Tom Sterud

Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway

Aims This study examines the impact of work-related psychosocial and mechanical exposure on the development of low back pain (LBP) in the general working population. Methods A randomly drawn cohort from the general population in Norway aged 18–66 years was followed up for 3 years (n=12 550, response rate at baseline=67%). Eligible respondents were in paid work during a reference week in 2006 and 2009, or temporarily absent from such work (n=6745). Five work-related psychosocial factors and seven mechanical exposures were measured. Outcomes of interest were moderate or severe LBP at follow-up adjusted for baseline LBP. Results In total, 12.8% (861 individuals) reported LBP during the last month at follow-up. Work-related psychosocial predictors of LBP were high job demands (OR 1.41, 95% CI 1.16 to 1.72) and low job control (OR 1.26, 95% CI 1.01 to 1.57). Mechanical factors were prolonged standing (OR 1.48, 95% CI 1.20 to 1.83), awkward lifting (OR 1.55, 95% CI 1.28 to 1.88) and squatting/kneeling (OR 1.29, 95% CI 1.04 to 1.61). The estimated population risk attributable to these factors was approximately 42%. The risk for LBP associated with psychosocial exposure was not influenced by adjustment for mechanical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress. Conclusions Highly demanding jobs, prolonged standing and awkward lifting appear as the most consistent and important predictors of LBP.

Effects of occupational role conflict and emotional demands on subsequent psychological distress: A 3-year follow-up study of the general working population in Norway

Objective: To examine the impact of occupational role conflict and emotional demands on subsequent psychological distress. Methods: A randomly drawn cohort from the general Norwegian working-age population was followed up for 3 years (n = 12,550; response rate = 67%). Eligible respondents were in paid work during the reference week in 2006 and 2009 or temporarily absent from such work (n = 6,745; response rate = 68%). Results: In the fully adjusted model, both high role conflict (odds ratios = 1.53; 95% CI = 1.15 to 2.03) and high emotional demands (odds ratios = 1.38; 95% CI = 1.13 to 1.69) were significant predictors of psychological distress. Additional significant predictors were low job control, bullying/harassment, and job insecurity (P < 0.05). Conclusions: Considering all of the evaluated work-related factors, role conflict and emotional demands contributed the most to the population risk of developing psychological distress.

Work-related mechanical risk factors for long-term sick leave: a prospective study of the general working population in Norway

BACKGROUND The overall evidence for work-related mechanical exposures as risk factors for long-term sick leave (LTSL) in the general working population is limited. METHODS The study cohort was randomly drawn from the general population in Norway, aged 18-69 years (n = 12 255, response at baseline = 60.9%). Eligible respondents were interviewed in 2009 and were registered with an active employee relationship of at least 100 actual working days in 2009 and 2010 (n = 6758). The outcome of interest was medically confirmed LTSL ≥40 working days during 2010. RESULTS In total, 9.4% (635 individuals) were classified with LTSL during 2010. The risk of LTSL was higher in women, employees with fewer years of education, regular smokers, employees with chronic health complaints and employees with LTSL during 2009. After adjusting for these factors, we estimated that 24.6% of LTSL cases were attributable to work-related mechanical exposure. Mechanical risk factors were neck flexion, hand/arm repetition, standing, working with upper body bent forward and awkward lifting. The odds ratio for highest exposure levels ranged from 1.32 (95% confidence interval 1.04-1.69) for standing to 2.15 (95% confidence interval 1.24-3.73) for awkward lifting. A test for trend was statistically significant for all contributing factors (P ≤ 0.05), except standing. No psychosocial factors acted as major confounders related to any of the mechanical risk factors. CONCLUSION This study underlines the importance of work-related mechanical exposures as risk factors for LTSL in the general working population. An exposure-response relationship was indicated for 5 of the 10 factors evaluated.

Work-related psychosocial and organizational risk factors for headache: A 3-year follow-up study of the general working population in Norway

Objectives: To determine the effects of work-related psychosocial and organizational factors on headache. Methods: A random cohort from the Norwegian general population (aged 18 to 66 years) had been observed for 3 years. Eligible respondents answered a question about headache, and were engaged in paid employment during the reference weeks in 2006 and 2009, or were temporarily absent from such work (N = 3325). Results: In the fully adjusted model, the main risk factors were high role conflict (highest odds ratio [OR] = 2.86; 95% confidence interval [CI] = 1.49 to 5.48), low social climate (highest OR = 2.21; 95% CI = 1.09 to 4.49), bullying/harassment (OR = 3.94; 95% CI = 1.36 to 11.42), and downsizing (OR = 2.38; 95% = 1.20 to 4.71). Conclusions: Role conflict, low social climate, and bullying/harassment were the main predictors of headaches. These factors should be considered to prevent headaches at work.

The contribution from psychological, social, and organizational work factors to risk of disability retirement: a systematic review with meta-analyses

BackgroundPrevious studies indicate that psychological, social, and organizational factors at work contribute to health, motivation, absence from work, and functional ability.The objective of the study was to assess the current state of knowledge of the contribution of psychological, social, and organizational factors to disability retirement by a systematic review and meta-analyses.MethodsData sources: A systematic literature search for studies of retirement due to disability in Medline, Embase, and PsychINFO was performed. Reference lists of relevant articles were hand-searched for additional studies. Data extraction: Internal validity was assessed independently by two referees with a detailed checklist for sources of bias. Conclusions were drawn based on studies with acceptable quality. Data synthesis: We calculated combined effect estimates by means of averaged associations (Risk ratios) across samples, weighting observed associations by the study’s sample size. Thirty-nine studies of accepted quality were found, 37 of which from the Nordic countries.ResultsThere was moderate evidence for the role of low control (supported by weighted average RR = 1.40; 95% CI = 1.21-1.61) and moderate evidence for the combination of high demands and low control (although weighted average was RR = 1.45; 95% CI = 0.96-2.19) as predictors of disability retirement. There were no major systematic differences in findings between the highest rated and the lowest rated studies that passed the criterion for adequate quality. There was limited evidence for downsizing, organizational change, lack of employee development and supplementary training, repetitive work tasks, effort-reward imbalance to increase risk of disability pension. Very limited evidence was found for job demands, evening or night work, and low social support from ones superior.ConclusionsPsychological and organizational factors at work contribute to disability retirement with the most robust evidence for the role of work control. We recommend the measurement of specific exposure factors in future studies.

Work-related psychosocial risk factors for long-term sick leave: a prospective study of the general working population in Norway.

Objective: To examine the effect of work-related psychosocial exposures on long-term sick leave (LTSL) in the general working population. Methods: A prospective study of the general working population in Norway. Eligible respondents were interviewed in 2009 and registered with at least 100 working days in 2009 and 2010 (n = 6758). The outcome was medically confirmed LTSL of 40 days or more during 2010. Results: In the fully adjusted model, high exposure to role conflict (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.20 to 2.09), emotional demands (OR, 1.32; 95% CI, 1.03 to 1.69), and low supportive leadership (OR = 1.50; 95% CI, 1.15 to 1.96) predicted LTSL. A test for trend was statistically significant for all factors (P ⩽ 0.05). We estimated that 15% of LTSL cases were attributable to these factors. Conclusions: This study underlines the importance of taking into account psychosocial exposures as risk factors for LTSL.

Do work-related mechanical and psychosocial factors contribute to the social gradient in long-term sick leave: A prospective study of the general working population in Norway

Aims: A social gradient in long-term sick leave (LTSL) rates is well established, but only a few studies have examined to what extent this gradient may be explained by mechanical and psychosocial work environment factors. Methods: A randomly drawn cohort from the general population in Norway, aged 18–69 years, was interviewed in the second half of 2009 (n=12,255, response at baseline 60.9%) and followed up in national registries to the end of 2010. Eligible respondents were registered with an active employee relationship of at least 100 actual working days in 2009 and 2010 (n=6758). Based on administrative register data, respondents were coded into five educational levels (university/college ≥4 years was set as the reference group). Eight work-related psychosocial factors and 10 mechanical exposures were measured. The outcome of interest was medically confirmed LTSL ≥40 working days during 2010. Results: In total, 9.4% (635 individuals) were classified with LTSL during 2010. There was a strong social gradient ranging from 12.4% (elementary) to 3.3% (university/college ≥4 years) among men. The corresponding figures among women were 15.4 and 4.6%. Adjusting for work-related mechanical and psychosocial factors explained between 41 and 44% of the social gradient in men. Among women, the corresponding figures were 31 and 54%. Conclusions: Work-related mechanical and psychosocial factors contribute to the social gradient in LTSL. The work-related factors that accounted for this gradient were rather similar for men and women.

Do Work-Related Mechanical and Psychosocial Factors Contribute to the Social Gradient in Low Back Pain?: A 3-Year Follow-Up Study of the General Working Population in Norway.

Study Design. A prospective cohort study. Objective. The aim of the study was to investigate the extent to which work-related factors contribute to the social gradient in low back pain (LBP). Summary of Background Data. A social gradient in LBP is well established, but only a few studies have examined the extent to which exposure to mechanical and psychosocial work environment factors is a pathway for this gradient. Methods. A randomly drawn cohort from the general population in Norway aged 18 to 66 years was followed up for 3 years (n = 12,550, response rate at baseline = 67%). Eligible respondents were in paid work during 2006 and 2009 (n = 6819). Based on administrative register data respondents were coded into five educational levels (university/college ≥4 years was set as the reference group). Outcome of interest was self-reported moderate or severe LBP at follow-up adjusted for baseline LBP. Results. In total, 11.2% (397 individuals) men and 14.5% (461 individual) women reported LBP at follow-up. There was a strong social gradient ranging from 16.4% (elementary) to 6.4% (university/college ≥4 years). The corresponding figures among women were 22.4% and 7.5%. Corrected for age, LBP at baseline and working hours, educational level was a significant predictor of LBP at follow-up (odds ratios 1.8–2.3 in men and 1.7–3.1 in women). Adjusting for mechanical factors reduced the gradient by 39% to 43% in men and 28% to 34% in women. Adjusting for psychosocial factors reduced the gradient by 5% to 12% in men and increased the gradient by 7% to 11% in women. Conclusion. Work-related mechanical factors contributed substantially to the social gradient in LBP among both men and women. The impact of psychosocial factors was modest among men and contributed to an increased gradient among women. Level of Evidence: 3

Influence of occupational factors on regional differences in sick leave: A prospective population study:

Aims: Number of sick leave days vary by county, but little is known about the extent to which this gradient may be explained by differences pertaining to occupational composition and occupational exposure. Methods: A randomly drawn cohort from the general population in Norway, aged 18–69 years, was interviewed by telephone in the second half of 2009 (n=12,255; response at baseline=60.9%) and followed up in national registries to the end of 2010. Eligible respondents were registered with an active employee relationship in 2009 and 2010 (n=8275). Information on counties (n=19) was based on the administrative register. The outcome of interest was the number of physician-certified sick-leave days divided by scheduled man-days during 2010 (i.e. sick-leave percentage (SLP)). Results: The average SLP during 2010 was 5.2%. The between-county variation in SLP ranged from 4.0% to 7.2%. Compared to the age- and gender-adjusted model, adjustment for occupation, economic sector and self-reported occupational exposure reduced the median difference in SLP between the county with the lowest SLP (reference county) and the SLP in the other counties by 1.08 percentage points (i.e. a 58% reduction). The impact of occupational composition and occupational exposure on the total between-county variance in SLP was a 16% reduction. Conclusions: Occupational composition and self-reported occupational exposure help to explain a significant part of the difference in SLP between counties, and appear to be more important explanatory factors than demographic variables, self-reported health and smoking.

Interaction of smoking with respiratory effects of occupational dust exposure: a prospective population study among Norwegian men

Occupational exposure to airborne pollutants increases the risk of respiratory symptoms and diseases among workers [1]. There is, however, a lack of prospective studies addressing the temporal relationship between airborne dust at work and respiratory symptoms in the general working population. Such studies permit the calculation of the population attributable fraction [2, 3]. The attributable fraction of airborne pollutants at work to respiratory symptoms has not been estimated since 2003 [1]. As the labour market undergoes changes, there is a need for new prospective studies with updated estimates. We aimed to examine the prospective association between dust exposure and respiratory symptoms in the general working population of men. Further, we also aimed to examine if smoking is a possible effect modifier of the association between dust exposure and symptoms. Dust at work is associated with risk of respiratory symptoms, the population attributable fraction is 19, and smoking is an effect modifier http://ow.ly/w0RF30jUL2Z