Relationship between cumulative exposure to occupational lifting throughout working life and risk of ischemic heart disease in men and women. The Copenhagen Aging and Midlife Biobank.

Ischemic heart disease (IHD) causes mortality and morbidity. High levels of occupational physical activity (OPA) increases IHD risk, and occupational lifting (OL) is suggested as a detrimental OPA exposure. This study investigated the association between accumulated OL throughout working life, and risk for IHD, and potential sex and hypertension differences. Data from Copenhagen Ageing and Midlife Biobank linked to register-based information on incident IHD during 9 years follow-up in the Danish National Patient Registry were included. The outcome was the odds of IHD from baseline (2009-2011) to end of follow-up (2018), among participants without IHD at baseline. Accumulated OL was assessed by linking occupational codes to a Job Exposure Matrix, creating a measure in ton-years (lifting 1,000 kg/day/year). Multivariable logistic regression tested associations between level of accumulated OL and IHD, among the 6,606 included individuals (68% men). During follow-up, 7.3% men and 3.6% women were hospitalized with IHD. Among all participants, the odds for IHD were 47% (OR 1.47, 95% CI 1.05-2.06) higher among those with ≥5 to <10 ton-years, 39% (OR 1.39, 95% CI 1.06-1.83) higher among those with ≥10 to <30 ton-years, and 62% (OR 1.62, 95% CI 1.18-2.22) higher among those with ≥30 ton-years, compared to no accumulated OL. However, these increased odds were in the same direction in the fully-adjusted model but statistically insignificant, ≥5 to <10 ton-years OR 1.28, 95% CI 0.88-1.88; ≥10 to <30 ton-years OR 1.20, 95% CI 0.85-1.69; and ≥30 ton-years OR 1.22, 95% CI 0.81-1.84. No statistically significant interactions, nor any associations, between OL and sex, or hypertension were seen.

Design and validation of pictograms and educational video clips to improve the knowledge of skin care and protection: Comprehension and recall among professional hospital cleaners.

INTRODUCTION: Insufficient knowledge about protection and care of the skin among Danish hospital cleaners, particularly immigrant cleaners, is guessed to be a widespread issue that can increase the likelihood of them developing occupational hand eczema (OHE). This study aimed to design and validate 10 pictograms and 10 short video clips showing recommendations for skin care that would help prevent OHE among professional cleaners. METHODS: Ten pictograms and 10 short, educational video clips, based on standard, recommended information were developed in collaboration with a medical illustrator and a video director. The materials were validated in a two-step process that included bus drivers (primary validation) and professional cleaners (secondary validation). RESULTS: During the primary validation, 5 of the 10 pictograms (50%) were comprehended correctly by at least 85%. Those that were misinterpreted, were modified and retested several times until they were understood correctly by at least 85%. During the secondary validation, all 10 pictograms achieved acceptable levels of comprehension among professional cleaners. All the video clips were comprehended correctly by both bus drivers and cleaners. CONCLUSION: Ten easy-to-understand pictograms and 10 educational video clips for cleaners about the prevention of OHE have been designed and validated.

The distribution of diagnoses in a population of individuals on long-term sick leave.

INTRODUCTION: The aim of this study was to investigate the distribution of International Classification of Primary Care, second edition, (ICPC-2) diagnoses in a population of individuals on long-term sick leave. Furthermore, we wanted to test if the number of diagnoses varied between assessors. METHODS: The study population was comprised of people on sick leave aged 18-65 years attending rehabilitation appointments in Region Zealand in the period from 1 March to 31 August 2018. Five general practitioners assigned between one and three ICPC-2 diagnoses per subject. It was investigated whether there was independence between the doctors collecting the data. RESULTS: A total of 29 diagnostic categories were established, and the three most common conditions were back pain (9.8%), musculoskeletal disorders (8.6%) and depression (7.5%). During the data collection period, a primary ICPC-2 diagnosis was made in 743 subjects, a secondary diagnosis in 371 subjects (49.9%) and a tertiary diagnosis in 101 subjects (13.6%). No significant differences were found between the number of ICPC-2 diagnoses made by the five doctors (p = 0.49). CONCLUSIONS: The most common diagnoses were back conditions, musculoskeletal disorders and depression, and half of the study population had at least two diagnoses. The study shows that health professionals can assign ICPC-2 diagnoses for individuals on sick leave during rehabilitation sessions. This will give the municipalities the necessary knowledge to systematically track the development of diagnoses in order to plan individualised interventions. FUNDING: none. TRIAL REGISTRATION: not relevant.

Accelerometer-Measured Physical Activity at Work and Need for Recovery: A Compositional Analysis of Cross-sectional Data.

OBJECTIVES: Previous research has shown strong associations between occupational physical activity (OPA) and need for recovery (NFR). However this research has only utilized self-reported measures of OPA which may be biased. Thus, there is a need for investigating if the previously documented association between self-reported OPA and NFR can be found when using technical measures of OPA. There is also the need to investigate whether older workers are particularly susceptible to increased NFR, since age-related declines in physical capacity mean that it is likely these workers will have a higher NFR for a given physical activity. The aim of this study was to investigate the association between technically measured OPA and NFR, and whether this relationship is modified by age. METHODS: This study utilized data from the Danish Physical Activity Cohort with Objective Measurements cohort-comprising Danish workers (n = 840) from the cleaning, manufacturing, and transportation sectors. OPA was measured by accelerometers attached to the thigh and upper back for at least one work day and classified into four physical behaviour categories (sedentary, standing, light, or moderate/vigorous). NFR was measured using a shortened version of the Danish NFR scale. Analysis was conducted using linear regression and isotemporal substitution analyses for compositional data. RESULTS: The overall association between OPA and NFR was statistically significant in the unadjusted model (P < 0.001), but not when adjusted for age, sex, occupation, and shift work (P = 0.166). Isotemporal substitution showed small but significant reductions in NFR when increasing sedentary time relative to other behaviours (adjusted: ΔNFR = -0.010 [-0.019; -0.001]). There were no significant interactions between age and OPA (P = 0.409). CONCLUSIONS: This study found significant associations between OPA and NFR, but the effect sizes were small. Reallocating 30 min to sedentary behaviours from other behaviours was associated with a reduced NFR, but the effect size may not be practically relevant. Moreover, no clear modifying effects of age were identified.

Validation of a Short-Form Version of the Danish Need for Recovery Scale against the Full Scale.

INTRODUCTION: The Need for Recovery (NFR) Scale facilitates the understanding of the factors that can lead to sustainable working and employability. Short-form scales can reduce the burden on researchers and respondents. Our aim was to create and validate a short-form Danish version of the NFR Scale. METHODS: Two datasets were used to conduct the exploratory and confirmatory analyses. This was done using qualitative and quantitative methods. The exploratory phase identified several short-form versions of the Danish NFR Scale and evaluated the quality of each through the assessment of content, construct and criterion validity, and responsiveness. These evaluations were then verified through the confirmatory analysis, using the second dataset. RESULTS: A short-form NFR scale consisting of three items (exhausted at the end of a work day, hard to find interest in other people after a work day, it takes over an hour to fully recover from a work day) showed excellent validity and responsiveness compared to the nine-item scale. Furthermore, a short-form consisting of just two items also showed excellent validity and good responsiveness. CONCLUSION: A short-form NFR scale, consisting of three items from the Danish NFR Scale, seems to be an appropriate substitute for the full nine-item scale.

Employment and sick leave in patients with prostate cancer before, during and after radiotherapy.

OBJECTIVE: The aim of this study was to determine employment outcomes after radiotherapy (RT) for prostate cancer (PCa). MATERIALS AND METHODS: The Danish DREAM database contains information about social benefits paid to Danish citizens. Data are recorded prospectively every week. From the database, it is possible to assess whether a patient is working, on sick leave or retired at a certain time. Data on 417 Danish citizens treated with RT for PCa at Rigshospitalet, Copenhagen, between 1 January 2005 and 1 May 2010 were obtained from the database. The data were collected during a 2 year period from 1 year before RT to 1 year after RT. RESULTS: Among patients of working age, 75% were still available for work 1 year after RT. The degree of sick leave increased almost continuously in the year before the start of RT and reached a maximum of 56% during RT. After RT it gradually declined. There was no significant difference between the number of patients on sick leave 1 year after RT compared to 1 year before RT (p = 0.23). Patients spent a significantly higher number of weeks on sick leave in the year after the start of RT compared to the year before RT (p = 0.001). CONCLUSION: Except for a transient increase in sick leave during treatment, RT did not seem to affect the working lives of patients with PCa significantly.

Effect of training supervision on effectiveness of strength training for reducing neck/shoulder pain and headache in office workers: cluster randomized controlled trial.

OBJECTIVE: To investigate the effect of workplace neck/shoulder strength training with and without regular supervision on neck/shoulder pain and headache among office workers. METHOD: A 20-week cluster randomized controlled trial among 351 office workers was randomized into three groups: two training groups with the same total amount of planned exercises three times per week (1) with supervision (3WS) throughout the intervention period, (2) with minimal supervision (3MS) only initially, and (3) a reference group (REF). Main outcome is self-reported pain intensity in neck and shoulder (scale 0-9) and headache (scale 0-10). RESULTS: Intention-to-treat analyses showed a significant decrease in neck pain intensity the last 7 days in 3MS compared with REF: -0.5 ± 0.2 (P < 0.02) and a tendency for 3WS versus REF: -0.4 ± 0.2 (P < 0.07). Intensity of headache the last month decreased in both training groups: 3WS versus REF: -1.1 ± 0.2 (P < 0.001) and 3MS versus REF: -1.1 ± 0.2 (P < 0.001). Additionally, days of headache decreased 1.0 ± 0.5 in 3WS and 1.3 ± 0.5 in 3MS versus REF. There were no differences between the two training groups for any of the variables. CONCLUSION: Neck/shoulder training at the workplace reduced neck pain and headache among office workers independently of the extent of supervision. This finding has important practical implications for future workplace interventions.

Patient transfers and assistive devices: prospective cohort study on the risk for occupational back injury among healthcare workers.

OBJECTIVES: This prospective cohort study investigates work-related risk factors for occupational back injury among healthcare workers. METHODS: The study comprised 5017 female healthcare workers in eldercare from 36 municipalities in Denmark who responded to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using logistic regression, the odds for occupational back injury (ie, sudden onset episodes) in 2006 from patient transfers in 2005 was modeled. RESULTS: In the total study population, 3.9% experienced back injury during follow-up, of which 0.5% were recurrent events. When adjusting for lifestyle (body mass index, leisure-time physical activity, smoking), work-related characteristics (seniority and perceived influence at work), and history of back pain and injury, daily patient transfers increased the risk for back injury (trend, P=0.03): odds ratio (OR) 1.75 [95% confidence interval (95% CI) 1.05-2.93] for 1-2 transfers per day, OR 1.81 (95% CI 1.14-2.85) for 3-10 transfers per day, and OR 1.56 (95% CI 0.96-2.54) for >10 transfers per day, referencing those with <1 patient transfer on average per day. The population attributable fraction of daily patient transfer for back injury was estimated to be 36%. Among those with daily patient transfer (N=3820), using an assistive device decreased the risk for back injury for "often" and "very often" use [OR 0.59 (95% CI 0.36-0.98) and OR 0.62 (95% CI 0.38-1.00), respectively] referencing those who "seldom" use assistive devices. CONCLUSION: Daily patient transfer was associated with increased risk for back injury among healthcare workers. Persistent use of an assistive device was associated with reduced risk for back injury among healthcare workers with daily patient transfers.

Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities.

OBJECTIVES: The aim of this study was to evaluate the effect of the Danish return-to-work (RTW) program on long-term sickness absence in a randomized controlled trial in three municipalities. METHODS: The intervention group comprised 1948 participants while the control group comprised 1157 participant receiving ordinary sickness benefit management (OSM). Study participants were working-age adults receiving long-term (≥8 weeks or more) benefits, included regardless of reason for sickness absence or employment status. Each beneficiary was followed-up for a maximum period of 52 weeks. Cox proportional hazards model was used to estimate hazard ratios (HR) for return to work (RTW) with 95% confidence intervals (95% CI). RESULTS: The intervention effect differed significantly between the municipalities (P=0.00005). In one municipality (M2) the intervention resulted in a statistically significant increased rate of recovery from long-term sickness absence (HR 1.51, 95% CI 1.31-1.74). In the other two municipalities, the intervention did not show a statistically significant effect (HR M11.12, 95% CI 0.97-1.29, and HR M30.80, 95% CI 0.63-1.03, respectively). Adjustment for a series of possible confounders only marginally altered the estimated HR. CONCLUSION: The effect of the intervention differed substantially between the three municipalities, indicating that that contextual factors are of major importance for success or failure of this complex intervention.

Does a history of physical exposures at work affect hand-grip strength in midlife? A retrospective cohort study in Denmark.

OBJECTIVE: The aim of this cohort study was to examine associations between physical exposures throughout working life and hand-grip strength (HGS) in midlife. METHODS: The Copenhagen Aging and Midlife Biobank (CAMB) provided data about employment and HGS for 3843 Danes. Individual job histories, including duration of employment in specific jobs, were assigned exposures from a job exposure matrix. Exposures were standardized to ton-years (lifting 1000 kg each day in one year), stand-years (standing/walking for six hours each day in one year) and kneel-years (kneeling for one hour each day in one year). The effects of exposure-years on HGS were analyzed as linear effects and cubic splines in multivariate regression models, adjusted for potential confounders. RESULTS: Mean age was 59 years among both genders and HGS was 49.19 kg [standard deviation (SD) 8.42] and 30.61 kg (SD 5.49) among men and women, respectively. Among men, exposure to kneel-years was associated with higher HGS [>0.030 kg (P=0.007) per exposure-year]. Ton- and stand-years were not associated with HGS among either men or women in linear analyses. In spline regression analyses, associations between ton- and stand-years and HGS were non-linear and primarily positive among men. Among women, the associations were non-linear and, according to ton-years, primarily negatively associated with HGS but statistically insignificant. CONCLUSION: A history of physical exposures at work explained only a minor part of the variation in HGS, though exposure to kneeling throughout working life was associated with a slightly higher HGS among men. Exposure to lifting and standing/walking was not associated with HGS.

Dose-response of strengthening exercise for treatment of severe neck pain in women.

Specific strength training is shown to relieve neck pain in office workers. The purpose of this study is to evaluate the effectiveness of specific strength training in women with severe neck pain and to analyze the dose-response relationship between training adherence and pain reduction. One hundred eighteen untrained women with severe neck pain (>30 mm VAS pain) were included from a larger study, in which the subjects were randomized to 20-week specific strength training for the neck/shoulders or to a control group. In the intention-to-treat analysis, the training group experienced greater pain relief than the control group (p < 0.01). Participants who adhered "per protocol" decreased pain by 35 mm VAS (95% confidence interval: -26 to -44) from baseline to follow-up corresponding to a 70% reduction. In the dose-response analyses, participants with medium and high training adherence showed better pain relief than the control group and those with low adherence (p < 0.0001). The decrease from baseline in the medium and high adherence groups was 37 mm VAS (28-46 mm) and 33 mm VAS (24-43 mm), respectively. Specific strength training reduces pain intensity in women with severe neck pain, and 1-2 training sessions per week for 20 weeks (∼30 training sessions) seems sufficient for optimal pain relief.

Central adaptation of pain perception in response to rehabilitation of musculoskeletal pain: randomized controlled trial.

BACKGROUND: Understanding the mechanisms of long-standing musculoskeletal pain and adaptations in response to physical rehabilitation is important for developing optimal treatment strategies. The influence of central adaptations of pain perception in response to rehabilitation of musculoskeletal pain remains unclear. OBJECTIVE: To investigate the effect of neck/shoulder resistance training on pressure pain threshold (PPT) of the painful neck/shoulder muscles (upper trapezius) and a non-painful reference muscle of the leg (tibialis anterior) in adults with neck/shoulder pain. STUDY DESIGN: Examiner-blinded, parallel-group randomized controlled trial with allocation concealment. TRIAL REGISTRATION: ISRCTN60264809 SETTING: Office workplaces in the capital of Denmark. METHODS: The study contained 198 adults with frequent neck/shoulder pain (174 women and 24 men, mean: age 43 years, duration of pain 186 days during the previous year, computer use 93% of work time) were randomly allocated to 10 weeks of specific resistance training for the neck/shoulder muscles for 2 or 12 minutes per day 5 times a week, or weekly information on general health (control group). Primary outcomes were changes in PPT of the painful neck/shoulder muscles (upper trapezius) and a distant non-painful reference muscle (tibialis anterior) at 10 weeks. RESULTS: PPT of both the trained painful trapezius and the non-trained reference muscle of the leg increased more in the training groups compared with the control group (P < 0.05), providing evidence of central adaptations. The change in PPT of the reference muscle was of similar magnitude to that of the painful muscle. Compared with the control group, the change in PPT of the trapezius and tibialis anterior was 31 (95% CI 3 to 60) kPa and 36 (8 to 65) kPa in the 2 min group, respectively, and 29 (1 to 58) kPa and 36 (7 to 64) kPa in the 12 min group. LIMITATIONS: Blinding of participants is not possible in behavioural interventions. CONCLUSION: Central adaptations of pain perception occur in response to rehabilitation of musculoskeletal pain. Thus, treating pain in one region of the body reduces sensitivity to pressure in other regions of the body. Clinicians and researchers may use this knowledge to better understand adaptations of pain perception in patients with musculoskeletal pain.

Time trend analysis of return to work after stroke in Denmark 1996-2006.

BACKGROUND: In the period 1997-2005, the Danish government initiated a series of legislative changes aimed at facilitating RTW (return to work) in the Danish population. In the present study, we investigated the odds of being gainfully occupied ca. two years after stroke as a function of onset calendar year, 1996-2006. METHODS: All previously employed 20-57 year-old stroke patients in Denmark 1996-2006 (N = 19985) were followed prospectively through national registers. The analysis was controlled for the type of stroke and a series of demographic, structural and occupational variables. RESULTS: The odds for RTW increased significantly during the study period (P < 0.0001). The odds at the end of the period were more than twice as high as they were at the beginning, even after post hoc control for improved survival and decreased unemployment rates. The most conspicuous increase coincided with a change in the sickness benefit act that took place in 2005. CONCLUSION: The study provides quite strong circumstantial evidence that the legislative changes had an effect on the odds of return to work after stroke. More direct evidence is desirable, but such can only be obtained through a randomized controlled study.

Effect of specific resistance training on forearm pain and work disability in industrial technicians: cluster randomised controlled trial.

OBJECTIVES: To determine the effect of specific resistance training on forearm pain and work disability in industrial technicians. DESIGN AND SETTING: Two-armed cluster randomised controlled trial of 20 weeks performed at two industrial production units in Copenhagen, Denmark. PARTICIPANTS: Working-age industrial technicians both with and without pain and disability. INTERVENTIONS: The training group (n=282) performed specific resistance training for the shoulder, neck and arm muscles three times a week. The control group (n=255) was advised to continue normal physical activity. OUTCOME: All participants rated forearm pain intensity (Visual Analogue Scale, 0-100 mm) once a week (primary outcome) and replied to a questionnaire on work disability (Disability of the Arm Shoulder and Hand, 0-100) at baseline and follow-up (secondary outcome). RESULTS: Questionnaires were sent to 854 workers of which 30 (n=282) and 27 (n=255) clusters were randomised to training and control, respectively. Of these, 211 and 237 participants, respectively, responded to the follow-up questionnaire. Intention-to-treat analyses including both individuals with and without pain showed that from baseline to follow-up, pain intensity and work disability decreased more in the training group than in the control group (4-5 on a scale of 0-100, p<0.01-0.001). Among those with pain >30 mm Visual Analogue Scale at baseline (n=54), the OR for complete recovery at follow-up in the training group compared with the control group was 4.6 (95% CI 1.2 to 17.9). Among those with work disability >30 at baseline (n=113), the OR for complete recovery at follow-up in the training group compared with the control group was 6.0 (95% CI 1.8 to 19.8). CONCLUSION: Specific resistance training of the shoulder, neck and arm reduces forearm pain and work disability among industrial technicians. TRIAL REGISTRATION NUMBER: NCT01071980.

Occupational and leisure time physical activity: risk of all-cause mortality and myocardial infarction in the Copenhagen City Heart Study. A prospective cohort study.

OBJECTIVES: Men with low physical fitness and high occupational physical activity are recently shown to have an increased risk of cardiovascular disease and all-cause mortality. The association between occupational physical activity with cardiovascular disease and all-cause mortality may also depend on leisure time physical activity. DESIGN: A prospective cohort study. SETTING: The Copenhagen City Heart Study. PARTICIPANTS: 7819 men and women aged 25-66 years without a history of cardiovascular disease who attended an initial examination in the Copenhagen City Heart Study in 1976-1978. OUTCOME MEASURES: Myocardial infarction and all-cause mortality. Occupational physical activity was defined by combining information from baseline (1976-1978) with reassessment in 1981-1983. Conventional risk factors were controlled for in Cox analyses. RESULTS: During the follow-up from 1976 to 1978 until 2010, 2888 subjects died of all-cause mortality and 787 had a first event of myocardial infarction. Overall, occupational physical activity predicted all-cause mortality and myocardial infarction in men but not in women (test for interaction p=0.02). High occupational physical activity was associated with an increased risk of all-cause mortality among men with low (HR 1.56; 95% CI 1.11 to 2.18) and moderate (HR 1.31; 95% CI 1.05 to 1.63) leisure time physical activity but not among men with high leisure time physical activity (HR 1.00; 95% CI 0.78 to 1.26) (test for interaction p=0.04). Similar but weaker tendencies were found for myocardial infarction. Among women, occupational physical activity was not associated with subsequent all-cause mortality or myocardial infarction. CONCLUSIONS: The findings suggest that high occupational physical activity imposes harmful effects particularly among men with low levels of leisure time physical activity.

The Danish national return-to-work program--aims, content, and design of the process and effect evaluation.

The Danish national return-to-work (RTW) program aims to improve the management of municipal sickness benefit in Denmark. A study is currently ongoing to evaluate the RTW program. The purpose of this article is to describe the study protocol. The program includes 21 municipalities encompassing approximately 19 500 working-age adults on long-term sickness absence, regardless of reason for sickness absence or employment status. It consists of three core elements: (i) establishment of multidisciplinary RTW teams, (ii) introduction of standardized workability assessments and sickness absence management procedures, and (iii) a comprehensive training course for the RTW teams. The effect evaluation is based on a parallel group randomized trial and a stratified cluster controlled trial and focuses on register-based primary outcomes - duration of sickness absence and RTW - and questionnaire-based secondary outcomes such as health and workability. The process evaluation utilizes questionnaires, interviews, and municipal data. The effect evaluation tests whether participants in the intervention have a (i) shorter duration of full-time sickness absence, (ii) longer time until recurrent long-term sickness absence, (iii) faster full RTW, (iv) more positive development in health, workability, pain, and sleep; it also tests whether the program is cost-effective. The process evaluation investigates: (i) whether the expected target population is reached; (ii) if the program is implemented as intended; (iii) how the beneficiaries, the RTW teams, and the external stakeholders experience the program; and (iv) whether contextual factors influenced the implementation. The program has the potential to contribute markedly to lowering human and economic costs and increasing labor force supply. First results will be available in 2013. The trial registrations are ISRCTN43004323, and ISRCTN51445682.

Muscle activation strategies during strength training with heavy loading vs. repetitions to failure.

Going to failure, or not, has probably been one of the most debated issues during the history of strength training. However, few studies have directly compared the physiological effect of failure vs. nonfailure strength training. The purpose of this study was to evaluate muscle activation strategies with electromyography (EMG) during heavy repetitions vs. repetitions to failure with lighter resistance. Fifteen healthy untrained women performed a set with heavy loading (3 repetition maximum [RM]) and a set of repetitions to failure with lower resistance (∼15 RM) during lateral raise with elastic tubing. Electromyographic amplitude and median power frequency of specific shoulder and neck muscles were analyzed, and the BORG CR10 scale was used to rate perceived loading immediately after each set of exercise. During the failure set, normalized EMG was significantly lower during the first repetition and significantly higher during the latter repetitions compared with the heavy 3-RM set (p < 0.05). Normalized EMG for the examined muscles increased throughout the set to failure in a curvilinear fashion--e.g., for the trapezius from 86 to 124% maximal voluntary contraction (p < 0.001)--and reached a plateau during the final 3-5 repetitions before failure. Median power frequency for all examined muscles decreased throughout the set to failure in a linear fashion, indicating progressively increasing fatigue. In conclusion, going to complete failure during lateral raise is not necessary to recruit the entire motor unit pool in untrained women--i.e., muscle activity reached a plateau 3-5 repetitions from failure with an elastic resistance of approximately 15 RM. Furthermore, strengthening exercises performed with elastic tubing seem to be an efficient resistance exercise and a feasible and practical alternative to traditional resistance equipment.

A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare.

PURPOSE: The socioeconomic burden of sickness absence from musculoskeletal disorders is considerable. However, knowledge about the risk of sickness absence from pain in different body regions among specific job groups is needed to more efficiently target preventative strategies. This study estimates the risk of long-term sickness absence (LTSA) from pain in different body regions among healthcare workers. METHODS: Prospective cohort study among 8,952 Danish healthcare workers responding to a questionnaire in 2004-2005 and followed for 1 year in a national register of social transfer payments (DREAM). Using Cox regression hazard ratio (HR) analysis controlled for age, gender, BMI, smoking, seniority, leisure physical activity and psychosocial working conditions, we modeled risk estimates of sub-chronic (1-30 days last year) and chronic pain (>30 days last year) in the low back, neck/shoulder and knees for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks) during one-year follow-up. RESULTS: At baseline, the prevalence of chronic pain was 23% (low back), 28% (neck/shoulder) and 12% (knees). During follow-up, the 12-month prevalence of LTSA was 6.3%. Chronic pains in the low back (HR 1.47 [95% CI 1.17-1.85]), neck/shoulder (HR 1.60 [95% CI 1.27-2.02]) and knees (HR 1.92 [95% CI 1.52-2.42]) were significant risk factors for LTSA. However, only chronic neck/shoulder (HR 1.41 [95% CI 1.09-1.82]) and knee pain (HR 1.69 [95% CI 1.32-2.16]) remained significant with mutual adjustment for all three musculoskeletal pain regions. CONCLUSION: Musculoskeletal pain is a risk factor for LTSA among healthcare workers. Future research among healthcare workers in eldercare should include the management of neck/shoulder and knee pain in addition to the management of back pain.

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.

Perceived psychological pressure at work, social class, and risk of stroke: a 30-year follow-up in Copenhagen male study.

OBJECTIVE: Investigate if the association between perceived psychological work pressure and risk of stroke is modified by socioeconomic status. METHODS: Thirty-year follow-up of 4943 middle-aged men without cardiovascular disease. RESULTS: In the higher social classes (I, II, and III), perceived regular exposure to psychological work pressure was common and a significant predictor of stroke; almost 10% of the stroke events could be attributed to this exposure in the higher social classes; among lower social classes (IV and V), perceived psychological pressure was no predictor at all. CONCLUSIONS: Regular psychological work pressure is a highly prevalent and independent risk factor for stroke among men in higher social classes. In contrast, no association to stroke risk was found among low social class men.