Occupational physical activity predicts baseline and 8-year progression of carotid atherosclerosis among women.

INTRODUCTION: Recent reviews link higher levels of occupational physical activity (OPA) to cardiovascular disease (CVD). However, the evidence for women is inconsistent and studies of activity-limiting symptomatic CVD are prone to healthy worker survivor effect. To address these limitations, this study investigated OPA effects on asymptomatic carotid artery intima-media thickness (IMT) among women. METHODS: Participants include 905 women from the population-based Kuopio Ischemic Heart Disease Risk Factor Study with baseline (1998-2001) data on self-reported OPA and sonographic measurement of IMT. Linear mixed models with adjustment for 15 potential confounders estimated and compared mean baseline IMT and 8-year IMT progression for five levels of self-reported OPA. Analyses stratified by cardiovascular health and retirement status were planned because strong interactions between preexisting CVD and OPA intensity have previously been reported. RESULTS: Light standing work, moderately heavy active work, and heavy or very heavy physical work were all consistently associated with greater baseline IMT and 8-year IMT progression than light sitting work. The greatest baseline IMT was observed for heavy or very heavy physical work (1.21 mm), and the greatest 8-year IMT progression for light standing work and moderately heavy active work (both 0.13 mm), 30% above sitting work (0.10 mm). Stratified analyses showed that these differences were driven by much stronger OPA effects among women with baseline carotid artery stenosis. Retired women experienced slower IMT progression than those working at baseline. CONCLUSIONS: Higher levels of OPA predict higher baseline IMT and 8-year IMT progression, especially among women with baseline stenosis.

Occupational risk factors for work disability following carpal tunnel syndrome: a pooled prospective study.

BACKGROUND: Although recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored. OBJECTIVE: To examine the associations between personal, workplace psychosocial and biomechanical factors and incident work disability among workers with CTS. METHODS: Between 2001 and 2010 five research groups conducted coordinated prospective studies of CTS and related work disability among US workers from various industries. Workers with prevalent or incident CTS (N=372) were followed for up to 6.4 years. Incident work disability was measured as: (1) change in work pace or work quality, (2) lost time or (3) job change following the development of CTS. Psychosocial factors were assessed by questionnaire. Biomechanical exposures were assessed by observation and measurements and included force, repetition, duty cycle and posture. HRs were estimated using Cox models. RESULTS: Disability incidence rates per 100 person-years were 33.2 for changes in work pace or quality, 16.3 for lost time and 20.0 for job change. There was a near doubling of risk for job change among those in the upper tertile of the Hand Activity Level Scale (HR 2.17; 95% CI 1.17 to 4.01), total repetition rate (HR 1.75; 95% CI 1.02 to 3.02), % time spent in all hand exertions (HR 2.20; 95% CI 1.21 to 4.01) and a sixfold increase for high job strain. Sensitivity analyses indicated attenuation due to inclusion of the prevalent CTS cases. CONCLUSION: Personal, biomechanical and psychosocial job factors predicted CTS-related disability. Results suggest that prevention of severe disability requires a reduction of both biomechanical and organisational work stressors.

Effort-reward imbalance and ambulatory blood pressure among female Las Vegas hotel room cleaners.

BACKGROUND: Effort-reward imbalance (ERI) was hypothesized to be associated with ambulatory blood pressure (ABP) and pulse pressure (PP) among female hotel room cleaners. METHODS: ERI, ABP, and PP were assessed among 419 cleaners from five hotels during 18 waking hours. Adjusted linear regression models were used to assess associations of ERI with ABP and PP during 18-hours, work hours, and after work hours. RESULTS: There was a pattern of higher ERI being associated with higher 18-hour systolic ABP and 18-hour PP although the results were imprecise. An increase of ERI by half its range was associated with a 1.6 mmHg (95% CI, -1.6-4.7) increase in 18-hour systolic blood pressure (SBP) and a 0.7 mmHg (95% CI, -1.1-2.5) increase in 18-hour PP. An increase in rewards by half its range was associated with a 2 mmHg decrease in after-hours SBP (-2.2, 95% CI, -5.4-1.0) and after-hours PP (-1.9, 95% CI, -3.8-0.0). Among females 45 years or older, ERI was associated with 2.1 and 2.2 mmHg increase in 18-hour and work hours diastolic ABP, respectively, compared to a 0 mmHg change in 18-hour and work hours diastolic ABP in younger women. The number of dependents at home attenuated the association. CONCLUSIONS: ERI was positively associated with ABP, particularly SBP, and the association was modified by age and the number dependents at home, although the estimates were imprecise. Workplace interventions that integrate stress management and active ABP surveillance appear warranted. However, larger studies with Latina women need to confirm our results.

Occupational physical activity and all-cause and cardiovascular disease mortality: Results from two longitudinal studies in Switzerland.

BACKGROUND: Research regarding the effects of occupational physical activity on health remains inconsistent. We analyzed the association of occupational physical activity with all-cause and cardiovascular disease (CVD) mortality. METHODS: We analyzed two cohorts with baseline assessments from 1977 to 1993 ("National Research Program 1A" (NRP1A) and "MONItoring of trends and determinants in CArdiovascular disease" [MONICA]) and mortality follow-up until 2015 using adjusted Cox regression models. RESULTS: We included 4396 NRP1A participants (137 793 person-years of follow-up, 1541 deaths) and 5780 MONICA participants (135 410 person-years, 1158 deaths). All-cause mortality was higher for men in the high compared with the low occupational physical activity category according to NRP1A (hazard ratio [HR] 1.25, 95% confidence intervals [CI] 1.05-1.50). CVD mortality was higher for men in the moderate compared with the low occupational physical activity category according to MONICA (HR, 1.41; 95% CI, 1.03-1.91). Results for women were not statistically significant. CONCLUSIONS: We observed higher total and CVD mortality risks in men with higher occupational physical activity but inconsistent results for women and across cohorts.

Parental occupational exposures and the risk of childhood sporadic retinoblastoma: a report from the Children's Oncology Group.

OBJECTIVES: We examined associations between parental occupational chemical exposures up to 10 years before conception and the risk of sporadic retinoblastoma among offspring. METHODS: In our multicentre study on non-familial retinoblastoma, parents of 187 unilateral and 95 bilateral cases and 155 friend controls were interviewed by telephone. Exposure information was collected retroactively through a detailed occupational questionnaire that asked fathers to report every job held in the 10 years before conception, and mothers 1 month before and during the index pregnancy. An industrial hygienist reviewed all occupational data and assigned an overall exposure score to each job indicating the presence of nine hazardous agents. RESULTS: We estimated elevated ORs for unilateral and bilateral retinoblastoma among offspring of fathers who were exposed to polycyclic aromatic hydrocarbons or paints in the 10 years before conception. However, only for exposure to paints did confidence limits exclude the null for bilateral disease (OR: 8.76, 95% CI: 1.32 to 58.09). Maternal prenatal exposure to at least one of the nine agents was related to increased risk of unilateral disease in their children (OR: 5.25, 95% CI: 1.14 to 24.16). Fathers exposed to at least one of the nine agents and who were ≥30 years of age were at increased risk of having a child diagnosed with bilateral retinoblastoma (OR: 6.59, 95% CI: 1.34 to 32.42). CONCLUSIONS: Our results suggest a role for several hazardous occupational exposures in the development of childhood retinoblastoma.

Job strain associated with increases in ambulatory blood and pulse pressure during and after work hours among female hotel room cleaners.

BACKGROUND: Previously documented elevated hypertension rates among Las Vegas hotel room cleaners are hypothesized to be associated with job strain. METHODS: Job strain was assessed by questionnaire. Ambulatory blood pressure (ABP) was recorded among 419 female cleaners from five hotels during 18 waking hours. Multiple linear regression models assessed associations of job strain with ABP and pulse pressure for 18-h, work hours, and after work hours. RESULTS: Higher job strain was associated with increased 18-h systolic ABP, after work hours systolic ABP, and ambulatory pulse pressure. Dependents at home but not social support at work attenuated effects. Among hypertensive workers, job strain effects were partially buffered by anti-hypertensive medication. CONCLUSIONS: High job strain is positively associated with blood pressure among female hotel workers suggesting potential for primary prevention at work. Work organizational changes, stress management, and active ABP surveillance and hypertension management should be considered for integrated intervention programs.

Do highly physically active workers die early? A systematic review with meta-analysis of data from 193 696 participants.

OBJECTIVE: Recent evidence suggests the existence of a physical activity paradox, with beneficial health outcomes associated with leisure time physical activity, but detrimental health outcomes for those engaging in high level occupational physical activity. This is the first quantitative systematic review of evidence regarding the association between occupational physical activity and all-cause mortality. DESIGN: Systematic review with meta-analysis. DATA SOURCE: A literature search was performed in electronic databases PubMed, Embase, CINAHL, PsycINFO and Cochrane. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We screened for peer reviewed articles from prospective studies assessing the association of occupational physical activity with all-cause mortality. A meta-analysis assessed the association of high (compared with low) level occupational physical activity with all-cause mortality, estimating pooled hazard ratios (HR) (with 95% CI). RESULTS: 2490 unique articles were screened and 33 (from 26 studies) were included. Data from 17 studies (with 193 696 participants) were used in a meta-analysis, showing that men with high level occupational physical activity had an 18% increased risk of early mortality compared with those engaging in low level occupational physical activity (HR 1.18, 95% CI 1.05 to 1.34). No such association was observed among women, for whom instead a tendency for an inverse association was found (HR 0.90, 95% CI 0.80 to 1.01). CONCLUSIONS: The results of this review indicate detrimental health consequences associated with high level occupational physical activity in men, even when adjusting for relevant factors (such as leisure time physical activity). These findings suggest that research and physical activity guidelines may differentiate between occupational and leisure time physical activity.

Physical activity and 22-year all-cause and coronary heart disease mortality.

BACKGROUND: This study explores the effects of occupational (OPA) and leisure time physical activity (LTPA) on mortality relative to cardiorespiratory fitness and pre-existing coronary heart disease (CHD). METHODS: Associations between OPA, measured as energy expenditure (kcal/day) and relative aerobic workload (%VO2 max), LTPA, and 22-year mortality among 1891 Finnish men were assessed by Cox regression models stratified by CHD and adjusted for 19 confounders. RESULTS: In fully adjusted models, each 10% of relative aerobic workload increased all-cause mortality by 13% and CHD mortality 28% (P < 0.01). Compared to healthy subjects, men with CHD experienced lower mortality risks due to OPA and higher risks due to LTPA. While LTPA had no effect among healthy men, in men with CHD each weekly hour of conditioning LTPA increased all-cause mortality risks by 10% and CHD mortality by14%. CONCLUSION: OPA was positively associated with both all-cause and CHD mortality. LTPA was not protective. Among men with CHD, LTPA increased mortality risks.

Shift work and 20-year incidence of acute myocardial infarction: results from the Kuopio Ischemic Heart Disease Risk Factor Study.

OBJECTIVES: It remains unclear whether different types of shift work impose similar risks for cardiovascular events in middle-aged workers, especially those with pre-existing ischaemic heart disease (IHD). This study investigated the relations between different shift types and incident acute myocardial infarction (AMI) among men with and without pre-existing IHD, respectively. METHODS: We analysed data on 1891 men, aged 42-60 years at baseline, in the prospective Kuopio Ischemic Heart Disease Risk Factor Study cohort, using Cox proportional hazard models with adjustment for demographic, biological, behavioural and psychosocial job factors. We evaluated the associations of baseline shift work with 20-year incidence of AMI, and their modification by pre-existing IHD, using both stratified analysis and models with product terms between shift work and IHD. RESULTS: Travelling work (at least 3 nights per week away from home) was strongly positively associated with AMI among men with IHD (HR=2.45, 95% CI 1. 08 to 5.59) but not among men without (HR=0.93, 95% CI 0.43 to 2.00). No clear associations were found between other types of shift work and AMI for both men with and without IHD. On both additive and multiplicative scales, baseline IHD status positively modified the association of travelling work with AMI (relative excess risk for interaction=3.23, 95% CI -0.50 to 6.97, p for multiplicative interaction=0.044). CONCLUSIONS: We found mixed results for the associations between different types of shift work and AMI among those with and without pre-existing IHD. Future research should investigate these associations and effect modification for a broad spectrum of work schedules.

Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update.

Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12 months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12 months post-injury. Participants self-reported they had not received a depression diagnosis 1 year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12 months was 50.3 % (95 % CI 44.9-55.7 %). At 12 months, 24.7 % (95 % CI 20.1-29.3 %) of workers exhibited high levels. Over 12 months, 49.7 % (95 % CI 44.3-55.1 %) had low levels at all 3 interviews, 14.5 % (95 % CI 10.7-18.2 %) had persistently high levels, and 25.6 % (95 % CI 20.9-30.3 %) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12 months was 6.0 % (95 % CI 2.7-9.3 %). For workers with high baseline levels, 36.1 % (95 % CI 27.9-44.3 %) exhibited persistent high symptoms at 6 and 12 months, while 38.4 % (95 % CI 30.1-46.6 %) experienced low levels at 6 and 12 months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8 % (95 % CI 7.7-29.8 %) self-reported receiving a depression diagnosis by 12 months and 29.2 % (95 % CI 16.3-42.0 %) were receiving treatment at 12 months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12 months post-injury. While symptoms appear to improve over time, the first 6 months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.

Work schedules and 11-year progression of carotid atherosclerosis in middle-aged Finnish men.

OBJECTIVES: This study investigated the relationship between different work schedules and progression of carotid atherosclerosis, an early indicator of cardiovascular disease (CVD). METHODS: We studied 621 men, aged 42-60 years, in the prospective Kuopio Ischemic Heart Disease Risk Factor Study cohort. Using multivariable regressions adjusting for 22 covariates including total time worked during follow-up, we evaluated the associations of baseline work schedules with 11-year progression of ultrasonographically assessed carotid intima-media thickness (IMT), and their variation by preexisting CVD. RESULTS: Standard daytime work, weekend shifts, and evening/night/rotating shifts were associated with 31%, 37%, and 33% increases in IMT, respectively. Compared to daytime workers, weekend workers experienced a faster progression of carotid atherosclerosis [relative change ratio (RCR) = 1.05, 95% CI: 1.00-1.09)]. This ratio was higher among men who had preexisting CVD. CONCLUSIONS: Weekend shifts, more than standard daytime work, appear to accelerate carotid atherosclerosis progression among middle-aged Finnish men, especially those with pre-existing CVD.

Psychosocial job factors and biological cardiovascular risk factors in Mexican workers.

BACKGROUND: Psychosocial job factors (PJF) have been implicated in the development of cardiovascular disease. The paucity of data from developing economies including Mexico hampers the development of worksite intervention efforts in those regions. METHODS: This cross-sectional study of 2,330 Mexican workers assessed PJF (job strain [JS], social support [SS], and job insecurity [JI]) and biological cardiovascular disease risk factors [CVDRF] by questionnaire and on-site physical examinations. Alternative formulations of the JS scales were developed based on factor analysis and literature review. Associations between both traditional and alternative job factor scales with CVDRF were examined in multiple regression models, adjusting for physical workload, and socio-demographic factors. RESULTS: Alternative formulations of the job demand and control scales resulted in substantial changes in effect sizes or statistical significance when compared with the original scales. JS and JI showed hypothesized associations with most CVDRF, but they were inversely associated with diastolic blood pressure and some adiposity measures. SS was mainly protective against CVDRF. CONCLUSION: Among Mexican workers, alternative PJF scales predicted health outcomes better than traditional scales, and psychosocial stressors were associated with most CVDRF.

Wage theft as a neglected public health problem: an overview and case study from San Francisco's Chinatown District.

Wage theft, or nonpayment of wages to which workers are legally entitled, is a major contributor to low income, which in turn has adverse health effects. We describe a participatory research study of wage theft among immigrant Chinatown restaurant workers. We conducted surveys of 433 workers, and developed and used a health department observational tool in 106 restaurants. Close to 60% of workers reported 1 or more forms of wage theft (e.g., receiving less than minimum wage [50%], no overtime pay [> 65%], and pay deductions when sick [42%]). Almost two thirds of restaurants lacked required minimum wage law signage. We discuss the dissemination and use of findings to help secure and enforce a wage theft ordinance, along with implications for practice.

Job stress and work-related musculoskeletal symptoms among intensive care unit nurses: a comparison between job demand-control and effort-reward imbalance models.

BACKGROUND: The aims of this study were to compare job demand-control (JDC) and effort-reward imbalance (ERI) models in examining the association of job stress with work-related musculoskeletal symptoms and to evaluate the utility of a combined model. METHODS: This study analyzed cross-sectional survey data obtained from a nationwide random sample of 304 intensive-care unit (ICU) nurses. Demographic and job factors were controlled in the analyses using logistic regression. RESULTS: Both JDC and ERI variables had strong and statistically significant associations with work-related musculoskeletal symptoms. Effort-reward imbalance had stronger associations than job strain or iso-strain with musculoskeletal symptoms. Effort-reward imbalance alone showed similar or stronger associations with musculoskeletal symptoms compared to combined variables of the JDC and ERI models. CONCLUSIONS: The ERI model appears to capture the magnitude of the musculoskeletal health risk among nurses associated with job stress at least as well and possibly better than the JDC model. Our findings suggest that combining the two models provides little gain compared to using effort-reward imbalance only.

Risk perception of musculoskeletal injury among critical care nurses.

BACKGROUND: Nursing is known as an occupation with high risk of musculoskeletal injury. Nurses' perceptions about the risk of injury may have a role in preventing such injury. OBJECTIVES: The aim of this study was to investigate how nurses perceived the risk of musculoskeletal injury from work and identify factors associated with their risk perception. METHODS: In a cross-sectional study using a postal survey, 361 critical care nurses reported on risk perception, physical workload, psychosocial job factors, safety climate, musculoskeletal symptoms, and safe work behavior. RESULTS: Of all critical care nurse respondents, 83% perceived that they were more likely than not to have a musculoskeletal injury within 1 year. On average, nurses perceived the risk of musculoskeletal injury as lower to themselves than to coworkers. This more positive perception of risk to self had stronger correlations with symptom experiences. Multiple linear regression analysis revealed that higher risk perception of injury was associated with greater job strain, greater physical workload, lack of availability of lifting devices or lifting teams, and more symptoms. DISCUSSION: Study findings indicated that most critical care nurses were concerned about their ergonomic job risks. Their risk perceptions about musculoskeletal injury risk were affected by physical work exposures, psychosocial job stressors, and experience with musculoskeletal symptoms, but not by perceived workplace safety climate. The findings underscore the need for management efforts to improve physical and psychosocial working conditions and create a safe work environment.

Assessment of cardiovascular load among hotel room cleaners.

Hotel room cleaners are a vulnerable population at risk for cardiovascular disease. To evaluate their workload heart rate (HR), % heart rate reserve (%HRR), blood pressure (BP), metabolic equivalent (MET), and energy expenditure (EE) were measured over two workdays and two off-workdays. The mean age was 45.5 (SD 8.2) years with a mean 10.4 (SD 7.8) years of work experience. Mean average and peak HR, %HRR, MET, and EE were significantly higher during a workday than an off-workday for the entire work shift, first and last hour of work. Mean average HR and %HRR saw the largest increase between the lunch and post-lunch interim. One-fourth of subjects exceeded the recommended 30% HRR threshold for 8-hour shifts. Some workers experienced a substantial increase in HR and DBP over a workday indicating physiologic fatigue and thus may be at increased risk for cardiovascular disease and premature death due to excessive physical work demands.

Occupational physical activity and mortality among Danish workers.

PURPOSE: The relationship between occupational physical activity (OPA) and mortality has mainly been studied among males and shows conflicting results. This study examines this relationship in a cohort of both male and female workers. METHODS: OPA was determined by 4 self-reported questions in a representative sample of 5,839 Danish workers aged 18-59 years at baseline. A 19-year follow-up on mortality was assessed by linkage with the national death registry. Gender-stratified Cox regression models were used to determine the effect of high OPA on all-cause mortality while controlling for age, BMI, smoking, alcohol consumption, doctor-diagnosed disease, influence at work, and social class. RESULTS: Two hundred and sixty-two males (8.6%) and 174 females (6.2%) died during follow-up. Being in the highest quartile of OPA predicted an increased risk for all-cause mortality among male workers (HR: 1.79, CI: 1.19-2.70), but not among female workers (HR: 0.99, CI: 0.65-1.49) compared with workers in the lowest quartile of OPA. Among females, indications of a u-shaped relationship between occupational physical activity and all-cause mortality were found. CONCLUSIONS: The findings indicate that high occupational physical activity increases the risk for all-cause mortality among male workers. Future studies need to further examine gender differences in the effects of OPA on mortality.

Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants.

OBJECTIVES: Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality. METHODS: A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality. RESULTS: We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87-1.15] and females (HR 0.95, 95% CI 0.82-1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88-1.49). CONCLUSIONS: While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.