Harald Hannerz

Socioeconomic status and psychosocial work environment: results from a Danish national study.

Objective: The aim of this study was to analyse the associations between socioeconomic status (SES) and a number of psychosocial work environment factors with a potential impact on inequality in health. Methods: A representative sample of 1,684 adult Danish employees fi lled in a standardized questionnaire or were interviewed by telephone. The response rate was 62%. The population was divided into four levels of SES (I to IV). The psychosocial work environment was described with 19 scales. Results: Quantitative, cognitive, and emotional job demands and a number of dimensions related to active and developmental work showed higher levels among high SES individuals. Job insecurity was highest among women with low SES. Dimensions describing interpersonal relations, social support, and leadership showed no clear associations with SES. Conclusions: Prevention aiming at improving health and reducing inequality in health should focus on the dimensions of active and developmental work: infl uence at work, possibilities for development, degrees of freedom, and meaning of work. Furthermore, job insecurity should be reduced.

Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: Randomised controlled trial

&NA; Regular physical exercise is a cornerstone in rehabilitation programs, but adherence to comprehensive exercise remains low. This study determined the effectiveness of small daily amounts of progressive resistance training for relieving neck/shoulder pain in healthy adults with frequent symptoms; 174 women and 24 men working at least 30 h per week and with frequent neck/shoulder pain were randomly assigned to resistance training with elastic tubing for 2 or 12 minutes per day 5 times per week, or weekly information on general health (control group). Primary outcomes were changes in intensity of neck/shoulder pain (scale 0 to 10), examiner‐verified tenderness of the neck/shoulder muscles (total tenderness score of 0 to 32), and isometric muscle strength at 10 weeks. Compared with the control group, neck/shoulder pain and tenderness, respectively, decreased 1.4 points (95% confidence interval −2.0 to −0.7, p < 0.0001) and 4.2 points (95% confidence interval −5.7 to −2.7, p < 0.0001) in the 2‐minute group and 1.9 points (95% confidence interval −2.5 to −1.2, p < 0.0001) and 4.4 points (95% confidence interval −5.9 to −2.9, p < 0.0001) in the 12‐minute group. Compared with the control group, muscle strength increased 2.0 Nm (95% confidence interval 0.5 to 3.5 Nm, p = 0.01) in the 2‐minute group and 1.7 Nm (95% confidence interval 0.2 to 3.3 Nm, p = 0.02) in the 12‐minute group. In conclusion, as little as 2 minutes of daily progressive resistance training for 10 weeks results in clinically relevant reductions of pain and tenderness in healthy adults with frequent neck/shoulder symptoms. Trial registration: www.isrctn.org/ISRCTN60264809. In generally healthy adults with frequent neck/shoulder muscle pain, as little as 2 minutes of daily progressive resistance training reduces pain and tenderness.

A 12 year prospective study of circulatory disease among Danish shift workers

Background: Previous studies of the risk of heart disease after shift work reached different estimates and review authors disagree about the validity of some of the studies. A cross sectional study showed that shift workers had a higher prevalence of nearly every unfavourable work environment factor investigated. Conflicts at work and low decision latitude were more frequent among shift workers, and all-day walking or standing work and part-time jobs were more often found among female shift workers. Objectives: To estimate the risk of circulatory disease in a prospective follow up of a representative sample of gainfully employed Danes, considering known or suspected confounding factors. Methods: A cohort of 5517 people who were gainfully employed in 1990 were followed up for all hospital treatments due to circulatory diseases (390–458, ICD-8; I00–I99, ICD-10) from 1991 to 2002 inclusive. A log linear Poisson regression model was applied to control confounding factors and calculate the relative risk for 927 men and women working nights, evenings, or other non-day shifts compared to 4579 day workers. Results: Non-day workers compared to day workers had a relative risk (RR) for all circulatory diseases of 1.31 (95% CI 1.06–1.63). Without control for BMI and smoking, the RR estimate was 1.33 (95% CI 1.07–1.65). For a subgroup of workers with at least three years’ seniority, the RR was 1.40 (95% CI 1.09–1.81). The population based aetiological fraction of shift work was estimated to 5%. Conclusion: This study adds to a growing body of evidence suggesting that shift work carries an excess risk of circulatory diseases.

Implementation of neck/shoulder exercises for pain relief among industrial workers: a randomized controlled trial.

BackgroundAlthough leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers.MethodsCluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9).Results85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders.ConclusionHigh-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain.Trial registrationNCT01071980.

Prolonged standing at work and hospitalisation due to varicose veins: a 12 year prospective study of the Danish population.

Background: Recent studies suggest that prolonged standing at work is associated with the development of diseases of varicose veins (VV). Aims: To assess the risk of hospitalisation due to VV in the lower extremities prospectively in workers standing or walking at least 75% of their time at work. Methods: A representative random sample of 9653 working age adults was drawn from the Central Population Register of Denmark in 1991. Of these, 8664 accepted to be interviewed by telephone (response rate 90%). Respondents (2939 men and 2708 women) were 20–59 years old and employed in 1990. Risk ratios for VV were estimated by log-linear Poisson regression models separately for men and women with adjustment for smoking status, body mass index (BMI), heavy lifting, and, for females only, number of children at baseline. Results: During 12 years of follow up, 40 hospitalisations due to VV were observed among the men and 71 among the women. For employees with jobs that require prolonged standing or walking compared to all other employees, the relative risk was 1.75 (95% CI 0.92 to 3.34) for men and 1.82 (95% CI 1.12 to 2.95) for women. The pooled estimate of the relative risk was 1.78 (95% CI 1.19 to 2.68). The aetiological fraction of prolonged standing or walking at work was estimated as 22.5% for men and 22.6% for women. Conclusions: This prospective study confirms that prolonged standing at work constitutes an excess risk of hospital treatment due to varicose veins and accounts for more than one fifth of all cases of working age.

Hospital admissions among male drivers in Denmark

OBJECTIVES To facilitate decisions about interventions and to establish baseline values for future evaluation of preventive efforts, the aim of the present study was to elucidate the disease pattern among male professional drivers in Denmark. The study differentiated between drivers of goods vehicles and drivers of passenger transport. METHODS Cohorts of all 20–59 year old Danish male professional drivers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardised hospital admission ratios (SHRs) and time trends (1981–97) for many diagnostic aggregations. RESULTS SHRs for diseases in practically all systems and organs of the body were higher among professional drivers than they were in the male working population at large. Also drivers of passenger transport, compared with drivers of goods vehicles, had significantly high SHRs due to infectious and parasitic diseases, diseases of the circulatory system, and diseases of the respiratory system, and significantly lower rates of injury. For both driver groups, the SHRs for acute myocardial infarction increased with time whereas the SHR for acute gastritis decreased, and for drivers of passenger transport an increasing SHR for chronic obstructive pulmonary disease, was found over time. CONCLUSION Drivers of passenger transport and drivers of goods vehicles differ in their disease patterns. The results support the hypothesis that preventive efforts are needed in both groups, but underline that different strategies are required for different categories of drivers.

Occupational Factors and 5-Year Weight Change Among Men in a Danish National Cohort

This study explored whether factors related to the work environment could predict changes in body mass index (BMI) and whether the effect of psychosocial factors was dependent on baseline BMI. The sample consisted of 1,980 male employees from the Danish National Work Environment Cohort Study. Changes in BMI between 1995 and 2000 were analyzed, by multiple regression, as a function of background variables and a series of occupational variables obtained in 1995. Age, baseline BMI, job insecurity, and psychological demands predicted changes in BMI. Job insecurity and high or low psychological demands increased the likelihood of weight gain among obese employees, whereas they increased the likelihood of weight loss among employees with a low BMI.

Do dimensions from the Copenhagen Psychosocial Questionnaire predict vitality and mental health over and above the job strain and effort—reward imbalance models?

Aims: The Copenhagen Psychosocial Questionnaire (COPSOQ) comprises dimensions (emotional demands, demands of hiding emotions, meaning of work, quality of leadership, and predictability) that are not in the job strain or the effort—reward imbalance (ERI) models. The study aim was to investigate whether these dimensions explain changes in vitality and mental health over and above the job strain and ERI models. Methods: A cohort of 3552 employees in 2000 were followed up in 2005 (cohort participation of 51%). Regression analyses were carried out with mental health and vitality as dependent variables. A significance level of 0.01 was applied when comparing regression models. Results: Regarding mental health, both the full COPSOQ—ERI model (p = 0.005) and the full job strain—COPSOQ model (p = 0.01) were significantly better than the ERI and the job strain models. Regarding vitality, none of the full COPSOQ models (i.e. with new COPSOQ dimensions together with job strain or ERI respectively) was significantly better than the ERI (p = 0.03) or the job strain (p = 0.04) models. Emotional demands and low meaning of work predicted poor mental health and low vitality. Conclusions: In relation to mental health, new psychosocial risk factors have the potential to add to the predictive power of the job strain and ERI models. The current practice of including only items from the ERI and job strain models in public health studies should be reconsidered. Theories regarding the status of, for example, emotional demands and meaning of work should be developed and tested.

Work environment and smoking cessation over a five-year period

Aims: The authors set out to estimate effects of occupational factors on smoking cessation among Danish employees. Methods: Data from 3,606 observations of smokers gathered from the Danish National Work Environment Cohort Study in 1990, 1995, and 2000 were analysed by logistic regression. The model comprised background variables, smoking variables, and measures of psychosocial and other aspects of the work environment. Results: Statistically significant odds ratios (OR) for cessation were found for medium versus no exposure to noise (OR 0.71, 95% CI 0.54 - 0.93), for high versus low physical workload (OR 0.49, 95% CI 0.47 - 0.73), for high versus low psychological demands (OR 1.42, 95% CI 1.12 - 1.80), and for medium versus low levels of responsibility at work (OR 1.31, 95% CI 1.03 - 1.65). Conclusion: The probability of smoking cessation differs between people with different exposures to certain work environmental factors.

Hospitalization for lifestyle related diseases in long haul drivers compared with other truck drivers and the working population at large

Personal lifestyle and working conditions are closely linked for long haul truck drivers. We compare lifestyle related diseases in long haul drivers with other drivers of goods and the working population at large. Standardized hospital treatment ratios (SHR) for lifestyle related diseases were compared for long haul truck drivers and other truck drivers to the working population at large. The follow up group comprised of 2,175 long haul drivers and 15,060 other truck drivers. An increased risk was found for lifestyle related diseases among truck drivers except for alcohol related diseases. We identified a strong association between hospital treatment for obesity and working as a driver and an association between diabetes and working as a driver. No major differences in lifestyle related diseases were found in long haul drivers compared to other truck drivers with the exception of a significant lower risk for alcohol-related diseases and a possibly higher risk for lung cancer in long haul drivers. It is concluded that diseases related to excess caloric intake or lack of exercise may be a problem for truck drivers. This risk is preventable and of importance both in occupational medicine as in public health.