Reliability and criterion validity of an observation protocol for working technique assessments in cash register work.

We evaluated the intra- and inter-observer reliability and criterion validity of an observation protocol, developed in an iterative process involving practicing ergonomists, for assessment of working technique during cash register work for the purpose of preventing upper extremity symptoms. Two ergonomists independently assessed 17 15-min videos of cash register work on two occasions each, as a basis for examining reliability. Criterion validity was assessed by comparing these assessments with meticulous video-based analyses by researchers. Intra-observer reliability was acceptable (i.e. proportional agreement >0.7 and kappa >0.4) for 10/10 questions. Inter-observer reliability was acceptable for only 3/10 questions. An acceptable inter-observer reliability combined with an acceptable criterion validity was obtained only for one working technique aspect, 'Quality of movements'. Thus, major elements of the cashiers' working technique could not be assessed with an acceptable accuracy from short periods of observations by one observer, such as often desired by practitioners. Practitioner Summary: We examined an observation protocol for assessing working technique in cash register work. It was feasible in use, but inter-observer reliability and criterion validity were generally not acceptable when working technique aspects were assessed from short periods of work. We recommend the protocol to be used for educational purposes only.

How common is change of primary diagnosis during an episode of sickness benefit? A register study of medical sickness certificates issued 2010-2012 in Sweden.

AIM: The aims of this study were to investigate how common it is to change primary diagnosis between different diagnostic chapters during a sick-leave spell, and to explore patterns of diagnostic changes. METHODS: The unit for analysis was episode of sickness benefit, that is, sick leave >14 days, which commenced between 2010 and 2012 in Sweden. For each case, the primary diagnosis was retrieved from the first and last/latest medical sickness certificate, respectively. The number of days of sickness benefit was linked to the cases. Any change of primary diagnosis was analysed by diagnostic chapter according to the ICD-10, and this was done separately for women and men. RESULTS: In total, 803,041 cases of sickness benefit (63% women) were included in the study. During a sick-leave spell, 7.1% of female cases and 6.6% of male cases changed their primary diagnosis to a diagnosis from another diagnostic chapter. The change of primary diagnosis increased with the number of days with sickness benefit. For female cases, this increase was from 2.0% for cases that lasted 15-30 days to 20.2% for cases that lasted >365 days. For male cases, the corresponding increase was from 1.8% to 21.2%. A change of primary diagnosis was least common among those initially sick-listed for mental disorders and musculoskeletal disorders. The patterns of diagnostic changes were rather similar for women and men. CONCLUSIONS: A change of diagnosis during a sick-leave spell needs to be taken into consideration by the sickness insurance system and in the actions taken by its administration. Registry-based studies of sickness insurance need to consider diagnostic changes in both the study design and the interpretation of results.

Sick-listing adherence: a register study of 1.4 million episodes of sickness benefit 2010-2013 in Sweden.

BACKGROUND: This register study aims to increase the knowledge on how common it is that sickness benefit recipients are sick-listed for as long as their physician prescribes in their medical sickness certificate, i.e. sick-listing adherence, or wholly/partly bring return-to-work (RTW) forward, i.e. early RTW. METHODS: The unit for analysis was an episode of 100% sickness benefit, commenced between 1 January 2010 and 31 December 2013. Completed episodes of sickness benefit and full or partial early RTW was analysed by comparing the prescribed length of sick leave in medical sickness certificates and benefit days disbursed by the sickness insurance system. Probability for a full and partial early RTW was estimated with hazard ratio (HR) using the Cox proportional hazard model. RESULTS: In total, about 1.4 million episodes of sickness benefit (60% women) were included in the study. The overall sick-listing adherence was 84% for women and 82% for men during the first year of sick leave. Adherence varied between 82 and 87% among women and between 79 and 86% among men with regard to ICD-10 diagnosis chapter. The probability of an early RTW varied between diagnosis chapters, where mental disorders was associated with a lower probability of a full early RTW among women and men (HR 0.52 and HR 0.47) as well as a partial early RTW (HR 0.51 and HR 0.46). Younger age (16-29 years), high educational level and high income was associated with a higher probability of an early RTW, while older age (≥ 50 years), not native-born, low educational level, unemployment and parental leave were associated with a lower probability. CONCLUSION: The study demonstrates that sick-listing adherence is relatively high. Probability of an early RTW differs with regard to diagnosis chapter, demographic, socioeconomic and labour market characteristics of the sickness benefit recipients. Interventions intended to improve the sick-listing process, and to affect the length and degree of sick leave in certain target groups, should include measures targeted at physicians' sick-listing practices. Policies and economic incentives aimed at promoting RTW need to focus on individuals' residual capacity for work.

Musculoskeletal disorders and working conditions among Iranian nursing personnel.

This study investigated the prevalence of musculoskeletal disorders (MSDs) and associations with organizational, physical and psychosocial working conditions among 520 nursing personnel in Tehran, Iran. The results of the cross-sectional study on aids and different educational levels of nurses showed that the participants experienced 88% of MSDs in at least one body region during the past 12 months. The 3 most prevalent body regions were the low back (65.3%), knee (56.2%) and neck (49.8%). The participants reported inflexible work schedule, poor quality of devices for transferring patients, overexertion and job dissatisfaction. Physical and psychosocial exposure revealed an elevated odds ratio (95% confidence interval) of MSDs. The results showed a combination of high physical and psychosocial work demands along with low control over the work which increased work-related stress and enhanced the risk of MSDs. This study findings could help to understand work-related MSDs among nursing personnel in a developing country where the work situation and sociocultural context differ from other countries.

Swedish entrepreneurs' use of occupational health services.

Small-scale enterprises are less often covered by occupational health services and have insufficient awareness about health and risks in the work environment. This study investigated how Swedish entrepreneurs in small-scale enterprises use occupational health services. The study used a questionnaire sent in two waves, 5 years apart. At baseline, 496 entrepreneurs responded, and 251 participated 5 years later. The questionnaire included items about affiliation with and use of occupational health services, physical and psychosocial work environments, work environment management, sources of work environment information, and membership in professional networks. Only 3% of entrepreneurs without employees and 19% of entrepreneurs with employees were affiliated with an occupational health service. Entrepreneurs affiliated with occupational health services were more active in work environment management and gathering information about the work environment. The occupational health services most used were health examinations, health care, and ergonomic risk assessments. Affiliation with occupational health services was 6% at both measurements, 4% at baseline, and 10% 5 years later.

Comparisons between five self-administered instruments predicting sick leaves in a 4-year follow-up.

OBJECTIVES: This study aimed to explore and compare the ability of five instruments for self-rating to predict future sick leave rates. METHODS: In three Swedish municipalities 2,252 employees completed a baseline questionnaire and were followed up for 4 years. Five health-oriented instruments for self-rating were used as potential predictors of the two outcome measures no sick leave at all, and one or more spells of long-term sick leave >or=28 days. Positive and negative predictive values as well as Cox proportional hazard ratios (denoted as RRs) adjusted for age and work type were calculated. RESULTS: The instruments showed no statistical difference in predicting future sick leave for either of the sexes. For no sick leave RRs ranged between 1.27 and 1.52 (women), 1.35 and 1.61 (men); for long-term sick leave RRs ranged between 1.78 and 2.39 (women), 2.87 and 5.53 (men). However, the best prediction of long-term sick leave for men, RR 5.53, 95% confidence interval (CI) 3.37-9.08, was significantly higher than the best prediction for women, RR 2.39, 95% CI 1.97-2.90. CONCLUSION: Prediction of long-term sick leave was better than that of no sick leave, and better among men than among women. There was a tendency for somewhat better prediction of future sick leave by multiple-question instruments, but single-question instruments can very well be used in predicting future sick leaves, and crude analyses stratified by sex can be used for screening purposes.

Does sickness presenteeism have an impact on future general health?

PURPOSE: The primary aim of this prospective study was to investigate whether working despite illness, so called "sickness presenteeism", has an impact on the future general health of two different working populations during a follow-up period of 3 years. METHODS: The study was based on two bodies of data collected at a number of Swedish workplaces from 1999 to 2003. The first material comprised 6,901 employees from the public sector and the second 2,862 subjects from the private sector. A comprehensive survey was issued three times: at baseline, after 18 months and after 3 years. Apart from the explanatory variable sickness presenteeism, several potential confounders were considered. The outcome variable was good/excellent versus fair/poor self-reported health. RESULTS: Sickness presenteeism at baseline was consistently found to heighten the risk of fair/poor health at both the 18-month and 3-year follow ups even after adjusting for the detected confounders. CONCLUSIONS: To the best of the authors' knowledge, this study is the first to show that sickness presenteeism appears to be an independent risk factor for future fair/poor general health.

Differences in sickness absence in Sweden and Denmark: the cross national HAKNAK study.

AIM: To investigate potential differences in sickness absence among public sector employees in Sweden and Denmark, and to what extent a difference was associated with age, gender, physical and psychosocial work environment exposures, lifestyle factors, self-rated health or work ability. METHODS: In 2000, two cross-sectional samples of 8562 public sector employees in Sweden and Denmark were surveyed. The study outcome, self-reported number of sick-leave days the year preceding interview, was dichotomized into 7 days or less, and more than 7 days. Chi square test was used to analyse distribution of dependent and independent variables in the two sub-cohorts. Stratified logistic regression analysis was performed to identify causes for absence within the two sub-cohorts, and logistic regression analysis was performed to study differences in sickness absence levels between the two sub-cohorts. RESULTS: More subjects from the Swedish study population reported more than 7 days of sickness absence. Factors associated with sickness absence were largely similar in the two countries. The difference in absence level between Sweden and Denmark was not associated with differences in age, gender, skill level, lifestyle, psychosocial or physical work environment, musculoskeletal symptoms or self-rated health, whereas work ability score decreased the difference in sickness absence level. CONCLUSION: The results could indicate an increased retention of employees with health problems in the Swedish labour market compared with the Danish labour market. A possible explanation for the differences in sickness absence ascertained in this study could be due to differences in the sickness insurance legislation.

Influence of self-reported work conditions and health on full, partial and no return to work after long-term sickness absence.

OBJECTIVES: This study aimed at describing the frequency of full, partial, and no return to work after long-term sick leave and at ascertaining the influence of psychosocial work conditions, work ability and health, reported before the onset of sick leave, on full and partial return to work. METHODS: Altogether 853 public-sector employees in Sweden, mainly women, with at least one sick leave lasting > or = 28 days, were studied. The outcome was the level of sick leave 2 years after the sick leave began. Potential predictors were self-rated health, work ability, and psychosocial work conditions assessed by questionnaire before the sick leave. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by multinomial regression analyses. RESULTS: Altogether 41% of the participants went directly from full sick leave to full return to work; 21% had periods of partial return to work, but, at the 2-year follow-up, were fully back to work; 15% had partial return to work; and 23% were still not working. A relaxed work situation, a combination of low demands and high decision latitude, increased the odds for full (OR 2.72, 95% CI 1.60-4.62) and partial (OR 2.42, 95% CI 1.21-4.85) return to work. Negative consequences of organizational changes were associated with decreased odds for full return to work (OR 0.54, 95% CI 0.38-0.77). Good self-rated health and work ability were associated with full return to work. CONCLUSIONS: Partial return to work often precedes full return to work, but also operates as a long-term solution for remaining occupationally active. Promoting relatively low demands and high decision latitude at work may support both full and partial return to work after long sick leaves.

The same factors influence job turnover and long spells of sick leave--a 3-year follow-up of Swedish nurses.

BACKGROUND: In many countries, a general shortage of nurses is a public health problem, and retention of nurses in active work is a challenge. The aim of this study was to ascertain whether the same individual factors, working conditions and health problems had led to increased probability of both leaving jobs and prolonged sickness absence in a cohort of Swedish nurses over a period of 3 years. METHODS: A baseline questionnaire was answered by 2293 nurses, representing a response rate of 86%. Exposed and unexposed nurses were compared with regard to two outcomes. During the 3-year follow-up, exposed and unexposed nurses were compared with regard to two outcomes: resigning and having at least one sick leave spell that lasted 28 days or longer. RESULTS: We found that 18% of the nurses left their employment, and 16% had sick leave spells > or =28 days. Work in geriatric care, being socially excluded by superiors and/or workmates, negative effects of organizational changes and poor self-rated general health were factors that increased the likelihood of both leaving jobs and long-term sick leave. CONCLUSIONS: The present results underline the importance of improving working conditions and supporting sustainable health in order to prevent high turnover and prolonged sick leave among nurses. Resigning and moving to another institution can be interpreted as a way to actively cope with an unhealthy work environment.

Effect of psychosocial factors on low back pain in industrial workers.

AIM: To test the hypothesis that workplace psychosocial factors such as demand, control, support, job satisfaction and job appreciation can predict the future onset of disabling low back pain (LBP). METHODS: The present study involved a prospective cohort of 4500 Iranian industrial workers. Data were gathered by means of a self-reported questionnaire about LBP, as well as working life exposure, lifestyle factors, social exposures, co-morbidity, life events and psychosomatic complaints in 2004. All new episodes of disabling LBP resulting in medically certified sick leave during the 1-year follow-up registered by occupational health clinic inside the factory. RESULTS: The participation rate was good (85%). A total of 744 subjects reported current LBP (point prevalence cases). A total of 52 (<2%) new episodes of disabling LBP were observed during the 1-year follow-up (incident cases). Male employees reported higher demands, lower control and lower support than female employees. Employees with high demands, low control, job strain, low job satisfaction and low job appreciation showed increased odds ratios, and these results were statistically significant. CONCLUSIONS: Few prospective studies in this field have been published, but all of them are related to industrialized countries. This prospective study suggests the aetiological role of job strain for LBP. The findings of this study indicate a substantial potential for disease prevention and health promotion at the workplace.

Life events and the risk of low back and neck/shoulder pain of the kind people are seeking care for: results from the MUSIC-Norrtalje case-control study.

OBJECTIVE: To expand the knowledge about the occurrence of life events, and how they affect the risk of low back and neck/shoulder pain. DESIGN: A population-based case-control study. SETTING: Men and women 20-59-years old, living in and not working outside the municipality of Norrtälje, Sweden, from November 1993 to November 1997. PARTICIPANTS: Cases (n = 1,148) were defined as all subjects from the study base who sought healthcare for a new episode of low back and/or neck/shoulder pain by any of the care givers in the municipality. Controls (n = 1,700) were selected as a stratified random sample from the study base, considering sex and age. Study subjects were interviewed about life events and critical life changes. Critical life changes were defined as events that brought about a marked psychosocial change. Odds ratios (ORs) associated with different numbers of life events or critical life changes were calculated. RESULTS: Having experienced at least two life events during the preceding 5 years was associated with an increased risk of neck/shoulder pain (OR = 1.6, 95% CI 1.1 to 2.4). At least two critical life changes were associated with an increased risk of neck/shoulder pain (OR = 1.9, 95% CI 1.3 to 2.7). In general, no associations were observed in relation to risk of low back pain. CONCLUSION: Life events and critical life changes are of importance for the risk of neck/shoulder pain of the kind that people are seeking care for. The study provides useful information for clinical practice and for future aetiological research on neck/shoulder pain.

Different working and living conditions and their associations with persistent neck/shoulder and/or low back disorders.

OBJECTIVES: To investigate whether different combinations of working and living conditions are associated with the risk for persistent neck/shoulder and/or low back disorders. The underlying purpose of this contextual approach was to identify target groups for primary/secondary prevention. METHODS: In a baseline study, 11 groups with different working and living conditions were identified by cluster analysis. In this study, these 11 groups were followed up by a postal questionnaire 5 years after baseline (response rate 82%, n = 1095). RESULTS: Five of the groups--the onerous human services job, the free agent, the family burden, the mentally stretched and the physically strained groups--had an increased risk for persistent disorders (OR 2.38-2.70). Four of these groups had rather sex-specific working and living conditions. CONCLUSIONS: The results support the hypothesis that different combinations of working and living conditions may increase the risk for persistent neck/shoulder and/or low back disorders to different degrees. Sex-specific working and living conditions increased the risk for women as well as for men, irrespective of whether the conditions were specific to women or men.

The influence of work-related exposures on the prognosis of neck/shoulder pain.

To determine associations between work-related exposures and the prognosis of self-reported neck/shoulder pain. This prospective cohort study was based on 803 working subjects who reported neck/shoulder pain at baseline. The proportion of subjects who 5-6 years later were symptom-free was calculated. Data concerning work-related biomechanical, psychosocial, and organizational exposures were collected at baseline. The Cox regression analyses were used to calculate the relative chances (RC) of being symptom-free at the end of the study for single exposures, and also for up to three simultaneous work-related exposures. Adjustments were made for sex and age. Only 36% of the subjects were symptom-free 5-6 years later. The relative chance for being symptom-free at the end of the study was 1.32 (95% CI = 0.99-1.74) for subjects who were exposed to sitting > or =75% of the working time and 1.53 (95% CI = 1.02-2.29) for subjects who were exposed to job strain, i.e., the combination of high demands and low decision latitude. The relative chance of being symptom-free at the end of the study was 0.61 (95% CI = 0.40-0.94) for subjects with at least two out of three simultaneous biomechanical exposures at work; manual handling, working with the hands above shoulder level, and working with vibrating tools. In a heterogeneous population with moderate nonspecific neck/shoulder pain, sedentary work enhanced the chance of being symptom-free 5-6 years later, whereas simultaneous exposures to at least two of manual handling, working with hands above shoulder level and working with vibrating tools were associated with a lower chance of being symptom-free at the end of the study. This could imply that subjects with neck/shoulder pain should avoid such simultaneous exposures.

Self rated health and working conditions of small-scale enterprisers in Sweden.

This study was an investigation of prevalence and associations between self-rated health and working conditions for small-scale enterprisers in a county in Sweden. A postal questionnaire was answered by 340 male and 153 female small-scale enterprisers in different sectors, with a response rate of 66%. For comparative purposes, data from a population study of 1,699 employees in private companies was included in the analyses. Differences were tested by Chi(2)-test and associations were presented as odds ratios (OR) with a 95% confidence interval (95% CI). The frequency of health problems in male enterprisers was higher than in employees in the private sector, while the frequency of health problems in female enterprisers was equal to that of the control employees. The main findings highlighted that male enterprisers reported higher rate of health problems and female enterprisers equal rate compared with employees in the private sector. Enterprisers stated musculoskeletal pain (women 59%, men 56%) and mental health problems (women 47%, men 45%) as the most frequent health problems. Poor job satisfaction, reported by 17% of the females and 20% of the male enterprisers, revealed an OR of 10.42 (95% CI 5.78-18.77) for poor general health. For the enterprisers, the most frequent complaints, musculoskeletal pain and mental health problems, were associated with poor job satisfaction and poor physical work environment. An association between poor general health and working as an enterpriser remained after adjusting for working conditions, sex and age.

Zest for work? Assessment of enthusiasm and satisfaction with the present work situation and health--a 1.5-year follow-up study.

The aim of the study was to investigate whether assessing zest for work is a valuable approach in occupational health work. The term "zest for work" comes from the expression "zest for life" and can roughly be interpreted as the degree of enthusiasm and satisfaction with the present work situation. The measurements comprise three components: listing important factors for the feeling of zest for work, attitude rating and stating whether it is possible to have any influence over the listed factors. Included in this study were 5539 employees, mainly women. Low zest for work was associated with job strain and insufficient social support and imposed an increased risk for poor health for working and long spells of sick leave. The results support that assessing zest for work can be useful in occupational health work.

Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study.

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.

Reasons for leaving nursing care and improvements needed for considering a return: a study among Swedish nursing personnel.

Based on two research projects in Sweden during the 1990s, the aim of this study was to identify former nursing personnel's main reasons for leaving nursing care, and to find out under what circumstances they would consider returning. Two open-ended questions in a questionnaire were analysed. The results showed that different aspects of working conditions, mainly working schedule, management and status of profession were the dominating reasons both for leaving and considering a return. The findings indicate that interventions required for retaining personnel in nursing care need to be addressed both at the political and at the local level.

Is an early retirement offer good for your health? Quasi-experimental evidence from the army.

This paper studies empirically the consequences on health of an early retirement offer. To this end we use a targeted retirement offer to military officers 55 years of age or older. Before the offer was implemented, the normal retirement age in the Swedish defense was 60 years of age. Estimating the effect of the offer on individuals' health within the age range 56-70, we find support for a reduction in both mortality and in inpatient care as a consequence of the early retirement offer. Increasing the mandatory retirement age may thus not only have positive government income effects but also negative effects on increasing government health care expenditures.

Prominent attractive qualities of nurses' work in operating room departments: A questionnaire study.

BACKGROUND: The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive. OBJECTIVE: To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context. METHODS: The Attractive Work Questionnaire was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data. RESULTS: Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original Attractive Work Questionnaire, Cronbach's alpha varied between 0.57-0.90. CONCLUSIONS: Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the Attractive Work Questionnaire and the results suggest that the questionnaire can be useful in a health care context.