Comprehensive evaluation of the impact of workplace exposures on physician-certified sick leave in the general working population.

BACKGROUND: Our objective was to quantify the prospective associations between work factors across chemical, physical, mechanical, and psychosocial domains and the onset of medically certified sick leave. METHODS: Eligible respondents were interviewed in 2009, 2013, or 2016 and were registered in the national sick leave register with an employee relationship lasting more than 50 working days during the year of the survey interviews and the following year (n = 15,294 observations). To focus on the onset of high-level sick leave (HLSL; >16 days a year), we excluded individuals with HLSL during the survey year (baseline). We then used mixed-effect logistic regression models to assess prospective associations between self-reported work conditions and the occurrence of doctor-certified HLSL in the following year. RESULTS: The average occurrence of HLSL was 13.1%. After adjusting for sex, age, level of education, chronic health problems, and smoking, we observed an exposure-response relationship between cumulative exposure to work factors within all domains and the occurrence of HLSL. When evaluating the impact of combined exposures, predicted odds ratios (OR) for employees exposed to 1, 2, and 3 or more work factors within all domains were 1.60 (95%CI 1.32 - 1.94), 2.56 (95%CI 1.73 - 3.74) and 4.09 (95%CI 2.28 - 7.25), compared to those not exposed. CONCLUSIONS: The results support the notion that exposure to multiple work factors in various domains, including psychosocial, mechanical, chemical, and physical work conditions, is associated with an increased risk of high-level sick leave. Employers and occupational health professionals should consider the joint impact of these domains when designing interventions.

Adverse social behaviour at work and health-related employment exit: a prospective population-based four-wave survey.

BACKGROUND: The level of evidence for various aspects of adverse social behaviour (ASB) at work as risk factors for exit from employment due to health problems or diseases is inconclusive. METHODS: We obtained data from four consecutive surveys (2006/09/13/16) of the general population of Norway. Respondents who were interviewed in two consecutive surveys and employed at the first survey time point constituted the sample (n = 17 110 observations). We investigated associations of self-reported exposure to ASB (i.e. experiencing sexual harassment, bullying or violence/threats in the first survey) and health-related employment exit (i.e. individuals reporting exit from employment due to health problems or disease between two consecutive surveys) by means of mixed-effect logistic regression. RESULTS: The prevalence of ASB and health-related employment exit was 10.8% (n = 1853) and 2.6% (n = 440), respectively. Adjusted for age, sex, level of education, occupation and weekly work hours, sexual harassment, bullying and violence/threats were associated with an increased risk of exit from employment. The odds ratios (ORs) for the association between exposure to any of the three aspects of ASB and employment exit was 1.78 [95% confidence interval (CI) 1.33-2.38]; the estimated corresponding population attributable risk was PAR% = 7.32 [95% CI 2.67-12.27]. Further adjustment of mental distress attenuated the observed association between exposure to any ASB and exit from employment (OR = 1.45 [95% CI 1.07-1.95], i.e. a reduction of 42% in the OR). CONCLUSIONS: ASB at work increases the risk of health-related exit from employment in the Norwegian workforce.

Work-life interference and physician-certified sick leave: a prospective study of a general working population.

BACKGROUND: Work-life interference has been associated with adverse health outcomes. Here, we quantify the association between work-life interference and subsequent sick leave. METHODS: Respondents from a randomly drawn cohort of the general working Norwegian population were interviewed in 2009, 2013 and/or 2016. Mixed-effects logistic regression models were used to assess prospective associations of self-reported work-life interference and risk of subsequent physician-certified sick leave of 1-16 days (low-level) and >16 days (high-level) in strata of men and women. To quantify the importance of work-life interference as risk factors for sick leave, we estimated the population attributable risk (PAR). RESULTS: Both low- and high-level sick leave were most prevalent among women while the prevalence of work-life interference was similar between sexes. Risk of sick leave was higher among women reporting work-life interference sometimes or often in comparison with seldom or never {low- and high-level sick leave odds ratio (OR) = 1.21 [95% confidence interval (CI) = 1.07-1.37] and 1.30 (95% CI = 1.14-1.49), respectively}. The associations for high-level sick leave progressively increased with the level of work-life interference [highest OR = 1.44 (95% CI = 1.19-1.75)]. In men, there was no consistent higher risk of sick leave according to more frequent work-life interference [low- and high-level sick leave OR = 1.00 (95% CI = 0.87-1.14) and 0.98 (95% CI = 0.84-1.16), respectively], but the risk of high-level sick leave tended to be higher among men reporting work-life interference often (OR = 1.21, 95% CI = 0.98-1.50). Estimating PAR, 6.69% (95% CI = 1.52-11.74) of low-level and 9.94% (95% CI = 4.22-15.45) of high-level sick leave could be attributed to work-life interference among women. CONCLUSIONS: Self-reported work-life interference was associated with a higher risk of sick leave, with the most consistent results among women.

Onset of Work-Life Conflict Increases Risk of Subsequent Psychological Distress in the Norwegian Working Population.

We aimed to assess whether the onset of work-life conflict is associated with a risk of subsequent onset of psychological distress. Respondents from a randomly drawn cohort of the general Norwegian working population were interviewed in 2009 (T1), 2013 (T2), and 2016 (T3) (gross sample n = 13,803). Participants reporting frequent work-life conflict at T1 and/or psychological distress (five-item Hopkins Symptom Checklist mean score ≥ 2) at T2 were excluded to establish a design that allowed us to study the effect of the onset of work-life conflict at T2 on psychological distress at T3. Logistic regression analysis showed that the onset of frequent work-life conflict more than doubled the risk of the onset of psychological distress at T3 (OR = 2.55; 95% CI 1.44-4.51). The analysis of the association between occasional work-life conflict and psychological distress was not conclusive (OR = 1.21; 95% CI 0.77-1.90). No differential effects of sex were observed (log likelihood ratio = 483.7, p = 0.92). The calculated population attributable risk (PAR) suggests that 12.3% (95% CI 2.84-22.9%) of psychological distress onset could be attributed to frequent work-life conflict. In conclusion, our results suggest that the onset of frequent work-life conflict has a direct effect on the future risk of developing symptoms of psychological distress in both male and female workers.

The Relationship between Workplace Conflicts and Subsequent Physician-Certified Sick Leave: A Prospective Population Study.

The impact of workplace conflicts on sick leave is largely unknown. We studied the associations between conflicts and physician-certified sick leave in a randomly drawn general working population sample. Eligible respondents were interviewed in 2009, 2013, and 2016 and were registered with an employee relationship ≥50 working days in the national sick-leave register the year following the survey interviews (n = 22,088 observations/13,731 respondents). We used mixed-effects logistic regression models (adjusted for sex, age, education level, occupation and sick leave days) to assess the associations of self-reported conflicts with superiors or colleagues and subsequent physician-certified sick leave of 1-16 days (i.e., low-level sick leave (LLSL)) and more than 16 days (i.e., high-level sick leave (HLSL)). Conflicts with superiors were associated with LLSL (OR = 1.73 95% CI 1.15-2.62) and HLSL (OR = 1.84 95% CI 1.15-2.94). The corresponding ORs for conflicts involving colleagues were weaker and largely non-significant. The population risks of LLSL and HLSL attributable to conflicts with superiors were 1.95% (95% CI 0.55-3.41) and 3.98% (95% CI 2.08-5.91), respectively. Conflicts with superiors appear to be an important risk factor for sick leave among employees. Organizations are well-advised to develop policies and competencies to prevent and manage conflicts at work.

Safety incidents associated with extended working hours. A systematic review and meta-analysis.

OBJECTIVE: We performed a systematic review to assess potential consequences of extended working hours on accidents, near-accidents, safety incidents and injuries (incidents) by considering the overall certainty of evidence. METHODS: We searched five databases systematically (Medline, Embase, PsycINFO, Web of Science, and Proquest Health and safety Science Abstract) and identified 10072 studies published until December 2020. Twenty-two studies met the inclusion criteria. We followed a systematic approach to evaluate risk of bias and synthesize results in a meta-analysis. The certainty of evidence was determined by a modified version of The Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Our analyses indicated an association between working >12 hours/day (RR: 1.24, 95%CI: 1.11, 1.40), or working >55 hours/week (RR: 1.24, 95%CI: 0.98, 1.57), and elevated risk of incidents. The certainty of evidence evaluated as low. Weak or no associations were observed for other exposure contrasts: working >8 hours/day (RR: 0.93, 95%CI: 0.72, 1.19), or working overtime (RR: 1.08, 95%CI: 0.75, 1.55), working 41-48 hours/week (RR: 1.02, 95%CI: 0.92, 1.13) or 49-54 hours/week (RR: 1.02, 95%CI: 0.97, 1.07). The certainty of evidence was evaluated as low (very low for 41-48 hours/week). CONCLUSIONS: Daily working hours >12 hours and weekly working hours exceeding 55 hours was associated and increased risk of incidents. The level of evidence was low. Hence, further high-quality research is warranted to elucidate these associations.

Adverse social behaviour at the workplace and subsequent physician certified sick leave: a three-wave prospective study of the general working population in Norway.

OBJECTIVES: We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at the workplace and sick leave. METHODS: Data from a randomly drawn prospective cohort of the general working population. Eligible respondents were interviewed in 2009, 2013 or 2016, and were registered with an employee relationship of at least 50 working days in the national register the year following the survey interviews (n=21 674 observations/13 470 respondents). We investigated the prospective associations of self-reported exposure to ASB, including threats/acts of violence, bullying and sexual harassment, with physician-certified sick leave of 1-16 days (ie, low level of sick leave (LLSL)) and >16 days (ie, high level of sick leave (HLSL)) by means of mixed effects logistic regression. RESULTS: The prevalence of sick leave was 18.4% (n=3986 observations) for LLSL and 16.1% (n=3492 observations) for HLSL. The different facets of ASB were independently associated with higher odds of sick leave, with stronger associations for HLSL than for LLSL. Adjusted for sex, age, education level, occupation, previous sickness absence level, OR (95% CI) for HLSL was 1.97 (1.61 to 2.35) for threats/acts of violence, 1.97 (1.53 to 2.54) for bullying and 1.41 (1.10 to 1.79) for sexual harassment. The population risks of LLSL and HLSL attributable to ASB were 5.27 (95% CI 1.85 to 8.81) and 8.27% (95% CI 4.01 to 12.48), respectively. CONCLUSIONS: Threats/acts of violence, bullying and sexual harassment were all independent predictors of sick leave, with threats/acts of violence appearing as the single most important factor.

Effects of adverse social behaviour at the workplace on subsequent mental distress: a 3-year prospective study of the general working population in Norway.

OBJECTIVE: We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at work and mental health problem. METHODS: Data were provided from a longitudinal nationwide study of the general population in Norway. Eligible respondents were in paid work during a reference week in 2013, or temporarily absent from such work, and was interviewed at 3-year follow-up (n = 3654, response at baseline/follow-up = 53.1%/71.8%). We investigated the prospective associations of self-reported exposure to ASBs, including threats/acts of violence, bullying, sexual harassment and workplace conflicts, with mental distress (the Hopkins Symptoms Checklist) at follow-up, by means of multiple logistic regression. RESULTS: In total, 6.6% (242 individuals) were classified with mental distress at follow-up. Work-related predictors were sexual harassment (OR = 1.64 07, 95% CI 1.03 - 2.61), bullying (OR = 2.07, 95% CI 1.19 - 3.60) and workplace conflicts (OR = 1.51, 95% CI 1.07 - 2.13). An elevated, but non-statistically significant association was observed for threats/acts of violence. No significant interactions were found between ASB and mental distress score at baseline. Overall there were few indications of substantial confounding related to age, sex, education level or occupation. After adjusting for these factors, the overall population attributable risk of mental distress attributable to any exposure to ASB was 11.3% (95%CI 0.6-22.3). CONCLUSIONS: We observed robust associations between exposure to three out of four types of ASB and risk of mental distress. Taken together, the results underscore that adverse social behaviour at the workplace may have a substantial impact on the level of mental distress in the general working population.

Effort-reward imbalance at work and weight changes in a nationwide cohort of workers in Denmark.

OBJECTIVE: To investigate the relation between effort-reward imbalance (ERI) at work and subsequent weight changes. METHODS: We included participants from a population-based cohort of workers in Denmark (mean age = 47 years, 54% women) with two (n = 9005) or three repeated measurements (n = 5710). We investigated the association between (a) ERI (ie, the mismatch between high efforts spent and low rewards received at work) at baseline and weight changes after a 2-year follow-up (defined as ≥5% increase or decrease in body mass index (BMI) vs stable), and (b) onset and remission of ERI and subsequent changes in BMI. Using multinomial logistic regression we calculated risk ratios (RR) and 95% confidence intervals (CI), adjusted for sex, age, education, cohabitation, migration background, and follow-up time. RESULTS: After 2 years, 15% had an increase and 13% a decrease in BMI. Exposure to ERI at baseline yielded RRs of 1.09 (95% CI: 0.95-1.25) and 1.04 (95% CI: 0.90-1.20) for the increase and decrease in BMI, respectively. There were no differences between sex and baseline BMI in stratified analyses. The onset of ERI yielded RRs of 1.04 (95% CI: 0.82-1.31) and 1.15 (95% CI: 0.84-1.57) for subsequent increase and decrease in BMI. The RRs for the remission of ERI and subsequent increase and decrease in BMI were 0.92 (95% CI: 0.71-1.20) and 0.78 (95% CI: 0.53-1.13), respectively. Of the ERI components, high rewards were associated with a lower risk of BMI increase. CONCLUSION: ERI was not a risk factor for weight changes. Future studies may investigate whether this result is generalizable to other occupational cohorts and settings.

Changes in effort-reward imbalance at work and risk of onset of sleep disturbances in a population-based cohort of workers in Denmark.

OBJECTIVE/BACKGROUND: Associations between exposure to effort-reward imbalance at work (eg, high time pressure/low appreciation) and risk of sleep disturbances have been reported, but the direction of the effect is unclear. The present study investigated changes in effort-reward imbalance and risk of concomitant and subsequent onset of sleep disturbances. METHODS: Participants with sleep disturbances at baseline were excluded. We included participants from a population-based cohort in Denmark (n = 8,464, 53.6% women, mean age = 46.6 years), with three repeated measurements (2012 (T0); 2014 (T1); 2016 (T2)). Changes in effort-reward imbalance (T0-T1) were categorized into 'increase', 'decrease' and 'no change'. Self-reported sleep disturbances (difficulties initiating or maintaining sleep, non-restorative sleep, daytime tiredness) were dichotomized (presence versus absence). We regressed concomitant (T1) and subsequent (T2) sleep disturbances on changes in effort-reward imbalance (T0-T1) and calculated odds ratios (OR) and 95% confidence intervals, adjusted for sex, age, education and cohabitation. RESULTS: At follow-up, 8.4% (T1) and 12.5% (T2) reported onset of sleep disturbances. Increased effort-reward imbalance was associated with concomitant sleep disturbances (T1) (OR = 3.16, 2.56-3.81), whereas decreased effort-reward imbalance was not (OR = 1.22, 0.91-1.63). There was no association between increased effort-reward imbalance and subsequent sleep disturbances (T2) (OR = 1.00, 0.74-1.37). Results were similar for men and women. CONCLUSIONS: Increased effort-reward imbalance was associated with a three-fold higher risk of concomitant onset of sleep disturbances at two-year follow-up, but not subsequent onset of sleep disturbances at four-year follow-up, indicating that changes in effort-reward imbalance have immediate rather than delayed effects on sleep impairment. It is possible that the results from the two-year follow-up were to some extent affected by reverse causality.

Effort-reward imbalance at work and risk of type 2 diabetes in a national sample of 50,552 workers in Denmark: A prospective study linking survey and register data.

OBJECTIVE: To examine the prospective relation between effort-reward imbalance at work and risk of type 2 diabetes. METHODS: We included 50,552 individuals from a national survey of the working population in Denmark, aged 30-64 years and diabetes-free at baseline. Effort-reward imbalance was defined, in accordance with the literature, as a mismatch between high efforts at work (e.g. high work pace, time pressure), and low rewards received in return (e.g. low recognition, job insecurity) and assessed as a continuous and a categorical variable. Incident type 2 diabetes was identified in national health registers. Using Cox regression we calculated hazard ratios (HR) and 95% confidence intervals (95% CI) for estimating the association between effort-reward imbalance at baseline and risk of onset of type 2 diabetes during follow-up, adjusted for sex, age, socioeconomic status, cohabitation, children at home, migration background, survey year and sample method. RESULTS: During 136,239 person-years of follow-up (mean = 2.7 years) we identified 347 type 2 diabetes cases (25.5 cases per 10,000 person-years). For each one standard deviation increase of the effort-reward imbalance score at baseline, the fully adjusted risk of type 2 diabetes during follow-up increased by 9% (HR: 1.09, 95% CI: 0.98-1.21). When we used effort-reward imbalance as a dichotomous variable, exposure to effort-reward imbalance was associated with an increased risk of type 2 diabetes with a HR of 1.27 (95% CI: 1.02-1.58). CONCLUSION: The results of this nationwide study of the Danish workforce suggest that effort-reward imbalance at work may be a risk factor for type 2 diabetes.

Mechanical and psychosocial work exposures: the construction and evaluation of a gender-specific job exposure matrix (JEM).

Objectives The aim of this study was to (i) construct and evaluate a gender-specific job exposure matrix (JEM) for mechanical and psychosocial work exposures and (ii) test its predictive validity for low-back pain. Methods We utilized data from the Norwegian nationwide Survey of Living Conditions on work environment in 2006 and 2009. We classified occupations on a 4-digit level based on the Norwegian version of the International Standard Classification of Occupations (ISCO-88). The mechanical and psychosocial exposure information was collected by personal telephone interviews and included exposures that were known risk factors for low-back pain. We evaluated the agreement between the individual- and JEM-based exposure estimates, with kappa, sensitivity and specificity measures. We assessed the JEM`s predictive validity by testing the associations between low-back pain and the individual- and JEM-based exposure. Results The results showed an overall fair-to-moderate agreement between the constructed JEM and individual work exposures. The JEM performed considerably better for mechanical work exposures compared with psychosocial work exposures. The predictive validity of the mechanical and psychosocial JEM showed a consistently lower but predominantly reproducible association with low-back pain for both genders. Conclusions The mechanical estimates and psychosocial stressors, such as psychological demands, monotonous work and decision latitude in the constructed JEM, may be useful in large epidemiological register studies. The predictive validity of the matrix was evaluated as being overall acceptable, it can thus be an effective and versatile approach to estimate the relationship between work exposures and low-back pain.

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

Dust at work is associated with risk of respiratory symptoms, the population attributable fraction is 19, and smoking is an effect modifier http://ow.ly/w0RF30jUL2Z.

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

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

Psychosocial factors at work and sleep problems: a longitudinal study of the general working population in Norway.

PURPOSE: A growing number of longitudinal studies report associations between adverse psychosocial factors at work and sleep problems. However, the evidence regarding the direction of these associations and the effects of changes in exposure across time is limited. This study examined the plausibility of normal, reverse, and reciprocal associations between ten psychosocial factors at work and sleep problems. In addition, we analyzed if reduced exposure across time had the anticipated result of reducing the risk of sleep problems. METHODS: Randomly drawn from the general working-age population, the cohort comprised respondents with an active employee relationship in 2009 and 2013 (N = 5760). Exposures and outcome were measured on two occasions separated by 4 years. We computed several sex-stratified logistic regression models with adjustments for various plausible confounders. RESULTS: We found support for the commonly hypothesized unidirectional forward associations between psychosocial factors at work and sleep problems among women only. Among men, psychosocial stressors at work and sleep problems were reciprocally and reversely related. Nevertheless, reduced exposure levels across time pertaining to effort-reward imbalance (OR = 0.36; 95% CI = 0.19-0.69) and lack of social support (OR = 0.55; 95% CI = 0.32-0.93) among men, and work-family imbalance (OR = 0.26; 95% CI = 0.15-0.46) among women were associated with a robust significant lower risk of sleep problems compared to those in the stable high exposure groups. CONCLUSIONS: The study results suggest that preventive measures targeting effort-reward imbalance and lack of social support among men, and work-family imbalance among women, might contribute to reduce the risk of troubled sleep among employees.

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

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

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

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

Do work-related factors contribute to differences in doctor-certified sick leave? A prospective study comparing women in health and social occupations with women in the general working population.

BACKGROUND: Doctor -certified sick leave is prevalent in the health and social sector. We examined whether the higher risk of doctor-certified sick leave in women in health and social occupations compared to women in other occupations was explained by particular work-related psychosocial and mechanical risk factors. METHODS: A randomly drawn cohort aged 18-69 years from the general population in Norway was surveyed in 2009 (n = 12,255, response at baseline = 60.9 %), and was followed up in the national registry of social transfer payments in 2010. Eligible respondents were women registered with an active employee relationship for ≥100 actual working days in 2009 and 2010 (n = 3032). Using this sample, we compared health and social workers (n = 661) with the general working population (n = 2371). The outcome of interest was long-term sick leave (LTSL) ≥21 working days during 2010. Eight psychosocial and eight mechanical factors were evaluated. RESULTS: After adjusting for age, previous LTSL, education and working hours/week, women in health and social occupations had a higher risk for LTSL compared with women in the general working population (OR = 1.42, 95 % CI = 1.13-1.79; p = 0.003). After adjusting for psychosocial and mechanical factors, 70 % of the excess risk for LTSL was explained compared with the initial model. The main contributory factors to the increased risk were threats of violence and violence, emotional demands and awkward lifting. CONCLUSIONS: Psychosocial and mechanical factors explained much of the excess risk for LTSL in women in health and social occupations compared with working women in general. Psychosocial risk factors were the most important contributors.

Psychosocial factors at work and occupational injuries: A prospective study of the general working population in Norway.

BACKGROUND: We examined the effects of psychosocial stressors at work on subsequent injuries, taking into account organizational and mechanical working conditions. METHODS: Randomly drawn from the general population, the cohort comprised respondents with an active employee relationship in 2006 and 2009 (n = 6,745). OUTCOME MEASURE: "Have you, over the past 12 months, afflicted injuries that were caused by an accident at work, and resulting in time off work after the day of the accident?". RESULTS: High job strain (Odds ratio [OR] 2.31; 95% confidence interval [CI] 1.16-4.57), high role conflict (OR 3.01; 95% CI 1.70-5.31), and high emotional demands (OR 1.96; 95% CI 1.15-3.35) predicted injury at follow up (P < 0.01). The population risk attributable to each of these factors ranged from 11% to 14%. CONCLUSIONS: Excess risk of occupational injuries was attributable to job strain, role conflict, and emotional demands. These factors are potentially amenable to preventive measures.