in aware and treated hypertensive patients as well as in aware and treated hypercholesterolaemic patients. In women findings were less consistent, probably due to the smaller sample size. When looking at cumulative effects by examining participants with both hypertension and hypercholesterolaemia and their level of awareness for one or both risk factors, a statistically significant gradient was noticed in men, with the highest sick leave incidence, whatever the definition, in men aware for both risk factors, followed by men aware for one. In women the same trends were observed, but no level of statistical significance was reached. Conclusion Without being able to test the effect of ‘labelling’ as such, our study provides support for the association between awareness of two different coronary risk factors and incidence of sick leave. Probably a common mechanism is at the base of these findings. Further research is needed, in order to reduce potential negative effects of screening on human wellbeing as well as on productivity.

Diabetes Mellitus in Middle-aged People Is Associated with Increased Sick Leave: The BELSTRESS Study

Abstract In a prospective study of the association between self-reported diabetes mellitus and sick leave from work, 21,149 men and women, aged 35-59 years, participated. Prevalence of diabetes was obtained by questionnaire. Sick leave was prospectively obtained from departments of human resources in the year after the baseline survey. Outcome variables related to duration of sick leave, repetitive absences, and long absences of at least seven consecutive days. In gender-specific multivariate analyses the relation between diabetes and sick leave was studied independent of age, body mass index, physical activity, alcohol intake, education, job title, and smoking habit. Prevalence rates of self reported diabetes were 2.8% and 2.2% in men and women, respectively. For each outcome variable a significant association between diabetes and sick leave was observed. Significant associations were found between diabetes and duration of sick leave and repetitive absences in men. In women a similar trend was observed for duration, and a significant association was found for repetitive absences.

Relationship of perceived job stress to total coronary risk in a cohort of working men and women in Belgium

Objective To examine the relationships of job strain and iso-strain psychosocial work environment exposures to ‘total coronary risk’ (TCR) in a cohort of male and female workers in Belgium. Methods The sample consists of 15 079 men and 4639 women aged 35-59 years employed in a wide range of occupations and free of any self-reported personal history of CHD. Karaseks job strain model was used to define high strain (high demands and low control), low strain, active and passive jobs. Iso-strain was defined as the combination of a high strain job with low worksite social support, and is compared to the other combinations. Total coronary risk is a composite measure based on a Framingham function assessing the risk of developing coronary heart disease (CHD) within the next 10 years; high and low levels of TCR were defined. Logistic regressions in each gender were applied to explore relationships, adjusting for age, level of education, occupational class and sector of employment. Results In male workers, the age-adjusted prevalence of high TCR is highest in (1) in the lowest quartile group of job control and (2) in the ‘high strain’ group. The multivariate logistic regressions comparing high strain, active and passive work exposures to low strain work did not indicate a significant association with high TCR. Likewise, iso-strain jobs were neither found to be associated with high TCR. Conclusion Our cross-sectional analysis provides no support for the hypothesis that the psychosocial work environment is strongly associated with the TCR estimate in healthy workers. Eur J Cardiovasc Prevention Rehab 10:345-354