The rapid growth in life expectancy of four years over the past two decades in most EU countries is a great testament to the success of achieving healthy ageing (1). In any ageing society, it is of ...paramount importance for economic prosperity to prolong working life in order to balance a population of active versus inactive persons. However, health and wealth are not distributed very fairly across society. Poorer educational attainment and lack of paid employment are persistent causes for inequalities in health and wealth (2). There is ample evidence of a recent widening of social inequalities in life expectancy in many countries. In Denmark – one of the most egalitarian societies in the world – educational inequality life expectancy increased among men from 4.8 years in 1987 to 6.4 years in 2011. For women, an increase was observed from 3.7 to 4.7 years (3). Two important theories are put forward to explain this striking development. The first theory points at the strong trend of decreasing prevalence of unhealthy behaviors with higher educational attainment. Since health promotion programs generally have higher uptake and effectiveness among better educated persons (4), the so-called “intervention-generated inequalities” might contribute to increased inequalities (3). The second theory posits that labor market conditions are more unfavorable for those with lower education and their jobs are more strenuous as well (3). A recent comparative study across selected European countries showed that lower educated persons had substantially higher rates of disability and unemployment and also had more often less stable employment contracts (5). A longitudinal study among older workers in 11 European countries reported that among work-related factors studied, perceived lack of job control was consistently a risk factor for disability benefits, unemployment, and early retirement during the four years of follow-up (6). Many countries are developing policies and strategies to encourage workers to remain at work longer. These seldom take into account the particular role of health and working conditions, which impact the ability of older workers to remain in paid employment until statutory retirement age. For example, if strenuous work has adverse effects on health, especially at older age with declining physical and cognitive functions, timely retirement may be health-preserving. It may also prevent such workers from spending the required added years before retirement in disability and unemployment rather than paid employment. The current issue of the Scandinavian Journal of Work, Environment & Health contains publications that contribute to the unravelling the role of work in socioeconomic inequalities. Addressed in this issue, two distinct mechanisms can be distinguished: educational differences in working conditions encountered on the job and educational attainment as a determinant of labor market position. The first study by Kaikkonen and colleagues (7) demonstrates a marked socioeconomic gradient in sickness absence in a longitudinal study with 8-year follow-up among Finnish citizens. The difference between the lowest and highest educational level was 4.8 days/year (60%) among men and 5.7 days/year (56%) among women for registered episodes of sickness absence of ≥10 days. In a mediation analysis, about 20–25% of these differences could be attributed to self-reported health status, health behavior, and physical and psychosocial working conditions. Interestingly, the crude influence of physical working conditions was substantially higher than all other factors with a maximum effect of 1.2–1.4 days/year (7). The study has several limitations that hamper more precise estimates of the direct and indirect effects of working conditions, health, and health behavior. For example, these factors were all based on self-reports in the baseline questionnaire and, thus, may suffer from common source bias. Another obvious problem is that these factors were measured only at baseline and treated as time-independent variables in the statistical analysis. When working conditions, health, and health behavior vary considerably over time, the reported associations will most likely underestimate the impact of these factors on sickness absence. A third point of concern may be that only sickness absence periods of ≥10 days were available from the register, but other studies have indicated that educational differences are more prominent in longer sickness absence periods (8). In spite of this critique, the study certainly corroborates the hypothesis that educational differences in working conditions have a substantial impact on the ability of workers to be productive at work. It complements earlier studies on educational differences in disability benefits due to musculoskeletal disorders linked to physically demanding work (9), and physical strain and low job control as explanatory factors for educational differences in disability benefits (10). The second publication presents a longitudinal study with 6-year follow-up among a national sample of households in Korea. Using annual waves with time-varying information on independent and dependent variables, precarious employment was associated with onset of severe depressive symptoms with a stronger effect among women than men. Moreover, change from a permanent to a temporary employment contract was also associated with an increase in onset of severe depressive symptoms. Precarious employment was more prevalent among those with intermediate or lower education, hence, employment status at the labor market introduced social inequalities (11). These results reflect previous reports in Asia that precarious employment increased the risk on serious psychological distress (12) and in Finland where adverse effects were observed for prolonged sickness absence and disability pension for depression, especially among the lower educated and older workers (13). Given the rapid growth in flexible labor contracts in most countries, their impact on socioeconomic health inequalities raises concerns on the effectiveness of current policies and social and institutional systems for temporary employees that will support them to work longer in good health. There is increasing evidence that work plays a key role in socioeconomic health inequalities. However, there is a shocking lack of evidence how current labor market and retirement policies will influence socio-economic inequalities in health and wealth. Currently available evidence suggests that disparities may increase when these policies are blind to the mechanisms of how work influences health. There is an urgent need for studies that present empirical evidence on the consequences of the rapid changes in national policies on disability and retirement aimed at prolonging working careers for the health of the workforce.
What has been largely overlooked, however, is the fact that these approaches are only valid in linear models and rely on the assumption that there is no interaction between exposure and mediator on ...the outcome (6). ...because the importance of controlling for mediator-outcome confounders was never mentioned in Baron & Kenny, many studies have neglected to account for potential confounding factors of the mediator-outcome relationship. ...whereas a total effect can always be decomposed into a natural direct and indirect effect, controlled direct effects are estimated for every level of the mediator (which may differ substantially depending on the magnitude of the interaction effect between exposure and mediator). An alternative approach in mediation analysis is to quantify controlled direct effects that only rely on assumptions (i) and (iii): no uncontrolled exposure-outcome confounding and no uncontrolled mediator-outcome confounding. ...some have argued that controlled direct effects are much more policy-relevant because they estimate the proportion of the total effect of the exposure on the outcome that could be eliminated by a specific intervention on the mediator (13, 14). ...sensitivity analysis is helpful to assess the robustness of the results to potential violations of the underlying assumptions.
Objectives The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, ...unemployment, and early retirement among older workers. Methods Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. Results Poor health was a risk factor for disability pension hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51—6.05, and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68—5.55) and unemployment (HR 1.84, 95% CI 1.13—3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30—1.77). Conclusions Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive interventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment.
Objective Our aim was to provide a quantitative assessment of the exposure-response relationships between work-related physical and psychosocial factors and the occurrence of specific shoulder ...disorders in occupational populations. Methods A systematic review of the literature was conducted on the associations between type of work, physical load factors, and psychosocial aspects at work, on the one hand, and the occurrence of tendinitis of the biceps tendon, rotator cuff tears, subacromial impingement syndrome (SIS), and suprascapular nerve compression, on the other hand. Associations between work factors and shoulder disorders were expressed in quantitative measures as odds ratio (OR) or relative risk (RR). Results The occurrence of SIS was associated with force requirements >10% maximal voluntary contraction (MVC), lifting >20 kg >10 times/day, and high-level of hand force >1 hour/day (OR 2.8—4.2). Repetitive movements of the shoulder, repetitive motion of the hand/wrist >2 hours/day, hand-arm vibration, and working with hand above shoulder level showed an association with SIS (OR 1.04—4.7) as did upper-arm flexion ≥45° ≥15% of time (OR 2.43) and duty cycle of forceful exertions ≥9% time or duty cycle of forceful pinch >0% of time (OR 2.66). High psychosocial job demand was also associated with SIS (OR 1.5—3.19). Jobs in the fish processing industry had the highest risk for both tendinitis of the biceps tendon as well as SIS (OR 2.28 and 3.38, respectively). Work in a slaughterhouse and as a betel pepper leaf culler were associated with the occurrence of SIS only (OR 5.27 and 4.68, respectively). None of the included articles described the association between job title/risk factors and the occurrence of rotator cuff tears or suprascapular nerve compression. Conclusions Highly repetitive work, forceful exertion in work, awkward postures, and high psychosocial job demand are associated with the occurrence of SIS.
This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region.
Studies conducted between January 2000 and ...December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18-65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated.
A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced.
The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.
Objectives The aim of this paper is to propose a new model of sustainable employability based on the capability approach, encompassing the complexity of contemporary work, and placing particular ...emphasis on work-related values. Methods Having evaluated existing conceptual models of work, health, and employability, we concluded that prevailing models lack an emphasis on important work-related values. Amartya Sen's capability approach (CA) provides a framework that incorporates a focus on values and reflects the complexity of sustainable employability. Results We developed a model of sustainable employability based on the CA. This model can be used as starting point for developing an assessment tool to investigate sustainable employability. Conclusions A fundamental premise of the CA is that work should create value for the organization as well as the worker. This approach challenges researchers, policy-makers, and practitioners to investigate what people find important and valuable - what they would like to achieve in a given (work) context - and moreover to ascertain whether people are able and enabled to do so. According to this approach, it is not only the individual who is responsible for achieving this; the work context is also important. Rather than merely describing relationships between variables, as existing descriptive models often do, the CA depicts a valuable goal: a set of capabilities that constitute valuable work. Moreover, the CA fits well with recent conceptions of health and modern insights into work, in which the individual works towards his or her own goals that s/he has to achieve within the broader goals of the organization.
Objectives The aims of this study were: (1) to evaluate the effect of manually lifting patients on the occurrence of low back pain (LBP) among nurses, and (2) to estimate the impact of lifting device ...use on the prevention of LBP and musculoskeletal disorder (MSD) injury claims. Methods A literature search of PubMed, Embase and Web of Science identified studies with a quantitative assessment of the effect of manually lifting patients on LBP occurrence and studies on the impact of introducing lifting devices on LBP and MSD injury claims. A Markov decision analysis model was constructed for a health impact assessment of patient lifting device use in healthcare settings. Results The best scenario, based on observational and experimental studies, showed a maximum reduction in LBP prevalence from 41.9% to 40.5% and in MSD injury claims from 5.8 to 5.6 per 100 work-years. Complete elimination of manually lifting patients would reduce the LBP prevalence to 31.4% and MSD injury claims to 4.3 per 100 work-years. These results were sensitive to the strengths of the association between manually patient lifting and LBP as well as the prevalence of manual lifting of patients. A realistic variant of the baseline scenario requires well over 25 000 healthcare workers to demonstrate effectiveness. Conclusions This study indicates that good implementation of lifting devices is required to noticeably reduce LBP and injury claims. This health impact assessment may guide intervention studies as well as implementation of programmes to reduce manual lifting of patients in healthcare settings.
Heavy industry emits many potentially hazardous pollutants into the air which can affect health. Awareness about the potential health impacts of air pollution from industry can influence people's ...risk perception. This in turn can affect (self-reported) symptoms. Our aims were to investigate the associations of air pollution from heavy industry with health symptoms and to evaluate whether these associations are mediated by people's risk perception about local industry.
A cross-sectional questionnaire study was conducted among children (2-18 years) and adults (19 years and above) living in the direct vicinity of an area with heavy industry. A dispersion model was used to characterize individual-level exposures to air pollution emitted from the industry in the area. Associations between PM2.5 and NOX with presence of chronic diseases (adults) and respiratory symptoms (adults and children) were investigated by logistic regression analysis. Risk perception was indirectly measured by worries about local industry (0-10 scale). Mediation analyses were performed to investigate the role of mediation by these worries.
The response was 54% (2,627/4,877). In adults exposure to modelled PM2.5 from industry (per μg/m3) was related with reported high blood pressure (OR 1.56, 95% CI 1.13-2.15) and exposure to modelled NOX (per μg/m3) was inversely related with cardiovascular diseases (OR 0.91, 95% CI 0.84-0.98). In children higher PM2.5 and NOX concentrations (per μg/m3) were related with wheezing (OR 2.00, 95% CI 1.24-3.24 and OR 1.13, 95% CI 1.06-1.21 respectively) and dry cough (OR 2.33, 95% CI 1.55-3.52 and OR 1.16, 95% CI 1.10-1.22 respectively). Parental worry about local industry was an important mediator in exposure-health relations in children (indirect effect between 19-28%).
Exposure from industry was associated with self-reported reported high blood pressure among adults and respiratory symptoms among their children. Risk perception was found to mediate these associations for children.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Lifting at work is considered an important risk factor for low back pain (LBP). However, contradictory findings have been reported, partly because frequency, duration and intensity (ie, the weight of ...the load) of lifting have not been systematically considered. This has hampered developments of threshold values for lifting. The aims of this study were: to assess the effect of lifting during work (quantified in duration, frequency or intensity) on the incidence of LBP and to quantify the impact of these relationships on the occurrence of LBP in occupational populations exposed to lifting. We searched in PubMed and EMBASE.com for longitudinal studies assessing the effect of occupational lifting on LBP incidence. For each study, the exposure–response slope of the association was estimated by loglinear regression analysis. When possible, a meta-analysis on these slopes was conducted. In a health impact assessment, the effects of the pooled exposure–response relationships on LBP incidence was assessed. Eight longitudinal studies were included. Pooled estimates resulted in ORs of 1.11 (1.05 to 1.18) per 10 kg lifted and 1.09 (1.03 to 1.15) per 10 lifts/day. Duration of lifting could not be pooled. Using these ORs, we estimated that lifting loads over 25 kg and lifting at a frequency of over 25 lifts/day will increase the annual incidence of LBP by 4.32% and 3.50%, respectively, compared to the incidence of not being exposed to lifting. Intensity and frequency of lifting significantly predict the occurrence of LBP. Exposure–response relationships show that lifting heavy loads may have a substantial impact on musculoskeletal health of the working population. This information may direct the development of occupational lifting guidelines and workplace design for LBP prevention.
Objectives The aim of this study was to investigate the effect of ill health and socioeconomic status on labor force exit due to unemployment, early retirement, disability pension, or becoming ...economically inactive. A secondary objective was to investigate the effect of ill health and socioeconomic status on return to work. Methods A representative sample of the Dutch working population (N=15152) was selected for a prospective study with ten years follow-up (93917 person-years). Perceived health and individual and household characteristics were measured at baseline with the Permanent Quality of Life Survey (POLS) during 1999—2002. Statistics Netherlands ascertained employment status monthly from January 1999 to December 2008. Cox proportional hazards analyses were used to determine the factors that predicted labor force exit and return to work. Results Ill health increased the likelihood of labor force exit into unemployment hazard ratio (HR) 1.89, disability pension (HR 6.39), and early retirement (HR 1.20), but was not a determinant of becoming economically inactive (HR 1.07). Workers with low socioeconomic status were, even after adjusting for ill health, more likely to leave the labor force due to unemployment, disability pension, and economic inactivity. Workers with ill health at baseline were less likely to return to work after unemployment (HR 0.75) or disability pension (HR 0.62). Socioeconomic status did not influence re-employment. Conclusions Ill health is an important determinant for entering and maintaining paid employment. Workers with lower education were at increased risk for health-based selection out of paid employment. Policies to improve labor force participation, especially among low socioeconomic level workers, should protect workers with health problems against exclusion from the labor force.
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