Sickness absence mesmerizes many researchers, given the numerous publications on risk factors for sickness absence. A large variety of risk factors have been identified, including work-related risk ...factors such as physical work demands and psychosocial work factors, unhealthy behaviors such as lack pf physical activity and smoking, and chronic health problems. A logical next step seems to be the development of a prediction model, whereby an individual's profile on risk factors is converted into a probability on future sickness absence. In the past few years, several prediction models have been developed and validated. It is in intriguing question how to use these models in occupational health practice to identify workers at risk for prolonged sickness absence reliably and to act on this. It may be argued that all-cause sickness absence is too crude a measure to predict, but prediction models for sickness absence due to specific causes have shown similar disappointing results.
We live in unprecedented modern times experiencing how an outbreak of a particular viral disease, COVID-19, caused by SARS-CoV-2, also commonly referred to as the Coronavirus, is disrupting societies ...and personal lives. The virus is likely to spread to most, if not all, countries, illustrating the interconnectedness of the world. While many national measures to contain, suppress, mitigate, or delay the spread of the virus are being taken, there is great uncertainty as to which measures are appropriate or not, varying from instructions of stringent hand hygiene; travel restrictions; social distancing; and closure of schools, restaurants, bars and shops to a complete lock down of large parts of society. Here, Burdorf et al discuss the long-lasting societal effects of this pandemic.
In this era of evidence-based medicine, the randomized controlled trial (RCT) has become the gold standard in determining whether a new intervention has beneficial effects. Although in recent years ...the RCT has given way to more flexible approaches, the strong reliance on this type of decisive study design in evidence production has had unintended consequences (1). An example in occupational health research would be that an RCT examining a health promotion app is more feasible than one assessing a workplace intervention, hence, there is disproportionately more robust evidence on individual-oriented behavioral interventions than organizational-level ones. Likewise, it would easier to evaluate a training program than an organizational intervention targeting work schedules. Indeed, a recent review on workplace mental health interventions concluded that interventions tended to focus on individual-level rather than organizational or system-level factors (2). The recent guidelines on mental health from the World Health Organization also illustrate that recommendations for individual interventions are more common than recommendations for organizational interventions (3). In the current debate about prevention, there is a strong plea for a shift in content and mode of delivery of prevention, specifically targeting the environments in which disadvantaged groups live and work (4). While targeting these environments, the traditional RCT paradigm cannot be used as an evaluation strategy for dynamic interventions with multiple interrelated changes in behavior and environments over time (5, 6). In occupational health we face the same challenge: with mental health as a premier concern in the workforce, we need to shift our attention from individual behaviors towards the psychosocial work environment, and our research methods should change accordingly to be able to demonstrate how we can improve it. There is compelling evidence that psychosocial work factors may introduce health effects (7). A recent meta-review of 72 reviews concluded that there is evidence for associations between high job strain and long working hours as exposures and, most notably, coronary heart diseases and (ischemic) stroke as outcomes (8). Despite many intervention studies, the insight about effective strategies to mitigate the impact of a strenuous psychosocial work environment on health is still limited. We know certainly more about the importance of the psychosocial work environment for health than we know how to improve it. In this issue of the Scandinavian Journal of Work Environment and Health, Aust and colleagues (9) have undertaken the courageous effort of conducting a meta-review of 52 reviews covering 957 original studies in an effort to uncover which organizational-level interventions are effective in improving the psychosocial work environment and workers’ health. Their analytical framework has some interesting choices. First, they restricted the review to the effectiveness of organizational-level interventions at the workplace, arguing that how work is organized and conducted determines the psychosocial work environment. Hence, their focus was on primary prevention strategies to improve the work environment rather than individually targeted interventions to support individual workers in coping with psychosocial factors at work. Second, the review distinguished improvements in the psychosocial work environment (eg, increased levels of job control) from improvements in workers’ health (eg, reduced sickness absence). This distinction seems obvious, but rather surprisingly previous reviews often lack this information. This restricts our understanding about the mechanism of how an intervention can be effective. This editorial is not the place to summarize the evidence of a meta-review, which itself summarizes the evidence of 52 reviews. Read the article yourself and be surprised by the quality and density of information on the evidence of organizational-level interventions. However, the meta-review shows some findings that should challenge the research community. First, 28 out of 52 reviews focus on the healthcare sector. Healthcare organizations are apparently easily accessible and reachable, and have plenty of study participants. The feasibility of a research project seems more important than scientific or societal considerations. Hence, the available evidence is extremely biased towards the specifics of work environments in healthcare with low generalizability to other workplaces. We must ask ourselves the question whether our research priorities reflect sufficiently societal needs. Second, the synthesis of evidence presented in the 52 reviews seldom demonstrates that improvements in the psychosocial work environment are causally linked to improvements in workers’ health. In line with the terminology of the authors, it remains to be seen in many interventions whether proximal effects are associated with distal ones. The noticeable exceptions were: (1) interventions increasing the influence of workers on work tasks or organization, thus increasing job control, had a positive effect on health and (2) interventions on teamwork, workflow changes, and the like, which resulted in substantial improvement in the work environment that in turn led to a reduction in occurrence of burnout. A linked issue, noted by the authors, is that the quality of the psychosocial work environment may moderate the effectiveness of the intervention. There is certainly a need for more advanced study designs that unravel the mechanism of how and when interventions are effective. Third, linked to the discussion about the appropriate study design for evaluating effectiveness of interventions in occupational health, in most reviews the majority of original studies had some type of control group, but the use of an RCT design was low. This illustrates the intrinsic difficulty of randomization of workplaces for many different reasons (10). The disadvantages of not being able to conduct a (cluster) RCT should be counteracted with designs for observational studies that offer better insights into the influence of the organizational context and the quality of implementation on successful organizational-level interventions. The meta-review of Aust and colleagues is not only of interest because of its specific content, it also raises important considerations for intervention research. I propose the following five guiding principles for intervention research on the psychosocial work environment: 1. Define the target population and subsequent prevention strategy carefully In primary prevention strategies, the essential choice is between selective or universal prevention (11). An organizational-level intervention targeting every worker in the company, ie, the universal prevention strategy, should be able to demonstrate a shift in the distribution of risk in the population, eg, flexible working time arrangements are used by a substantial proportion of the workers. Alternatively, selective prevention is more appropriate when particular groups in the company have an increased risk. In such a situation, organizational-level interventions must be much more aligned with the needs of these high-risk groups, eg, teamwork training in units with high sickness absence. 2. Choose your outcome measure wisely In intervention studies with a short follow-up period, it is sensible to focus on proximal endpoints, ie, changes in the psychosocial work environment, rather than distal endpoints such as sickness absence or workers’ health. 3. Consider the potential impact of the intervention When the proportion of workers’ health attributed to the risk factor of interest is modest then the reduction in the risk factor due to the intervention must be large to have a discernable impact on workers’ health. Remember that most workers are quite healthy, thus, large effects in universal interventions cannot be expected. 4. Evaluate the pathway of effectiveness of the intervention We often lack insight into whether an organizational intervention introduces improvements in the psychosocial work environment, and, consequently, that through these improvements the beneficial effects on workers’ health are achieved. Without insight into the pathway of effectiveness, interventions will remain a black box. 5. Determine the impact of implementation and context on effectiveness It is a misconception that the effectiveness of an intervention is primarily determined by its content and quality of delivery. The implementation and specific context in the organization are equally as important. New analytical evaluation methods may be required, acknowledging that individual behavior and circumstances, specific working conditions, and higher-level contextual factors interact continuously.
The Scandinavian Journal of Work, Environment & Health was launched 50 years ago. In this paper we describe how research topics have changed over time.
A complete list of all 2899 articles in the ...past 50 years was compiled. Each article was coded for type of exposure, type of health outcome, research design, first author, and country of correspondence address. Count of citations was based on the Scopus database.
Overall, the attention for chemical exposure in the first 30 years has shifted towards the psychosocial work environment, shift work, and physical work load. These shifts in exposure are mirrored by increased attention over time for mental disorders and musculoskeletal disorders. Cardiovascular disorders and cancer have been studied consistently over the past 50 years. Researchers from Scandinavian countries have been responsible for about 50% of the Journal's content, while authorship has broadened to about 30 countries in recent years.
During the past 50 years, some research topics have consistently remained highly visible in the Journal, whereas other topics have gained or lost interest. In terms of authors' contribution, the Journal has its roots in research from the Nordic countries, but has evolved over time as a truly international periodical with a well-recognized position in research on occupational health.
With this first issue of 2024, we kick off the celebration of 50 years of publishing research in the Scandinavian Journal of Work, Environment & Health. In January 1975, the inaugural issue of the ...Journal was published (read it here: www.sjweh.fi/issue/274). We are delighted that 50 years later not only are we still around, but we have retained our special position in the science publication business as an independent journal that is not owned by a commercial publishing house. We are grateful that our not-for-profit publisher, the Nordic Association of Occupational Safety and Health (NOROSH), has ensured this independence. And we are proud to belong to a community of authors, reviewers, editors, international advisory board members, and, of course, readers that is committed to research excellence and has carried this journal for now half a century. Thank you! We want to celebrate our anniversary by looking both back and ahead. In each issue of 2024, we will include an invited 50-year-anniversary article, authored by leading researchers in the field. In this first issue, we take a look at ourselves, reflecting on work environment exposures and health outcomes that have emerged as well as those that have vanished from the pages in the Journal. And we take a look at those papers that have generated the greatest interest among our readers (1). In the coming year, various authors will take a look at the research field, that is, they will discuss specific work environment conditions and health outcomes. This will include exposures as diverse as asbestos and the psychosocial work environment and outcomes such as musculoskeletal disorders and occupational cancers. We will in particular examine the successes and failures with regard to these exposures and outcomes. Has occupational health research made a difference? Are there success stories where our research has helped to protect and improve workers’ health and thereby contributed to a better population health? Did we provide solid evidence on health hazardous, health-protecting, and health enhancing working conditions and did this result in changes at the workplace? Or did we fail? Was our research not good enough to provide sufficient evidence for action? Or was our research good enough but action still did not happen? And what can we do in the future to improve? How can we do research better and thus make a difference in society? We are looking forward to the answers to these questions in the anniversary-related papers, which are incidently not yet written, so we do not know what they will tell us. Our guess is, though, that there are no easy answers and a lot of work still remains ahead of us. We and others have recently argued in a Discussion Paper series on “Work and Health” in The Lancet that “major gains in population health and reductions in health disparities can be made by an increased focus on improving the work environment.” (2). However, as we also argue in the series, there is still a long way to go in realizing the potential that good work has for better population health (2–4). Our objective with 50-year SJWEH anniversary series is that, by the end of the year, the occupational health community will have become more knowledgeable about what went well and not so well in our research field and that we feel confident where to go next. To engage the community further in this discussion, we are planning a half-day in-person and online symposium on 4 October 2024. We are still working on the exact format and content of the symposium. Please stay tuned on LinkedIn and follow the updates in our newsletter. References 1. Burdorf A, Rugulies R. Fifty years of research in the Scandinavian Journal of Work, Environment & Health. Scand J Work Environ Health. 2024;50(1):3–10. https://doi.org/10.5271/sjweh.4135 2. Frank J, Mustard C, Smith P, Siddiqi A, Cheng Y, Burdorf A, et al. Work as a social determinant of health in high-income countries: past, present, and future. Lancet. 2023;402(10410):1357-1367. https://doi.org/10.1016/S0140-6736(23)00871-1 3. Rugulies R, Aust B, Greiner BA, Arensman E, Kawakami N, LaMontagne AD, et al. Work-related causes of mental health conditions and interventions for their improvement in workplaces. Lancet. 2023;402(10410):1368-1381. https://doi.org/10.1016/S0140-6736(23)00869-3 4. Burdorf A, Fernandes RCP, Robroek SJW. Health and inclusive labour force participation. Lancet. 2023;402(10410):1382-1392. https://doi.org/10.1016/S0140-6736(23)00868-1
This paper discusses the failure and success of society to decrease the adverse health effects of asbestos exposure on workers' health in relation to scientific knowledge.
The findings are based on a ...narrative literature review.
Early warnings of the adverse health effects of workplace exposure to asbestos were published already in the 1930s. Serious health effects, such as malignancies and fibrosis due to occupational asbestos exposure, were highlighted in major medical journals and textbooks in late 1960s. New technologies could detect also asbestos fibers in the lung of non-occupational exposed persons in the 1970s. The first bans for using asbestos came in the early 1970s, and more general bans by authorities came in the 1980s and continue until today.
The rather late recognition of adverse effects of asbestos exposure in the general population and measures to decrease the exposure through more general bans came rather late. However, the very strong measures such as general bans in many countries have been a success. A Swedish study showed that the general ban and other measures have decreased the risk of malignancies due to occupational exposure. The effect of the bans on adverse effects in the general population has yet to be studied. Analysis of fibers in the lungs of persons born after the bans could be an efficient method.
At the Scandinavian Journal of Work, Environment & Health, it is our fundamental conviction that workers’ health is a value in itself. To put it simply, work must not be health-hazardous, and work ...must not make the worker neither physically nor mentally sick. In our minds, there is no need for any further rationale for healthy and safe work. That said, it would be naïve to think that, in a bottom-line world, the bottom-line would not count with regard to work and health. It does count at individual, company, and societal level. At individual level, a worker may worry about reduced payment during sickness absence. At company level, the phrase “is there a business case?” is often heard. At societal level, all economic consequences, rather than a partial interest, are considered. Therefore, there is a broad need to know the magnitude of the economic loss that comes with a health-hazardous work environment and, vice-versa, the magnitude of the economic benefit that comes with improving the work environment. For example, when the World Health Organization (WHO) published in 2022 its landmark guidelines on mental health at work using a societal perspective (1), a lot of attention was paid to the WHO`s estimation that the global economic costs of the most prevalent mental health conditions totalled USD1 trillion per year (2, 3). There is, thus, a great demand for work environment economics, for analyses that quantify the economic costs of a poor work environment and the economic benefits of a good work environment. However, this demand is yet not being met by the research community. As van Dongen & van der Beek (4) delineated in an editorial in this Journal in May 2022, there are two types of work environment economic studies: (i) observational studies that examine the economic costs of work-related ill-health among workers, the so-called `cost of illness` studies and (ii) economic evaluation studies that examine cost-effectiveness and return-on-investment of occupational health interventions. With regard to the latter, van Dongen & van der Beek point to a couple of recent promising evaluation studies (5, 6), however, they conclude that the methodological quality of economic evaluations of occupational health interventions leaves in general a lot to be desired (4). With regard to the former, observational studies on the economic costs of work-related ill-health among workers, Russo et al (5) recently published in this Journal a cost-estimation model for work-related stress that was tested in two case studies in Italy – in healthcare and public administration. Costs were estimated as loss of productivity due to sickness absence attributable to work-related stress. The authors showed that across different work organizations, the proportion of sickness absence attributable to work-related stress varied strongly, and that methodological choices influenced the cost estimations largely. In this issue of the Journal, Pedersen and colleagues (7) go a step further and present a paper that aims to estimate the effect of work-related stress on labor market costs at the societal level. Linking survey data from Denmark on indicators of self-reported work-related stress to register data on labor market affiliation, they first calculated the two-year prospective association between exposure to work stress and days of recurrent (being at work, sickness absence, unemployment, being temporarily out of the labor market for other reasons) and absorbing (retirement, disability pension, death) labor market states. Absorbing states occurred only rarely in their sample. Next, they calculated the costs incurred by the recurrent labor market states, ie, the costs associated with days lost due to all work absenteeism combined and work absenteeism stratified by sickness absence, unemployment, and being temporarily out of the labor market. Based on these calculations, the authors estimated an average annual work absenteeism loss per employee of €1903 for men and €3909 for women. For the Danish workforce, this corresponds to annual expenses of €305 million among men and €868 million among women, a total expense of €1.17 billion or 0.3% of the Danish gross domestic product in 2022. The results of this article caused a lot of interest in the Danish media and among unions and employer organizations (8, 9). We commend the authors for their bold approach to estimate the costs of an assumed work-environment-induced health condition at the societal level, taking advantage of the excellent Danish health and labor market registers and using multi-state modeling that takes recurrence of events into consideration. There are, though, also important challenges in the article, relating both to the outcome and health condition under study. Regarding the outcome, there are two major labor market costs to consider: (i) costs related to absenteeism, ie, costs due to not being at work, and (ii) costs related to loss of productivity, ie, costs due to being at work but with reduced work capacity. Pederson and colleagues limited their analyses to the former and did not analyze the latter. This is understandable, as absenteeism can be closely monitored in Danish national registers, whereas no national register is available for monitoring the productivity of workers. In terms of internal validity, it was therefore likely a wise decision by the authors to limit the analyses to an outcome where good data is available. However, as a consequence, an important part of the labor market costs of work-related stress – the loss in productivity among those who are present at work with reduced work capacity – could not be addressed in the article. Regarding the health condition under study, the authors analyzed work-related stress. On the one hand, this is laudable, stress at work is topical and a major point of public debate in many countries, including Denmark. On the other hand, the authors could hardly have chosen a more difficult health condition. Stress is on many accounts an intricate, some would say, hopeless concept in research. Since the early days of stress research by Walter B Cannon (1871–1945) and Hans Selye (1907–1982), the concept of stress has been plagued with ambiguities (10, 11). Today, there is no lack of elaborated stress models (stimulus-based models, reaction-based models, the transactional model, the allostatic load model, the cognitive-activation theory of stress, to name just a few) (12–14). However, there is no common definition of stress, and there is no agreement on basic questions, such as if stress research should focus on the environmental conditions (often called “stressors”) that may cause cognitive, emotional, behavioral, and physiological changes in the individual (often called “stress reactions”) or if the focus should be on these stress reactions of the individual and how these different types of reactions are related to each other. To make things further complicated, Pedersen and colleagues not only analyzed “stress”, but they analyzed “work-related stress”, thus, they based their analyses on the assumption that the stress condition reported by the participants were, to a considerable extent, caused by the work environment. To ensure the work-relatedness of their stress concept, Pedersen and colleagues combined three very different measures into one index. The three measures included (i) a kind of self-labeling method, where the definition of stress and the attribution to work or none-work related causes were solely at the discretion of the respondents; (ii) the measurement of a psychosocial work environment condition, job strain, that has been conceptualized as a stressor, ie, as an entity that is assumed to elicit stress reactions (15); and (iii) four items of Cohen’s Perceived Stress Scale (PSS-4), which is probably the most widely used questionnaire for assessing stress (16, 17), however, in a modified version that included references to work in three of the four items. When taking a closer look at the three stress measures, one cannot help but to wonder whether the stress index by Pedersen and colleagues is rather a measure of poor psychosocial working conditions than a measure of stress. One of the three measures, job strain, obviously, is conceptualized as a measure of psychosocial working conditions, defined by the simultaneous exposure of high job demands and low job control (15). But also the modified PSS-4 items that asked, for example, about feeling that difficulties at work were piling up or feeling confident about handling problems at work, may have captured important parts of the psychosocial work environment. Thus, it could be argued that the article is first and foremost about the labor market costs of poor psychosocial working conditions. To summarize, Pedersen and colleagues provided us with a thought-provoking paper on two hot but also very challenging topics in occupational health research, work-related stress and work environment economics. Both topics are likely strongly shaped by macro-level structural conditions that vary greatly between countries(18, 19). We look forward to further analyses and papers on these topics from other regions of the world. Conflict of interest statement Reiner Rugulies is employed at the same research institution as the authors of the article by Pedersen et al, and he collaborates closely with the last author (Ida EH Madsen). Dr Rugulies was neither involved in the design, analysis or writing of the article nor in the decision by the journal to accept the article for publication. References 1. World Health Organization. WHO guidelines on mental health at work. Geneva: World Health Organization, 2022. Available from: https://www.who.int/publications/i/item/9789240053052 (Accessed: 28 September 2022). 2. World Health Organization and International Labour Organization. Mental health at work: Policy brief. Geneva: World Health Organization and International Labour Organization, 2022. Availabl
The COVID-19 pandemic is discussed. This report points to the importance of occupation as a risk factor but also to the availability and use of appropriate personal protection to mitigate the risk of ...becoming infected. In addition, well-established socioeconomic factors of health inequalities intermingled with occupations at risk, demonstrated by the fact that most taxi drivers belonged to the same ethnic group and that taxi drivers had higher mortality rates when residing in London. These findings are mirrored in a recent preprint publication from the US state of California, reporting that relative excess mortality was particularly high among food/agriculture, transportation/logistics, facilities, and manufacturing workers.
In the past three years, we have witnessed the devastating effects of the COVID-19 pandemic, with unprecedented challenges to all aspects of human life worldwide. In the workforce, it rapidly became ...clear that workers in some jobs were more likely to suffer adverse consequences for morbidity and mortality. In our earlier editorials in the Scandinavian Journal of Work Environment and Health, we reviewed emerging evidence, suggesting that well-established socio-economic health inequalities intermingled with occupational risk factors, making it difficult to target the conditions at work that contributed to the transmission of SARS-CoV-2 in working populations (1, 2). As a first priority for the research agenda on COVID-19, we suggested the identification of occupations at higher risk for becoming infected and specific work characteristics that contribute to the risks. Such insights will be immensely valuable for preparedness to threats of future pandemics (2). Many researchers have addressed this pertinent question with gusto in different populations with different study approaches. In an illustrative example with a population-based approach, Nafilyan and colleagues (3) constructed a register-based cohort study of all 14 million people aged 40–64 years in England for confirmed or suspected COVID-19 death in 2020 across 41 occupational categories. Occupations with the highest age-standardised mortality rates (5–6-fold) were those working as taxi and cab drivers or chauffeurs, workers in elementary occupations, and care workers and home carers. Adjustment for sociodemographic factors attenuated the elevated mortality rates, and further adjustment for living conditions resulted in a residual variance of 20–30% as the best estimate of the maximum contribution of workplace exposure to COVID-19 mortality (3). A comparable registered-based study in Sweden among 4.6 million citizens with an occupation confirmed the highest mortality risk among taxi and bus drivers (4-fold risk), and also pointed towards elevated risk among cleaners and service workers. Likewise, adjustment for socioeconomic factors, such as education and income, greatly reduced the excess risk due to occupation. In contrast, country of birth and income tertile were the strongest socioeconomic determinants of COVID-19 mortality, and these associations were only marginally attenuated by adjustment for occupational groups (4). In countries with advanced hospital admission registers, occupational risk of COVID-19 related hospital admission can be studied. In Denmark, Bonde et al (5) reported an increased risk for hospitalization due to COVID-19 among healthcare workers, social workers, and a few occupations within transportation compared to office workers. Risk of hospital admission was also increased among spouses of workers in occupations with a high COVID-19 risk (6). The excess risk for hospital admission among healthcare workers, but not among other high-risk occupations, attenuated in the latest COVID-19 waves (7). Do these studies point towards the conclusions that occupation will at best play only a minor role in COVID-19 mortality? From a methodological point of view, we need to consider whether adjustment for education and income in the association between occupation and COVID-19 mortality is a sound strategy. Since education partly determines working careers and, thus, occupations that people will hold, over-adjustment may be a serious risk. From an exposure point of view, we would preferably measure airborne exposure of SARS-CoV-2 across occupations, and subsequently link levels of exposure across occupations to mortality patterns. Unfortunately, measuring exposure to a coronavirus is still a farfetched dream, although newly developed methods for waste-water surveillance may hold some promise (8). An alternative to hospitalization and mortality studies is to study SARS-CoV-2 infection rates across occupations. Early reports have shown that this is not a simple task. There are a variety of reasons why people get tested for SARS-CoV-2, such as access at work and employer requirements on testing regimes. Thus, differences in likelihood of being tested may contribute to biased comparisons across occupations (9). Recently, the test-negative design has been advocated as suitable design, eliminating bias through likelihood of being tested by comparing those with a positive test to those with a negative test, thus excluding those who have never been tested from the reference group (10). In this issue of the Scandinavian Journal of Work Environment and Health, the study by Eekhout and colleagues illustrates its usefulness (11). Based on over 200 000 workers with serological SARS-CoV-2 test results, the test-negative design was applied to identify occupations with increased risk for infections, while simultaneously talking into account potential confounders, such as socioeconomic position and household composition. Occupations with high infection rates were quite similar to those reported in the mortality studies described above, with many elementary and manually skilled jobs showing the highest probability to a positive test. The study also applied a job exposure matrix (12) with four work-related factors that could influence the transmission of SARS-CoV-2 at the workplace. Findings showed modestly increased odds of a positive test for these risk factors, and adjustment for several covariates slightly decreased or increased the odds ratios. However, due to substantial collinearity between these work-related risk factors, it was not possible to single out the relative contribution of each factor separately to the infections rates. The magnitude of the observed odd ratios (varying between 1.1 to 1.8) and the prevalence of the work-related risk factors suggest that the proportion of SARS-CoV-2 infections in the general population that is attributable to factors at work will not exceed 30%. This is in line with results of another job-exposure matrix, applied in a French cohort, suggesting that the proportion of COVID-19 cases attributable to work was 20–40% (13). Why are some occupations at risk and others not? Recent studies have reported in many occupations elevated risks of COVID-19 related morbidity and mortality. The occupational risk factors seem to be interrelated to well-established socioeconomic determinants of health inequalities that are also applicable to COVID-19. The few studies on associations between work-related risk factors and SARS-CoV-2 infection rates provide a rather scattered picture. This is likely partly due to uncertainty about mechanisms of transmission and appropriate mitigation measures (14). Emerging evidence clearly indicates that work plays a role, albeit limited, in the transmission of the coronaviruses and, as such, offers a point of entry for prevention strategies. We must learn from the valuable experiences in the past three years how conditions at the workplace have contributed to the rise and fall of the COVID-19 pandemic. References 1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health 2020;46:22930. https://doi.org/10.5271/sjweh.3893 2. Burdorf A, Porru F, Rugulies R. The COVID-19 pandemic: one year later - an occupational perspective. Scand J Work Environ Health 2021;47:2457. https://doi.org/10.5271/sjweh.3956 3. Nafilyan V, Pawelek P, Ayoubkhani D, Rhodes S, Pembrey L, Matz et al. Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults. Occup Environ Med 2022;79:433-41. https://doi.org/10.1136/oemed-2021-107818 4. Billingsley S, Brandén M, Aradhya S, Drefahl S, Andersson G, Mussino E. COVID-19 mortality across occupations and secondary risks for elderly individuals in the household: A population register-based study. Scand J Work Environ Health 2022;48:52-60. https://doi.org/10.5271/sjweh.3992 5. Bonde JP, Sell L, Meulengracht Flachs E, Coggon D, Albin M, Oude Hengel KM, et al. Occupational risk of COVID-19 related hospital admission in Denmark 2020-2021: a follow-up study. Scand J Work Environ Health 2023;49:84-94. https://doi.org/10.5271/sjweh.4063 6. Bonde JP, Mølenberg Begtrup L, Coggon D, Høy Jensen J, Meulengracht Flachs E, Jakobsson K, et al. COVID-19-related hospital admission in spouses of partners in at-risk occupations. Scand J Work Environ Health. 2023;49(3):193-200. https://doi.org/10.5271/sjweh.4080 7. Bonde JP, Sell L, Høy Jensen J, Mølenberg Begtrup L, Meulengracht Flachs E, Jakobsson K et al. Ocupational risk of COVID-19 across pandemic waves: a two-year national follow-up study of hospital admissions. Scand J Work Environ Health 2022;48:672-77. https://doi.org/10.5271/sjweh.4056 8. Nauta M, McManus O, Træholt Franck K, Lindberg Marving E, Dam Rasmussen E, et al. Early detection of local SARS-CoV-2 outbreaks by wastewater surveillance: a feasibility study. Epidemiol Infect 2023;151:e28. https://doi.org/10.1017/S0950268823000146 9. van Tongeren M, Rhodes S, Pearce N. Occupation and SARS-CoV-2 infection risk among workers during the first pandemic wave in Germany: potential for bias. Scand J Work Environ Health. 2022;48:586-57. https://doi.org/10.5271/sjweh.4052 10. Vandenbroucke JP, Brickley EB, Pearce N, Vandenbroucke-Grauls CMJE. The evolving usefulness of the test-negative Design in studying risk factors for COVID-19. Epidemiology 2022;33:e7-e8. https://doi.org/10.1097/EDE.0000000000001438 11. Eekhout I, van Tongeren M, Pearce N, Oude Hengel KM. The impact of occupational exposures on infection rates during the COVID-19 pandemic: a test-negative design study with register data of 207 034 Dutch workers. Scand J Work Environ Health. 2023;49(4):259-270. https://doi.org/10.5271/sjweh.4086 12. Oude Hengel KM, Burdorf A, Pronk A, Schlünssen V, Stokholm ZA, Kolstad HA, et al. Exposure to a SARS-CoV-2 infection at work: development of an international job exposure matrix (COVID-19-J
We examined whether changes in different forms of social participation were associated with changes in depressive symptoms in older Europeans. We used lagged individual fixed-effects models based on ...data from 9,068 persons aged ≥50 years in wave 1 (2004/2005), wave 2 (2006/2007), and wave 4 (2010/2011) of the Survey of Health, Ageing and Retirement in Europe (SHARE). After we controlled for a wide set of confounders, increased participation in religious organizations predicted a decline in depressive symptoms (EURO-D Scale; possible range, 0-12) 4 years later (β = -0.190 units, 95% confidence interval: -0.365, -0.016), while participation in political/community organizations was associated with an increase in depressive symptoms (β = 0.222 units, 95% confidence interval: 0.018, 0.428). There were no significant differences between European regions in these associations. Our findings suggest that social participation is associated with depressive symptoms, but the direction and strength of the association depend on the type of social activity. Participation in religious organizations may offer mental health benefits beyond those offered by other forms of social participation.
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