The effect of improving psychosocial stressors on psychological distress: a quasi-experiment of Finnish health and social care workers.

AIMS: To examine how a positive change in one to three psychosocial stressors (job demands, job rewards, and workplace social capital) influenced psychological distress. METHODS: The analysis included 3605 Finnish health and social services workers who completed surveys in 2019, 2020 and 2021. A logistic regression model was used to estimate the propensity score of experiencing a positive change in one to three psychosocial stressors between 2019 and 2020. We balanced the baseline characteristics with propensity scoring. A generalised linear model with a binomial distribution and a log link function was used to compare the quasi-intervention and quasi-control groups for the risk of psychological distress in 2021. RESULTS: Among the total sample, neither improving a single stressor nor two or three stressors affected psychological distress. However, among employees younger than 50 years, improving two or three psychosocial stressors in 2019-2020 decreased the risk of moderate to severe psychological distress in 2021 by 41% (risk ratio 0.59, 95% confidence interval 0.36-0.96). Among employees aged 50 years or older, improving job rewards lowered the risk of mild to severe psychological distress by 23% (risk ratio 0.77, 95% confidence interval 0.62-0.96). CONCLUSIONS: The results of this quasi-experiment suggest that the positive effect of improving psychosocial stressors is stronger among younger than older workers. Future interventions should be customised for different ages and aim to improve accumulated work stressors and individual stress-coping skills.

How does lowering psychosocial risks influence sickness absence? A prospective cohort study analyzed as a quasi-experiment.

BACKGROUND: We examined how reducing work-related psychosocial stressors affected long-term sickness absence of younger and older employees. METHODS: We used data from 43 843 public sector employees in Finland who participated in surveys in 2018 and 2020. We assessed psychosocial factors, such as job demands, job control, work effort, job rewards and worktime control. We obtained sickness absence data from registers for spells longer than 10 consecutive working days. We applied age-specific propensity score weighting and generalized linear models to estimate the effects of changes in psychosocial factors between 2018 and 2020 on sickness absence in 2020. RESULTS: Among employees under 50 years, increasing job rewards by 1 SD reduced the risk of sickness absence by 17% [risk ratio (RR) 0.83, 95% CI 0.72-0.96]. Among employees aged 50 years or older, decreasing job demands by 1 SD reduced the risk of sickness absence by 13% (RR 0.87, 95% CI 0.78-0.98), and increasing job control by 1 SD reduced the risk by 12% (RR 0.88, 95% CI 0.76-1.01). Changes in efforts and worktime control had no significant associations with sickness absence. CONCLUSIONS: Reducing psychosocial stressors can lower the occurrence of long-term sickness absence, but the associations differ by age group. Younger workers benefit more from enhancing job rewards, while older workers benefit more from lowering job demands and increasing job control. To establish the causal impact of psychosocial risk reduction on sickness absence across age groups, future research should employ randomized controlled trials as the methodological approach.

Sickness absence and disability pension after carpal tunnel syndrome diagnosis: A register-based study of patients and matched references in Sweden.

Aims: The aim of this study was to examine sickness absence and disability pension (SA/DP) during working lifespan among individuals diagnosed with carpal tunnel syndrome (CTS) and their matched references, accounting for sociodemographic factors. Methods: We used a register cohort of 78,040 individuals aged 19-60 years when diagnosed with CTS in secondary health care (hospitals and outpatient specialist health care) and their 390,199 matched references from the general population in 2001-2010. Sociodemographic factors and SA/DP net days during a three-year follow-up were included. Negative binomial regression was used. Results: For those not on DP at inclusion, the average number of SA/DP days per person-year was 58 days (95% confidence interval (CI) 56-60 days) among individuals with CTS and 20 days (95% CI 19-21 days) among the matched references. Among both groups, these numbers increased with age and were higher among women than among men. The rate ratio (RR) of SA/DP days was threefold higher among people with CTS than among the matched references (adjusted RR=3.00, 95% CI 2.91-3.10) Moreover, compared to the matched references, the RR for SA/DP was higher among men with CTS (RR=3.86, 95% CI 3.61-4.13) than among women with CTS (RR=2.69, 95% CI 2.59-2.78). The association between CTS and the number of SA/DP days was smaller among older age groups. Sociodemographic factors were similarly associated with SA/DP among people with and without CTS. Conclusions: Numbers of SA/DP days were higher among people with CTS than their matched references in all age groups, particularly among individuals in their early work careers, highlighting public-health relevance of the findings.

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. METHODS: For the data sources, a structured search of the peer-reviewed literature (English language; 1960-April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. RESULTS: Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. CONCLUSION: The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.

Indicators and determinants of the years of working life lost: a narrative review.

OBJECTIVE: This narrative review summarizes the available indicators for working life expectancy and years of working life lost (YWLL) and their determinants. METHODS: We searched PubMed and Embase databases from their inception until August 2020 and screened all studies proposing an indicator for working life expectancy or YWLL. We also reviewed studies focusing on sociodemographic, lifestyle and work-related determinants of working life expectancy and YWLL. The results were synthesized narratively. RESULTS: We identified 13 different indicators for the length of working life or YWLL. The most frequently used indicators were 'working life expectancy', 'healthy working life expectancy', and YWLL. Working life expectancy and healthy working life expectancy are longer for men than women. Working life expectancy at the age of 50 has been increasing since the mid-90s, and the increase has been larger for women, reducing the sex difference. Working life is shorter for people with a low level of education, in lower occupational classes, for people exposed to high physical work demands, those living in the most socioeconomically deprived areas, people with overweight or obesity, smokers, people who are inactive during leisure time and in people with a chronic health problem. CONCLUSIONS: Despite increasing interest in understanding the determinants of YWLL, only a few studies have simultaneously considered multiple exit routes from the labour market. We propose a new measure for total YWLL considering all relevant exit routes from employment. This comprehensive measure can be used to assess the effect of given policy changes on prolonging working life.

Predictors of working days lost due to sickness absence and disability pension.

OBJECTIVE: To identify social and health-related predictors of the number of days lost due to sickness absence (SA) and disability pension (DP) among initially 55-year-old public-sector workers. METHODS: The data from the Finnish Helsinki Health Study included participants aged 55 years at the baseline (in 2000-2002, N = 1630, 81% women), and were enriched with register-based information on SA and DP. The cumulative number of calendar days lost due to SA ≥ 1 day or DP between ages 55 and 65 was calculated. Negative binomial regression model was used to identify the predictors of days lost. RESULTS: The average calendar days lost was 316 days (about 220 working days) during a 10-year follow-up, and 44% were due to SA and 56% due to DP. Smoking [incidence rate ratio (IRR) = 1.19, 95% CI 1.01-1.40 for past and IRR = 1.30, CI 1.07-1.58 for current], binge drinking (IRR = 1.22, CI 1.02-1.46), lifting or pulling/pushing heavy loads (IRR = 1.35, CI 1.10-1.65), awkward working positions (IRR = 1.24, CI 1.01-1.53), long-standing illness limiting work or daily activities (IRR = 2.32, CI 1.93-2.79), common mental disorder (IRR = 1.52, CI 1.30-1.79), and multisite pain (IRR = 1.50, CI 1.23-1.84) increased the number of days lost, while high level of education (IRR = 0.66, CI 0.52-0.82) and moderate level of leisure-time physical activity (IRR = 0.80, CI 0.67-0.94) reduced the number of days lost. CONCLUSIONS: Modifiable lifestyle risk factors, workload factors, common mental disorder, and multisite pain substantially increase the number of days lost. However, the findings of this study could be generalized to female workers in the public sector. Future research should also consider shorter SA spells in estimating working years lost and working life expectancy.

Body mass index and the risk of disability retirement: a systematic review and meta-analysis.

The aim of this study was to determine the associations of body mass index (BMI) with all-cause and cause-specific disability retirement. Literature searches were conducted in PubMed, Embase and Web of Science from their inception to May 2019. A total of 27 (25 prospective cohort and 2 nested case-control) studies consisting of 2 199 632 individuals qualified for a meta-analysis. Two reviewers independently assessed the methodological quality of the included studies. We used a random effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. There were a large number of participants and the majority of studies were rated at low or moderate risk of bias. There was a J-shaped relationship between BMI and disability retirement. Underweight (hazard ratio (HR)/risk ratio (RR)=1.20, 95% CI 1.02 to 1.41), overweight (HR/RR=1.13, 95% CI 1.07 to 1.19) and obese individuals (HR/RR=1.52, 95% CI 1.36 to 1.71) were more commonly granted all-cause disability retirement than normal-weight individuals. Moreover, overweight increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.26, 95% CI 1.15 to 1.39) and cardiovascular diseases (HR=1.73, 95% CI 1.24 to 2.41), and obesity increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.66, 95% CI 1.42 to 1.94), mental disorders (HR=1.29, 95% CI 1.04 to 1.61) and cardiovascular diseases (HR=2.80, 95% CI 1.85 to 4.24). The association between excess body mass and all-cause disability retirement did not differ between men and women and was independent of selection bias, performance bias, confounding and adjustment for publication bias. Obesity markedly increases the risk of disability retirement due to musculoskeletal disorders, cardiovascular diseases and mental disorders. Since the prevalence of obesity is increasing globally, disease burden associated with excess body mass and disability retirement consequently are projected to increase. Reviewregistrationnumber: CRD42018103110.

Work participation and physicality of work in young adulthood and the development of unhealthy lifestyle habits and obesity later in life: a prospective cohort study.

OBJECTIVE: To determine the effects of early entry into the labour market and physicality of work in young adulthood on the development of obesity and unhealthy lifestyle habits later in life. METHODS: This study is a part of the Young Finns Study. Entry into the labour market and physicality of work were measured at baseline, when participants were aged 18, 21, or 24 years in 1986 or 18 years in 1989. Follow-up of lifestyle habits were conducted in 2001, 2007 and 2011. The outcomes were obesity (n=5558 observations), abdominal obesity (n=4060 observations), daily smoking (n=5628) and leisure time physical activity (n=5946) and analysed with generalised estimating equation. RESULTS: Compared with sedentary work, physicality of work in young adulthood increased the odds of future obesity (adjusted OR=1.32, 95% CI 1.01 to 1.74 for light/moderate work and OR=1.44, 95% CI 0.99 to 2.08 for heavy manual work (particularly in women OR=2.03, 95% CI 1.07 to 3.84)) and future smoking (OR=1.79, 95% CI 1.39 to 2.30 for light/moderate work and OR=2.01, 95% CI 1.47 to 2.76 for heavy manual work (particularly in women OR=2.81, 95% CI 1.60 to 4.91)). For those who entered the labour market at ages 18-21 or younger, the odds of smoking was 1.85 times (95% CI 1.26 to 2.73) and that of obesity 1.45 times (95% CI 1.01 to 2.10) higher, and the rate of leisure time physical activity was 0.73 times (95% CI 0.58 to 0.93) lower compared with those who entered the labour market at ages 22-24 years. CONCLUSION: Early entry into the labour market and physicality of work in young adulthood shape the development of obesity and unhealthy behaviours in later adulthood.

Excess Body Mass and Leisure Time Physical Activity in the Incidence and Persistence of Chronic Pain.

OBJECTIVE: To estimate the effects of excess body mass and leisure time physical activity on the incidence and persistence of chronic pain. DESIGN: A prospective cohort study. METHODS: As a part of the Finnish Helsinki Health Study, we included three cohorts of employees of the City of Helsinki (18,562 observations) and defined incident chronic pain as having pain in any part of the body for more than three months at follow-up in participants without chronic pain at baseline (N = 13,029 observations). Persistent chronic pain was defined as having pain for more than three months at both baseline and follow-up (N = 5,533 observations). RESULTS: Overweight (adjusted odds ratio [OR] = 1.18, 95% confidence interval [CI] = 1.06-1.31) and obesity (OR = 1.65, 95% CI = 1.45-1.88) increased the incidence of chronic pain. Moreover, overweight (OR = 1.16, 95% CI = 1.02-1.32) and obesity (OR = 1.48, 95% CI = 1.26-1.74) increased the risk of persistent chronic pain. Vigorous leisure time physical activity reduced the incidence of chronic pain (OR = 0.85, 95% CI = 0.75-0.96). Physical activity did not influence the risk of persistent chronic pain. Furthermore, overweight/obesity modified the effect of leisure time physical activity on incident chronic pain. Inactive overweight or obese participants were at the highest risk of chronic pain (OR = 1.71, 95% CI = 1.40-2.09), while the OR dropped to 1.44 (95% CI = 1.19-1.75) in moderately active overweight or obese participants and to 1.20 (95% CI = 0.97-1.47) in highly active overweight or obese participants. CONCLUSIONS: Obesity not only increases the risk of developing chronic pain, but also increases the risk of persistent pain, while leisure time physical activity reduces the risk of developing chronic pain.

Favourable changes in physical working conditions and the risk of all-cause sickness absence: a pseudo-experiment.

BACKGROUND: We determined whether favourable changes in physical workload and environmental factors reduce sickness absence (SA) days using observational cohort data as a pseudo-experiment. METHODS: The data from the Finnish Helsinki Health Study included three cohorts of employees of the City of Helsinki [2000/2002-07 (N = 2927), 2007-12 (N = 1686) and 2012-17 (N = 1118), altogether 5731 observations]. First, we estimated the propensity score of favourable changes (reduction in exposures) in physical workload and environmental factors during each 5-year follow-up period on the baseline survey characteristics using logistic regression. Second, we created and stabilized inverse probability of treatment weights for each participant using the propensity scores. Lastly, we used generalized linear model and fitted negative binomial regression models for over-dispersed count data to estimate whether the favourable changes decrease the risk of short-term (1-3 days), intermediate-term (4-14 days) and long-term (>14 days) SA using employer's register data. RESULTS: During a 5-year follow-up, 11% of the participants had favourable changes in physical workload factors, 13% in environmental factors and 8% in both factors. The incidence of short-term, intermediate-term and long-term SA were lower in employees with favourable workplace changes compared with those without such changes. The reductions were largest for long-term SA. Reporting favourable changes in both workload and environmental factors reduced the number of SA days by 41% within 1 year after the changes and by 32% within 2 years after the changes. CONCLUSION: This pseudo-experimental study suggests that improving physical working conditions reduces SA.

Breastfeeding rates in immigrant and non-immigrant women: A systematic review and meta-analysis.

Breastfeeding benefits mothers and infants. Although immigration in many regions has increased in the last three decades, it is unknown whether immigrant women have better breastfeeding outcomes than non-immigrants. The aim of this study was to conduct a systematic review and meta-analysis to determine whether breastfeeding rates differ between immigrant and non-immigrant women. We searched Medline, Embase, PsycINFO, CINAHL and Google Scholar, 1950 to 2016. We included peer-reviewed cross-sectional and cohort studies of women aged ≥16 years that assessed and compared breastfeeding rates in immigrant and non-immigrant women. Two independent reviewers extracted data using predefined standard procedures. The analysis included 29 studies representing 1,539,659 women from 14 countries. Immigrant women were more likely than non-immigrants to initiate any (exclusive or partial) breastfeeding (pooled adjusted prevalence ratio 1.13, 95% confidence interval [CI] 1.07-1.19; 11 studies). Exclusive breastfeeding initiation was higher but borderline significant (adjusted prevalence ratio 1.20, 95% CI 1.00-1.45; 5 studies, p = 0.056). Immigrant women were more likely than non-immigrants to continue any breastfeeding between 12- and 24-week postpartum (pooled adjusted risk ratio 2.04, 95% CI 1.79-2.32; 3 studies) and > 24 weeks (adjusted risk ratio 1.33, 95% CI 1.02-1.73; 6 studies) but not exclusive breastfeeding. Immigrant women are more likely than non-immigrants to initiate and maintain any breastfeeding, but exclusive breastfeeding remains a challenge for both immigrants and non-immigrants. Social and cultural factors need to be considered to understand the extent to which immigrant status is an independent predictor of positive breastfeeding practices.

Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials.

The aim of this systematic review and meta-analysis was to assess the effect of exercise in population-based interventions to prevent low back pain (LBP) and associated disability. Comprehensive literature searches were conducted in multiple databases, including PubMed, Embase, and the Cochrane Library, from their inception through June 2017. Thirteen randomized controlled trials (RCTs) and 3 nonrandomized controlled trials (NRCTs) qualified for the meta-analysis. Exercise alone reduced the risk of LBP by 33% (risk ratio = 0.67, 95% confidence interval: 0.53, 0.85; I2 = 23%, 8 RCTs, n = 1,634), and exercise combined with education reduced it by 27% (risk ratio = 0.73, 95% confidence interval: 0.59, 0.91; I2 = 6%, 6 trials, n = 1,381). The severity of LBP and disability from LBP were also lower in exercise groups than in control groups. Moreover, results were not changed by excluding the NRCTs or adjusting for publication bias. Few trials assessed health-care consultation or sick leave for LBP, and meta-analyses did not show statistically significant protective effects of exercise on those outcomes. Exercise reduces the risk of LBP and associated disability, and a combination of strengthening with either stretching or aerobic exercises performed 2-3 times per week can reasonably be recommended for prevention of LBP in the general population.

Carpal tunnel release: Lifetime prevalence, annual incidence, and risk factors.

INTRODUCTION: We estimated the lifetime prevalence and incidence of carpal tunnel release (CTR) and identified risk factors for CTR. METHODS: The study population consisted of individuals aged ≥30 years living in Finland during 2000-2001 (N = 6,256) and was linked to the Finnish Hospital Discharge Register from 2000 to 2011. RESULTS: Lifetime prevalence of CTR was 3.1%, and incidence rate was 1.73 per 1,000 person-years. Female sex (adjusted hazard ratio [HR] = 1.8, 95% confidence interval [CI] 1.2-2.8), age of 40-49 years (HR = 2.5, CI 1.7-3.8 compared with other age groups), education (HR = 0.6, CI 0.4-0.9 for high level vs. low/medium level), obesity (HR = 1.7, CI 1.2-2.5 for body mass index ≥30 vs. < 30 kg/m2 ), and hand osteoarthritis (HR = 2.4, CI 1.4-3.9) were associated with incidence of CTR. DISCUSSION: CTR is a common surgical procedure, performed on 1.9% of men and 4.1% of women during their lifetimes. Obesity and hand osteoarthritis are associated with an increased risk of CTR. Muscle Nerve 58: 497-502, 2018.

Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis.

BackgroundMaternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.AimsTo establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.MethodWe searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.ResultsWe reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6-22.8) in the first trimester, 19.1% (95% CI 15.9-22.4) in the second trimester and 24.6% (95% CI 21.2-28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0-21.4) and 4.1% (95% CI 1.9-6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1-24 weeks was 15.0% (95% CI 13.7-16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1-13.8), and 5.7% (95% CI 2.3-9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.ConclusionsResults suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.

Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies.

BACKGROUND: There are plausible mechanisms whereby leisure time physical activity may protect against low back pain (LBP) but there have been no quality systematic reviews and meta-analyses of the subject. OBJECTIVE: This review aims to assess the effect of leisure time physical activity on non-specific LBP. METHODS: Literature searches were conducted in PubMed, Embase, Web of Science, Scopus and Google Scholar databases from their inception through July 2016. Methodological quality of included studies was evaluated. A random-effects meta-analysis was performed, and heterogeneity and publication bias were assessed. RESULTS: Thirty-six prospective cohort studies (n=158 475 participants) qualified for meta-analyses. Participation in sport or other leisure physical activity reduced the risk of frequent or chronic LBP, but not LBP for > 1 day in the past month or past 6-12 months. Risk of frequent/chronic LBP was 11% lower (adjusted risk ratio (RR)=0.89, CI 0.82 to 0.97, I2=31%, n=48 520) in moderately/highly active individuals, 14% lower (RR=0.86, CI 0.79 to 0.94, I2=0%, n=33 032) in moderately active individuals and 16% lower (RR=0.84, CI 0.75 to 0.93, I2=0%, n=33 032) in highly active individuals in comparison with individuals without regular physical activity. For LBP in the past 1-12 months, adjusted RR was 0.98 (CI 0.93 to 1.03, I2=50%, n=32 654) for moderate/high level of activity, 0.94 (CI 0.84 to 1.05, I2=3%, n=8549) for moderate level of activity and 1.06 (CI 0.89 to 1.25, I2=53%, n=8554) for high level of activity. CONCLUSIONS: Leisure time physical activity may reduce the risk of chronic LBP by 11%-16%. The finding, however, should be interpreted cautiously due to limitations of the original studies. If this effect size is proven in future research, the public health implications would be substantial.

A square-shaped wrist as a predictor of carpal tunnel syndrome: A meta-analysis.

INTRODUCTION: This meta-analysis aims to assess an association between wrist ratio (wrist thickness/wrist width) and carpal tunnel syndrome (CTS). METHODS: Sixteen studies qualified for a random-effects meta-analysis. RESULTS: Mean wrist ratio was higher in individuals with CTS compared with those without CTS [pooled mean difference 0.036, 95% confidence interval (CI) 0.025-0.046]. Pooled odds ratio (OR) of CTS for mean wrist ratio was 4.56 (95% CI 2.97-6.99), and for wrist ratio ≥0.70 vs. <0.70 it was 2.73 (95% CI 1.49-5.01). In addition, the pooled OR for a 1-unit (0.01) increase in wrist ratio was 1.12 (CI 1.09-1.16). The association between wrist ratio and CTS did not differ between men and women. Moreover, there was no evidence of publication bias. CONCLUSIONS: This meta-analysis suggests that a square-shaped wrist is a predictor for CTS in both men and women. Future studies should explore whether a square-shaped wrist can potentiate the adverse effects of obesity and occupational workloads on CTS.

Cervical and lumbar pain and radiological degeneration among fighter pilots: a systematic review and meta-analysis.

To assess the associations of acceleration force indicators (aircraft type and flight hours) with cervical and lumbar pain and radiological degeneration among fighter pilots. The PubMed, Embase, Scopus and Web of Science databases were searched until October 2013. Twenty-seven studies were included in the review and 20 in the meta-analysis. There were no differences in the prevalence of neck pain (pooled OR=1.07, 95% CI 0.87 to 1.33), cervical disc degeneration (OR=1.26, CI 0.81 to 1.96), low back pain (OR=0.80, CI 0.47 to 1.38) or lumbar disc degeneration (OR=0.87, CI 0.67 to 1.13) between fighter pilots and helicopter or transport/cargo pilots. Moreover, the prevalence of cervical (OR=1.14, CI 0.61 to 2.16) or lumbar (OR=1.05, CI 0.49 to 2.26) disc degeneration did not differ between fighter pilots and non-flying personnel. Most studies did not control their estimates for age and other potential confounders. Among high-performance aircraft pilots, exposure to the highest G-forces was associated with a higher prevalence of neck pain compared with exposure to lower G-forces (pooled OR=3.12, CI 2.08 to 4.67). The studies on the association between flight hours and neck pain reported inconsistent findings. Moreover, looking back over the shoulder (check six) was the most common posture associated with neck pain. Fighter pilots exposed to high G-forces may be at a greater risk for neck pain than those exposed to low G-forces. This finding should be confirmed with better control for confounding. Awkward neck posture may be an important factor in neck pain among fighter pilots.

Obesity as a risk factor for sciatica: a meta-analysis.

The aim of this study was to assess the associations of overweight and obesity with lumbar radicular pain and sciatica using a meta-analysis. We searched the PubMed, Embase, Scopus, and Web of Science databases from 1966 to July 2013. We performed a random-effects meta-analysis and assessed publication bias. We included 26 (8 cross-sectional, 7 case-control, and 11 cohort) studies. Both overweight (pooled odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.14, 1.33; n = 19,165) and obesity (OR = 1.40, 95% CI: 1.27, 1.55; n = 19,165) were associated with lumbar radicular pain. The pooled odds ratio for physician-diagnosed sciatica was 1.12 (95% CI: 1.04, 1.20; n = 109,724) for overweight and 1.31 (95% CI: 1.07, 1.62; n = 115,661) for obesity. Overweight (OR = 1.16, 95% CI: 1.09, 1.24; n = 358,328) and obesity (OR = 1.38, 95% CI: 1.23, 1.54; n = 358,328) were associated with increased risk of hospitalization for sciatica, and overweight/obesity was associated with increased risk of surgery for lumbar disc herniation (OR = 1.89, 95% CI: 1.25, 2.86; n = 73,982). Associations were similar for men and women and were independent of the design and quality of included studies. There was no evidence of publication bias. Our findings consistently showed that both overweight and obesity are risk factors for lumbar radicular pain and sciatica in men and women, with a dose-response relationship.