Margareta Torgén

Risk factors for neck and upper limb disorders: results from 24 years of follow up.

OBJECTIVES: To investigate associations between different potential risk factors, related and not related to work, and disorders of the neck and upper extremities occurring up to 24 years later. METHODS: The study comprised 252 women and 232 men, Swedish citizens, 42-59 years of age and in a broad range of occupations. Information about potential risk factors was available from a former study conducted in 1969. Data on disorders of the neck, shoulder, and hand-wrist disorders were obtained retrospectively for the period 1970-93. RESULTS: Risk factors were found to differ between the sexes. Among women over-time work, high mental workload, and unsatisfactory leisure time were associated with disorders in the neck-shoulder region. Interaction was found between high mental workload and unsatisfactory leisure time. Neck symptoms earlier in life were associated with recurrent disorders. Hand and wrist disorders were associated mainly with physical demands at work. Among men blue collar work and a simultaneous presence of high mental workload and additional domestic workload predicted disorders in the neck-shoulder region. CONCLUSIONS: Factors related and not related to work were associated with disorders of the neck, shoulders, and hands and wrist up to 24 years later in life. These included factors related to working hours which previously have not been noted in this context. Interactions between risk factors both related and not related to work were commonly found.

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.

Physical and psychosocial factors related to low back pain during a 24-year period. A nested case-control analysis.

Study Design. A retrospective nested case–control study. Objectives. To identify occupational factors related to low back pain, and to study how interactions between psychosocial and physical factors, and between work-related and leisure-related factors affect low back pain in women and men. Summary of Background Data. A cohort of 484 subjects drawn from the general population was examined in 1969 and 1993, with a focus on occupational working conditions and musculoskeletal disorders. Methods. Information about the physical and psychosocial working conditions and low back pain during the period 1970 to 1993 was collected retrospectively. Odds ratios and confidence intervals were calculated for different potential risk factors. Results. During the 24-year period, 46% of the subjects became patients with low back pain. Among women, heavy physical workload, sedentary work, smoking, and the combination of whole-body vibrations and low influence over work conditions were associated with an excess risk of low back pain. Among men, excess risk for low back pain was seen in heavy physical workload, sedentary work, high perceived load outside work, and the combination of poor social relations and overtime. Conclusions. Factors at work were seen to be risk indicators for low back pain among both genders. Low influence over work conditions among women and poor social relations at work among men, in combination with other factors, seem to be of high relevance for the occurrence of low back pain.

Risk factors for neck and shoulder disorders: A nested case–control study covering a 24-year period

BACKGROUND In 1969 a population-based study was conducted in the Stockholm region. From the 2,579 randomly selected participants (18-65 years of age in 1969), the youngest subset were asked to participate in a reexamination in 1993. Information regarding working conditions, conditions outside work, and neck and shoulder disorders was collected retrospectively for the period 1970-1993. METHODS Of 783 eligible subjects (42-59 years of age in 1993), 484 responded. Cases of neck/shoulder disorders were defined by past sick leave or medical attention or recent symptoms, depending on available information. For each case (n = 271) two controls were randomly selected, matched by age and gender. Variables regarding both physical and psychosocial conditions were included in the matched analyses. RESULTS Among women mainly psychosocial factors and among men mainly physical factors were associated with neck/shoulder disorders. The only gender common risk indicator found was repetitive hand work (OR approximately 1.5). Interactive effects were also observed. CONCLUSIONS The impact on neck/shoulder disorders from separate factors was moderate but combinations of physical and psychosocial factors, as well as of work-related and non-work-related factors, produced relative risks above 2.

Physical capacity in relation to present and past physical load at work: a study of 484 men and women aged 41 to 58 years.

BACKGROUND A negative association has previously been reported between long-lasting physically heavy work and some measures of physical capacity. This relationship was further investigated in a 24-year follow-up study of 484 middle-aged men and women from the general population. METHODS A questionnaire was administered in 1993 concerning retrospective recall of physical work loads and physical training in the time span between 1970 and 1993. Laboratory tests performed in 1993 included tests of muscle function (maximal isometric strength and dynamic endurance) and aerobic power (submaximal ergometer test). RESULTS Consistent with the hypothesis, but mainly among the women, associations between long-lasting physically heavy demands and low trunk flexion strength, squatting endurance, and aerobic power were observed. In contrast, low isometric hand grip strength and low weight lifting endurance were seldom seen among those with high physical work loads, indicating a possible maintaining or training effect on the hand/arm/shoulder muscle groups. CONCLUSIONS Physically heavy work seems to have a different impact on different parts of the musculoskeletal system, an effect that is also different between men and women.

Occupational and nonoccupational risk indicators for incident and chronic low back pain in a sample of the swedish general population during a 4-year period: An influence of depression?

The objectives of this study were to examine the relation between occupational and nonoccupational conditions and both incident (IBLP) and chronic low back pain (CLBP), aswellasdepression, among women and men. Data from a4-year follow-up of a study group consisting of 420 participants of both genders from the general Swedish population were analysed. Occupational risk indicators were predictors for both ILBP and CLBP. Depression was not found to be a predictor for either IBLP or CLBP among women, but was a predictor for CLBP among men. Among women, depression had some risk indicators in common with ILBP and appeared to be a concurrent outcome rather than a risk indicator. Low back pain in 1993 was not a predictor for depression in 1997 in either women or men. Occupational conditions are of relevance in relation to both incident and CLBP. Nonoccupational conditions were stronger predictors for CLBP than for ILBP but had some predictive value also for ILBP.

Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population

OBJECTIVES The 12-item version of the General Health Questionnaire (GHQ-12) is frequently used to measure common mental disorder in public health surveys, but few population-based validations have been made. We validated the GHQ-12 against structured psychiatric interviews of depression using a population-based cohort in Stockholm, Sweden. METHODS We used a population-based cohort of 484 individuals in Stockholm, Sweden (participation rate 62%). All completed the GHQ-12 and a semi-structured psychiatric interview. Last month DSM-III-R symptoms were used to classify major and minor depression. Three scoring methods for GHQ-12 were assessed, the Standard, Likert and Corrected method. Discriminatory ability was assessed with area under the receiver operating characteristic (ROC) curve. RESULTS A total of 9.5% had a major or minor depression. The area under the ROC curve was for the Standard method 0.73 (0.65-0.82), the Likert method 0.80 (0.72-0.87) and the Corrected method 0.80 (0.73-0.87) when using major or minor depression as standard criterion. Adequate sensitivity and specificity for separating those with or without a depressive disorder was reached at ≥12 Likert scored points (80.4 and 69.6%) or ≥6 Corrected GHQ points (78.3 and 73.7%). Sensitivity and specificity was at ≥2 Standard scored points 67.4% and 74.2%. CONCLUSION When scored using the Likert and Corrected methods, the GHQ-12 performed excellently. When scored using the Standard method, performance was acceptable in detecting depressive disorder in the general population. The GHQ-12 appears to be a good proxy for depressive disorder when used in public health surveys.

Effects of drop out in a longitudinal study of musculoskeletal disorders

OBJECTIVES The drop out rates in different longitudinal studies of musculoskeletal disorders range between 7% and 57%, and little is known about the characteristics of the subjects who dropped out. The aim was to analyse various consequences of drop out in a longitudinal study of musculoskeletal disorders and occupational risk factors during 1969–97. METHOD Data about occupational conditions and health in 1969 and in 1993 were analysed. Differences between those who participated throughout (participants) and drop out subjects in these analyses formed the basis for recalculations of earlier reported analyses of associations between occupational conditions and low back pain. In the recalculation the data were weighted to compensate for the differences. RESULTS More female and male drop out subjects than participants in 1993 had monotonous work, fewer women and more male drop out subjects had heavy lifting in 1969. In 1997, more female and male drop out subjects had had heavy lifting and low stimulation at work in 1993. At both occasions, there were differences between the drop out subjects and participants in occurrence of musculoskeletal disorders. The weighted analyses resulted in changes in risk ratio of 0.1–0.2. CONCLUSIONS Differences in occupational conditions and health among participants and drop out subjects in a longitudinal study of musculoskeletal disorders and occupational risk factors during 1969–97 did not markedly influence the risk ratios.

Predictive validity of the Work Ability Index and its individual items in the general population

Aim: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population. Methods: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25–75-year-olds living in Sweden in 2000 that received a postal questionnaire (n = 6637, response rate = 53%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; ⩾ 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed. Results: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI. Conclusions: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.

Effect of Screening and Advising on Alcohol Habits in Sweden: A Repeated Population Survey Following Nationwide Implementation of Screening and Brief Intervention

Aims To examine: (a) to what extent individuals in contact with heath care had been asked and advised on their alcohol habits; (b) how self-reports of alcohol consumption and patient characteristics affected the probability of being asked and advised on alcohol consumption; (c) the potential effect of alcohol advice on readiness and ability to change, across levels of high alcohol consumption. Methods A repeated cross-sectional public health postal questionnaire in Uppsala County among 18–84 year old, covering a period of a national programme encouraging alcohol screening, brief interventions and motivational interviewing (2004–2012). Response rates were 65.5–52.2%. Respondent who stated that they had visited health-care services had a further question on whether the staff asked questions about habits including alcohol, and whether the staff had given them advice concerning the same habits. AUDIT-C was the measure of alcohol consumption, and there was a question on wanting to cut down on drinking and/or needing support to do so. Results Screening for and advising patients on alcohol consumption increased during the period, but there were no decreases in population-level consumption. Screening occurred independent of self-reports of AUDIT-C and varied with other individual characteristics. Advice was associated with AUDIT-C score. Being advised increased the likelihood of wanting to reduce drinking, both among those scoring above the national hazardous consumption levels and at higher scores. Conclusions Screening and advising on alcohol habits in health care impacted individual readiness and ability to change. Population-level effects have yet to be proven. Short summary Screening for and advising patients on alcohol consumption increased following a national programme encouraging alcohol screening, brief interventions and motivational interviewing. Overall consumption levels remained unchanged. Screening was largely systematic. The positive effect of advice on wanting to cut back drinking was similar in moderate and high drinkers.