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1.  Incidence rates of surgically treated rhegmatogenous retinal detachment among manual workers, non-manual workers and housewives in Tuscany, Italy 
Purpose
Candidate risk factors for idiopathic rhegmatogenous retinal detachment (RRD) include heavy manual handling (requiring Valsalva’s maneuver). We assessed incidence rates of surgically treated idiopathic RRD among manual workers, non-manual workers and housewives resident in Tuscany, Italy.
Methods
We retrieved all hospital discharge records bearing a principal diagnosis corresponding to RRD coupled with retinal surgery for any resident of Tuscany during 1997-2009. After elimination of repeated admissions and patients with coexistent, associated conditions (including recent trauma), subjects aged 25–59 years were classified as manual workers, non-manual workers or housewives. Population data were extracted from the 2001 census.
Results
We identified 1,946 eligible cases (1,142 men). Among men, manual workers experienced a 1.8-fold higher age-standardized rate per 100,000 person-years than non-manual workers (17.4 [95% CI, 16.1–18.7] vs. 9.8 [95% CI, 8.8–10.8]). Age-standardized rates among women were 1.9-fold higher for manual workers (11.1 [95% CI, 9.8–12.3]) and 1.7-fold higher for housewives (9.5 [95% CI, 8.3–10.8]) than in non-manual workers (5.7 [95% CI, 4.8–6.6]).
Conclusions
This large population-based study suggests that manual workers are affected by idiopathic RRD requiring surgical treatment more often than non-manual workers. The higher rates of surgically treated RRD experienced by manual workers accord with the hypothesis that heavy manual handling may have a causal role.
doi:10.1007/s00420-013-0894-5
PMCID: PMC3855483  PMID: 23893253
manual work; retinal surgery; patient discharge; incidence study
2.  Exacerbation of symptoms in agricultural pesticide applicators with asthma 
Purpose
Exacerbation is a critical event in asthma management. We investigated whether exacerbation of symptoms is associated with farming exposures among agricultural pesticide applicators with asthma.
Methods
Participants were pesticide applicators with active asthma (wheezing and breathing problems in past 12 months) who completed enrollment questionnaires for the Agricultural Health Study (AHS). Exacerbation of asthma was defined as having visited a hospital emergency room or doctor for an episode of wheezing or whistling in the past 12 months. Exposures of interest were using 36 specific pesticides in the past 12 months and conducting various agricultural activities. Adjusted odds ratios (ORs) were estimated by logistic regression while controlling for potential confounders.
Results
The 926 AHS adult pesticide applicators with active asthma included 202 (22%) with exacerbation. Inverse associations with exacerbation were observed for two herbicides (glyphosate, odds ratio (OR) = 0.5, 95% confidence interval (CI) 0.3–0.8, and paraquat, OR=0.3, 95% CI 0.1–0.9) and several agricultural activities (repairing engines, grinding metal, driving diesel tractors, and performing veterinary procedures). Only asthma cases with allergies (i.e., doctor-diagnosed hay fever or eczema, 46%) had positive exacerbation-pesticide associations, with OR=2.1 (95% CI 1.1–4.1) for the herbicide pendimethalin and OR=10.2 (95% CI 1.9–55) for the insecticide aldicarb.
Conclusions
The inverse associations with two pesticides and specific farm activities are consistent with the possibility that asthma cases prone to exacerbation may avoid exposures that trigger symptoms. Although limited by small sample size and a cross-sectional design, our study suggests that use of specific pesticides may contribute to exacerbation of asthma among individuals with allergies.
doi:10.1007/s00420-013-0881-x
PMCID: PMC4089194  PMID: 23670403
Asthma; Asthma exacerbation; Work-related;  Agriculture; Pesticides
3.  Contractor-, steward-, and coworker-safety practice: associations with musculoskeletal pain and injury-related absence among construction apprentices 
Objectives This paper sought to assess organizational safety practices at three different levels of hierarchical workplace structure and to examine their association with injury outcomes among construction apprentices.
Methods Using a cross-sectional sample of 1,775 construction apprentices, three measures of organizational safety practice were assessed: contractor-, steward-, and coworker-safety practice. Each safety practice measure was assessed using three similar questions (i.e., on-the-job safety commitment, following required or recommended safe work practices, and correcting unsafe work practices); the summed average of the responses ranged from 1 to 4, with a higher score indicating poorer safety practice. Outcome variables included the prevalence of four types of musculoskeletal pain (i.e., neck, shoulder, hand, and back pain) and injury-related absence.
Results In adjusted analyses, contractor-safety practice was associated with both hand pain (OR: 1.27, 95 % CI: 1.04, 1.54) and back pain (OR: 1.40, 95 % CI: 1.17, 1.68); coworker-safety practice was related to back pain (OR: 1.42, 95 % CI: 1.18, 1.71) and injury-related absence (OR: 1.36, 95 % CI: 1.11, 1.67). In an analysis that included all three safety practice measures simultaneously, the association between coworker-safety practice and injury-related absence remained significant (OR: 1.68, 95 % CI: 1.20, 2.37), whereas all other associations became non-significant.
Conclusions This study suggests that organizational safety practice, particularly coworker-safety practice, is associated with injury outcomes among construction apprentices.
doi:10.1007/s00420-013-0889-2
PMCID: PMC3883941  PMID: 23748366
Safety practice; Occupational injury; Musculoskeletal pain; Construction worker; Neck pain; Shoulder pain; Hand pain; Back pain
4.  Clinically assessed consequences of workplace physical violence 
Objectives
To assess consequences of physical violence at work and identify their predictors.
Methods
Among the patients in a medicolegal consultation from 2007 to 2010, the subsample of workplace violence victims (n = 185) was identified and contacted again in average 30 months after the assault. Eighty-six victims (47 %) participated. Ordinal logistic regression analyses assessed the effect of 9 potential risk factors on physical, psychological and work consequences summarized in a severity score (0–9).
Results
Severity score distribution was as follows: 4+: 14 %; 1–3: 42 %; and 0: 44 %. Initial psychological distress resulting from the violence was a strong predictor (p < 0.001) of the severity score both on work and long-term psychological consequences. Gender and age did not reach significant levels in multivariable analyses even though female victims had overall more severe consequences. Unexpectedly, only among workers whose jobs implied high awareness of the risk of violence, first-time violence was associated with long-term psychological and physical consequences (p = 0.004). Among the factors assessed at follow-up, perceived lack of employers’ support or absence of employer was associated with higher values on the severity score. The seven other assessed factors (initial physical injuries; previous experience of violence; preexisting health problems; working alone; internal violence; lack of support from colleagues; and lack of support from family or friends) were not significantly associated with the severity score.
Conclusions
Being a victim of workplace violence can result in long-term consequences on health and employment, their severity increases with the seriousness of initial psychological distress. Support from the employer can help prevent negative outcomes.
doi:10.1007/s00420-014-0950-9
PMCID: PMC4305101  PMID: 24929794
Physical assault; Psychological condition; Organizational support; Longitudinal study; Predictors; Severity score; Consequences of violence
5.  Occupational kneeling and squatting: development and validation of an assessment method combining measurements and diaries 
Objectives
As knee-straining postures such as kneeling and squatting are known to be risk factors for knee disorders, there is a need for effective exposure assessment at the workplace. Therefore, the aim of this study was to develop a method to capture knee-straining postures for entire work shifts by combining measurement techniques with the information obtained from diaries, and thus avoiding measuring entire work shifts. This approach was applied to various occupational tasks to obtain an overview of typical exposure values in current specific occupations.
Methods
The analyses were carried out in the field using an ambulatory measuring system (CUELA) to assess posture combined with one-day self-reported occupational diaries describing the durations of various work tasks. In total, 242 work shifts were measured, representing 81 typical tasks from 16 professions. Knee-straining postures were analysed as daily time intervals for five different postures. The accuracy of the method was examined by comparing the results to measurements of entire work shifts.
Results
Unsupported kneeling was the most widely used knee posture in our sample (median 11.4 % per work shift), followed by supported kneeling (3.0 %), sitting on heels (1.1 %), squatting (0.7 %), and crawling (0.0 %). The daily time spent in knee-straining postures varied considerably, both between the individual occupations, within an occupation (e.g. parquet layers: 0.0–88.9 %), and to some extent even within a single task (e.g. preparation work of floor layers (22.0 ± 23.0 %). The applied measuring method for obtaining daily exposure to the knee has been proven valid and efficient randomly compared with whole-shift measurements (p = 0.27).
Conclusions
The daily degree of postural exposure to the knee showed a huge variation within the analysed job categories and seemed to be dependent on the particular tasks performed. The results of this study may help to develop an exposure matrix with respect to occupational knee-straining postures. The tested combination of task-based measurement and diary information may be a promising option for providing a cost-effective assessment tool.
doi:10.1007/s00420-014-0946-5
PMCID: PMC4305088  PMID: 24859645
Posture capturing; Diary; Exposure; Kneeling and squatting; Knee osteoarthritis
6.  Work–family conflict, emotional exhaustion and performance-based self-esteem: reciprocal relationships 
Objectives
The three constructs of work–family conflict, emotional exhaustion and performance-based self-esteem are all related to tremendous negative consequences for the individual, the organization as well as for society. Even though there are studies that connect two of those constructs, the prospective relations between all three of them have not been studied yet.
Methods
We explored the prospective relations between the three constructs in a large Swedish data set representative of the Swedish workforce. Gender differences in the relations were investigated. Longitudinal data with a 2-year time lag were gathered from 3,387 working men and women who responded to the 2006 and 2008 waves of the Swedish Longitudinal Occupational Survey of Health. Four different cross-lagged models were analysed.
Results
In the best fitting model, higher levels of work–family conflict at time 1 were associated with an increased level of performance-based self-esteem at time 2, but not with emotional exhaustion, after controlling for having children, gender, education and age. Also, relationships between emotional exhaustion at time 1 and work–family conflict and performance-based self-esteem at time 2 could be established. Furthermore, relationships between performance-based self-esteem time 1 and work–family conflict and emotional exhaustion time 2 were found. Multiple-group analysis did not show any differences in the relations of the tested constructs over time for either men or women.
Conclusions
We conclude that the three constructs are interrelated and best understood through a reciprocal model. No differences were found between men and women.
doi:10.1007/s00420-014-0941-x
PMCID: PMC4286621  PMID: 24664455
Emotional exhaustion; Performance-based self-esteem; Self-esteem; Structural equation modelling; Work–family conflict
7.  Assessment of a prevention program for work-related stress among urban police officers 
Objective
To determine the efficacy of a primary prevention program designed to improve psychobiological responses to stress among urban police officers.
Methods
A random sample of 37 police cadets received complementary training in psychological and technical techniques to reduce anxiety and enhance performance when facing a series of police critical incidents. Training was done by Special Forces officers, trained by the authors in imaging. A random sample of 38 cadets, receiving training as usual, was followed in parallel. Assessment of somatic and psychological health, and stress biomarkers, was done at baseline, immediately following training, and after 18 months as regular police officers. Comparison was done using two-way repeated analysis of variance (ANOVA) and logistic regression.
Results
The intervention group improved their general health and problem-based coping as compared to the control group. They also demonstrated lower levels of stomach problems, sleep difficulties, and exhaustion. Training was associated with an OR of 4.1 (95% CI, 1.3–13.7; p < 0.05) for improved GHQ scores during the study as compared to no changes or worsening score.
Conclusions
This first primary prevention study of high-risk professions demonstrates the validity and functional utility of the intervention. Beneficial effects lasted at least during the first 2 years on the police force. It is suggested that preventive imagery training in first responders might contribute to enhanced resiliency.
doi:10.1007/s00420-012-0748-6
PMCID: PMC3596819  PMID: 22366986
Critical incident; First responder; GHQ; Psychosomatic; Resiliency
9.  Pesticide Use and Fatal Injury among Farmers in the Agricultural Health Study 
Purpose
To assess whether pesticide use practices were associated with injury mortality among 51,035 male farmers from North Carolina and Iowa enrolled in the Agricultural Health Study.
Methods
We used Cox proportional hazards models adjusted for age and state to estimate fatal injury risk associated with self-reported use of 49 specific pesticides, personal protective equipment, specific types of farm machinery, and other farm factors collected 1–15 years preceding death. Cause-specific mortality was obtained through linkage to mortality registries.
Results
We observed 338 injury fatalities over 727,543 person-years of follow-up (1993–2008). Fatal injuries increased with days per year of pesticide application, with the highest risk among those with 60+ days of pesticide application annually (Hazard Ratio (HR) =1.87; 95% Confidence Interval (CI) = 1.10, 3.18). Chemical-resistant glove use was associated with decreased risk (HR=0.73; 95%CI=0.58, 0.93), but adjusting for glove use did not substantially change estimates for individual pesticides or pesticide use overall. Herbicides were associated with fatal injury, even after adjusting for operating farm equipment, which was independently associated with fatal injury. Ever use of five of 18 herbicides (2,4,5–T, paraquat, alachlor, metribuzin, and butylate) were associated with elevated risk. In addition, 2,4–D and cyanazine were associated with fatal injury in exposure-response analyses. There was no evidence of confounding of these results by other herbicides.
Conclusion
The association between application of pesticides, particularly certain herbicides, and fatal injuries among farmers should be interpreted cautiously but deserves further evaluation, with particular focus on understanding timing of pesticide use and fatal injury.
doi:10.1007/s00420-012-0752-x
PMCID: PMC3515737  PMID: 22419121
pesticides; mortality; wounds; injuries
10.  Incidence rates of surgically treated rhegmatogenous retinal detachment among manual workers, non-manual workers and housewives in Tuscany, Italy 
Purpose
Candidate risk factors for idiopathic rhegmatogenous retinal detachment (RRD) include heavy manual handling (requiring Valsalva’s maneuver). We assessed incidence rates of surgically treated idiopathic RRD among manual workers, non-manual workers and housewives resident in Tuscany, Italy.
Methods
We retrieved all hospital discharge records bearing a principal diagnosis corresponding to RRD coupled with retinal surgery for any resident of Tuscany during 1997–2009. After elimination of repeated admissions and patients with coexistent, associated conditions (including recent trauma), subjects aged 25–59 years were classified as manual workers, non-manual workers or housewives. Population data were extracted from the 2001 census.
Results
We identified 1,946 eligible cases (1,142 men). Among men, manual workers experienced a 1.8-fold higher age-standardized rate per 100,000 person-years than non-manual workers [17.4 (95 % confidence interval (CI) 16.1–18.7) vs. 9.8 (95 % CI 8.8–10.8)]. Age-standardized rates among women were 1.9-fold higher for manual workers [11.1 (95 % CI 9.8–12.3)] and 1.7-fold higher for housewives [9.5 (95 % CI 8.3–10.8)] than in non-manual workers [5.7 (95 % CI 4.8–6.6)].
Conclusions
This large population-based study suggests that manual workers are affected by idiopathic RRD requiring surgical treatment more often than non-manual workers. The higher rates of surgically treated RRD experienced by manual workers are in accord with the hypothesis that heavy manual handling may have a causal role.
doi:10.1007/s00420-013-0894-5
PMCID: PMC3855483  PMID: 23893253
Manual work; Retinal surgery; Patient discharge; Incidence study
11.  High pesticide exposure events and central nervous system function among pesticide applicators in the Agricultural Health Study 
Purpose
While acute pesticide poisoning can be associated with persistent adverse central nervous system (CNS) effects, little is known about the effect of episodic and unusually high pesticide exposure events (HPEEs) that typically do not result in acute poisoning. The objective of this investigation was to examine the association between HPEEs and CNS function among licensed pesticide applicators enrolled in the Agricultural Health Study (AHS).
Methods
In 2006–2008, 693 male participants, with no history of a physician-diagnosed pesticide poisoning, completed nine neurobehavioral tests to assess memory, motor speed, sustained attention, verbal learning, and visual scanning and processing. Information on HPEEs and pesticide poisonings was obtained from previous AHS interviews. Associations between HPEEs and neurobehavioral outcomes were estimated with linear regression controlling for age and outcome-specific covariates.
Results
A history of at least one HPEE was reported by 156 (23%) participants. Adverse associations were observed between HPEEs and two of the nine neurobehavioral tests. On a test of visual scanning and processing (Digit-Symbol), participants with HPEEs were 4.2 seconds slower (95% CI: −7.27, −1.11) than those without HPEEs, equivalent to the effect of 3.9 years of age in this population. On a test of visual scanning and motor speed (Sequences A), participants with HPEEs were 2.5 seconds slower (95% CI: −4.53, −0.41) than those without HPEEs, equivalent to the effect of 3.9 years of age. No significant associations were observed between HPEEs and the other neurobehavioral tests.
Conclusions
HPEEs may contribute to adverse CNS outcomes independent of diagnosed pesticide poisoning.
doi:10.1007/s00420-011-0694-8
PMCID: PMC3595011  PMID: 21927986
agricultural workers; epidemiology; neurobehavioral testing; pesticide exposure
12.  Functional and occupational characteristics predictive of a return to work within 18 months after stroke in Japan: implications for rehabilitation 
Objective
This study examined clinical, functional, and occupational factors associated with return to work within 18 months after stroke, specifically focusing on the impact of higher cortical dysfunction on return to work in the chronic phase.
Methods
This prospective cohort study in 21 hospitals specializing in clinical and occupational health recruited consecutive working-age inpatients receiving acute care for their first stroke (n = 351). A unified database was used to extract patient information from hospital records at the time of admission, discharge, and follow-up at 18 months post-stroke. Cox proportional hazard regression analysis was conducted to determine clinical, functional, and occupational factors influencing return to work within 18 months.
Results
Of 351 registered stroke patients (280 males, 71 females, mean age ± SD, 55.3 ± 7.2 years) who met inclusion criteria, 250 responded to the follow-up survey and 101 were lost to follow-up. Half (51 %) succeeded in returning to work during the 18-month follow-up after stroke onset. After adjusting for age, gender, and Barthel index at initial rehabilitation, the following factors were identified as significant predictors of a return to work: white-collar versus blue-collar occupation (hazard ratio (HR) 1.5; 95 % confidence interval (CI) 1.1–2.2), no aphasia (HR 3.0; 95 % CI 1.5–5.9), no attention dysfunction (HR 2.0; 95 % CI 1.0–4.0), and walking ability (HR 3.1; 95 % CI 1.3–7.1).
Conclusions
This study indicated the importance of tailored rehabilitation to alleviate the impact of higher cortical dysfunction and to support return to work by stroke survivors.
doi:10.1007/s00420-013-0883-8
PMCID: PMC3996276  PMID: 23677520
Stroke; Employment; Occupational factors; Rehabilitation; Speech disorders
13.  [No title available] 
PMCID: PMC3636680  PMID: 17909839
14.  The influence of perceived stress and musculoskeletal pain on work performance and work ability in Swedish health care workers 
Objectives
To evaluate the influence of perceived stress and musculoskeletal ache/pain, separately and in combination, at baseline, on self-rated work ability and work performance at two-year follow-up.
Methods
Survey data were collected with a 2-year interval. Health care workers participating at both waves were included. Inclusion criteria were good self-reported work ability and unchanged self-rated work performance at baseline, resulting in 770 participants; 617 women and 153 men. Musculoskeletal pain was assessed using the question “How often do you experience pain in joints and muscles, including the neck and low back?”, perceived stress with a modified version of a single item from the QPS-Nordic questionnaire, work performance by the question “Have your work performance changed during the preceding 12 months?” and work ability by a single item from the work ability index. Associations between baseline data and the two outcomes at follow-up were analysed by means of the log binomial model and expressed as risk ratios (RR) with 95 % confidence intervals (CI).
Results
A combination of frequent musculoskeletal pain and perceived stress constituted the highest risk for reporting decreased work performance (RR 1.7; CI 1.28–2.32) and reduced work ability (RR 1.7; CI 1.27–2.30) at follow-up. Separately, frequent pain, but not stress, was clearly associated with both outcomes.
Conclusion
The results imply that proactive workplace interventions in order to maintain high work performance and good work ability should include measures to promote musculoskeletal well-being for the employees and measures, both individual and organizational, to minimize the risk of persistent stress reactions.
doi:10.1007/s00420-013-0875-8
PMCID: PMC3996278  PMID: 23609321
Stress; Musculoskeletal pain; Work ability; Work performance; Productivity
15.  Work-related airway symptoms, nasal reactivity and health-related quality of life in female hairdressers: a follow-up study during exposure 
Objectives
Hairdressers often complain of work-related rhinitis (WR). They are infrequently sensitized to persulphates. The cause and mechanism of the symptoms and the effects on their health-related quality of life (HRQoL) remains unclear. The objectives were to follow female hairdressers with WR mainly from bleaching powder regarding nasal reactivity to persulphate and to evaluate symptoms, HRQoL and inflammatory markers in nasal lavage during a working period after vacation and compared with hairdressers without symptoms and pollen allergic women.
Methods
Skin prick tests to persulphate were performed in the hairdressers. Participants kept a diary of symptoms and of work tasks (hairdressers only). They completed HRQoL questionnaires. Eosinophil cationic protein (ECP) in nasal lavage fluid was examined. The symptomatic hairdressers performed nasal challenges with persulphate before and after the exposure.
Results
Skin prick tests were negative. Although the nasal reactivity to persulphate did not change a steady increase in nasal symptoms, especially blockage, and in ECP was noticed in the symptomatic hairdressers. The HRQoL deteriorated in the symptomatic hairdressers indicating an effect on their working situation and daily life. The atopics had more, but varying symptoms (itching, sneezing and secretion).
Conclusions
The difference in the clinical picture between the symptomatic hairdressers and the pollen allergic women, the increase in symptoms and ECP in the nasal lavage support the view that a sensitization to hairdresser chemicals by a mechanism not yet understood is operating. The deterioration of the HRQoL in the symptomatic hairdressers indicates a considerable effect on their life.
doi:10.1007/s00420-012-0835-8
PMCID: PMC3880473  PMID: 23263693
Bleaching powder; Work-related nasal symptoms; Nasal lavage; Diary; Health-related quality of life
16.  Relationship between intensity of night shift work and antioxidant status in blood of nurses 
Purpose
Light-at-night exposure can disrupt the human circadian rhythm via clock gene expressions. The circadian rhythm influences antioxidant enzymes’ activity and cellular mRNA levels of these enzymes. The employees working based on a shift system adjust to the changes occurring both on the cell level and on the level of the whole organism. Therefore, a question should be answered whether shift work disturbs oxidant–antioxidant balance and/or generates oxidative stress.
Methods
A cross-sectional study was conducted among nurses selected from the Local Registry of the Chamber of Nurses and Midwives in Lodz: 359 nurses worked daily only and 349 working rotating night shifts. These two groups differed significantly in respect of age (p < 0.0001), menopausal status (p < 0.0001), and current smoking habit (p = 0.02). The average total work duration was significantly shorter (12.4 years) in nurses working currently rotating night shifts who worked significantly longer on night shifts than day-workers (26.6 years).
Results
We found statistically significant higher red blood cell glutathione peroxidase in nurses working on night shifts (21.0 ± 4.6 vs. 20.0 ± 5.0 U/g Hb, p < 0.009) after adjusting for age, oral contraceptive hormone use, smoking, and drinking alcohol during last 24 h. Statistically significant lower vitamin A and E levels were found in the premenopausal women working in rotating system (0.690 ± 0.238 vs. 0.786 ± 0.262 μg/ml, p < 0.0001 for vitamin A and 10.93 ± 4.15 vs. 12.78 ± 4.75 μg/ml, p < 0.0001 for vitamin E). The marker of lipid peroxidation (TBARS concentration) was significantly lower in the premenopausal nurses than postmenopausal ones working day shifts only (2.06 ± 0.76 vs. 2.21 ± 0.80 nmol/ml, p < 0.038). We observed that erythrocyte GSH-Px activity rose statistically significant in nurses working more night shifts per month (p < 0.01).
Conclusions
The results quoted above seem to support the existence of an association between light-at-night exposure and blood glutathione peroxidase activity in female shift workers. Nevertheless, in order to explain the mechanisms of this association, we need more studies.
doi:10.1007/s00420-012-0828-7
PMCID: PMC3825624  PMID: 23179107
Antioxidants; TBARS; Night shift work; Selenium; Light-at-night exposure
17.  The impact of bystanding to workplace bullying on symptoms of depression among women and men in industry in Sweden: an empirical and theoretical longitudinal study 
Background
Prospective studies on bystanding to workplace bullying and the health outcomes are scarce.
Aim
To investigate the work environmental risk factors of depressive symptoms among bystanders to bullying in both women and men in four large industrial organizations in Sweden.
Method
The number of respondents at four large industrial enterprises with more than one year at the workplace at T1: n = 2,563 (Women: n = 342; Men: n = 2,227). Bystanders to bullying at T1: n = 305 (Women: n = 30; Men: n = 275). The total number of those with symptoms of depression at T2: Women: n = 30; Men: n = 161. Two thousand one hundred and seventy-seven employees answered the questionnaire on T1 and T2 with an 18-month interval. “To have depressive symptoms” was defined as not having depressive symptoms at T1 but having depressive symptoms at T2.
Results
The number of men who were bystanders to bullying was larger compared to women. However, the proportion of women who were bystanders to bullying and developed depressive symptoms 18 months later was higher in comparison with men (33.3 and 16.4 %, respectively). Further, “Being a bystander to bullying” 1.69 (1.13–2.53), “Rumors of changes in the workplace” 1.53 (1.10–2.14), “Reduced role clarity” 2.30 (1.21–4.32), “Lack of appreciation of being in the group” 1.76 (1.22–2.53) increased the risk of future symptoms of depression. “Job Strain” was not an adjusted risk factor for depression.
Conclusion
Our results support previous findings that bystanding to workplace bullying is related to future depressive symptoms.
doi:10.1007/s00420-012-0813-1
PMCID: PMC3722445  PMID: 22940902
Job strain; Longitudinal; Industry; Bystanding workplace bullying; Depression; Model; Theory
18.  The influence of employment social support for risk and prognosis in nonspecific back pain: a systematic review and critical synthesis 
Purpose
To examine the influence of employment social support type (e.g. co-worker, supervisor, general support) on risk of occurrence of low back pain, and prognosis (e.g. recovery, return to work status) for those who have low back pain.
Methods
Systematic search of seven databases (MEDLINE, Embase, PsychINFO, CINAHL, IBSS, AMED and BNI) for prospective or case–control studies reporting findings on employment social support in populations with nonspecific back pain. Data extraction and quality assessment were carried out on included studies. A systematic critical synthesis was carried out on extracted data.
Results
Thirty-two articles were included that describe 46 findings on the effect of employment social support on risk of and prognosis of back pain. Findings show that there is no effect of co-worker, supervisor or general work support on risk of new onset back pain. Weak effects of employment support were found for recovery and return to work outcomes; greater levels of co-worker support and general work support were found to be associated with less time to recovery or return to work.
Conclusions
The evidence suggests that the association between employment support and prognosis may be subject to influence from wider concepts related to the employment context. This review discusses these wider issues and offers directions for future research.
doi:10.1007/s00420-012-0804-2
PMCID: PMC3555241  PMID: 22875173
Work social support; Social network; Back pain; Systematic review; Employment
19.  The role of lifestyle, health, and work in educational inequalities in sick leave and productivity loss at work 
Purpose
To investigate the influence of lifestyle, health, and work conditions in the association between education and productivity loss at work and sick leave.
Methods
Employees of six companies filled out a questionnaire on demographics, lifestyle-related, health, and work-related factors, and productivity loss at work and sick leave at baseline (n = 915) and after 1-year (n = 647).
Results
Employees with a low education were more likely to report productivity loss at work (OR = 1.49, 95 % CI 0.98–2.26) and sick leave (OR = 1.81, 95 % CI 1.15–2.85). After adjustment for lifestyle, health, and work conditions, the association between education and productivity loss at work did not attenuate. Work conditions attenuated the association between low education and sick leave (OR = 1.62, 95 % CI 1.01–2.61), and additional adjustment for health and lifestyle-related factors further reduced the strength of the association (OR = 1.42, 95 % CI 0.86–2.34).
Conclusion
Work conditions and lifestyle-related factors partly explained the association between education and sick leave, but did not influence the association between education and productivity loss at work. The educational differences in sick leave prompt for interventions that address behavioral aspects as well as work-related and lifestyle-related factors.
doi:10.1007/s00420-012-0793-1
PMCID: PMC3722458  PMID: 22772397
Productivity loss at work; Sick leave; Education; Inequalities
20.  What factors are most relevant to the assessment of work ability of employees on long-term sick leave? The physicians’ perspective 
Purpose
To reach insurance physician (IPs) consensus on factors that must be taken into account in the assessment of the work ability of employees who are sick-listed for 2 years.
Methods
A Delphi study using online questionnaires was conducted from October 2010 to March 2011.
Results
One hundred and two insurance physicians reached a consensus on important factors for return to work (RTW) of employees on long-term sick leave; from those factors, the most relevant for the assessment of work ability was determined. From a total of 22 relevant factors considered for the return to work of long-term sick-listed employees, consensus was reached on nine relevant factors that need to be taken into account in the assessment of the work ability of employees on long-term sick leave. Relevant factors that support return to work are motivation, attitude towards RTW, assessment of cognitions and behaviour, vocational rehabilitation in an early stage and instruction for the sick-listed employee to cope with his disabilities. Relevant factors that hinder RTW are secondary gain from illness, negative perceptions of illness, inefficient coping style and incorrect advice of treating physicians regarding RTW.
Conclusions
Non-medical personal and environmental factors may either hinder or promote RTW and must be considered in the assessment of the work ability of long-term sick-listed employees. Assessment of work ability should start early during the sick leave period. These factors may be used by IPs to improve the quality of the assessment of the work ability of employees on long-term sick leave.
doi:10.1007/s00420-012-0783-3
PMCID: PMC3679417  PMID: 22622322
Long-term sick leave; Sick-listed employees; Work ability assessment; Physicians’ perspective; Disability assessment
21.  Is specific IgE antibody analysis feasible for the diagnosis of methylenediphenyl diisocyanate-induced occupational asthma? 
Purpose
Early recognition improves the prognosis of isocyanate asthma. A major unanswered question is whether IgE-dependent mechanisms are of diagnostic value? Our objective was to appraise serological methods using various methylenediphenyl diisocyanate (MDI)-albumin conjugates and weigh up the data versus the outcome of standardized comprehensive clinical diagnostics to evaluate the viability of immunological analysis in supportive MDI-asthma diagnosis (OAI).
Methods
Specific IgE (sIgE) and IgG (sIgG) binding was measured with fluorescence enzyme immunoassay in 43 study subjects (using conjugates prepared in-vapor, in-solution and commercial preparations). The differential clinical diagnosis included standardized measurement of pulmonary function, non-specific bronchial hyper-responsiveness, specific MDI-prick test (MDI-SPT) and specific inhalation challenge (MDI-SIC).
Results
Detailed diagnostic scheme allows the differential OAI and MDI-induced hypersensitivity pneumonitis (PI). The presumed OAI diagnoses were confirmed in 84 % (45 % cases having demonstrable sIgE antibodies) with RR 5.7, P > 0.001, when OAI diagnosis is correlated with MDI-SIC/MDI-SPT (RR 1.28 for MDI-SIC alone); sIgG antibodies were clinically relevant for PI and not for the OA diagnosis. MDI-specific IgE data generated with commercial ImmunoCAP preparations show high correlation with our in-vapor generated MDI conjugates.
Conclusions
Isocyanate-specific IgE antibodies are not always detectable but their presence is strongly predictive of OAI and supportive for the diagnosis. MDI-SPT can be a valuable parameter differentiating OAI and PI. We have confirmed and extended published data showing that isocyanate-albumin conjugates perform better in specific antibody assays when prepared with volatile phase formulations and would like to stress additionally the necessity for further refinements and standardization in clinical diagnostics procedures.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-012-0772-6) contains supplementary material, which is available to authorized users.
doi:10.1007/s00420-012-0772-6
PMCID: PMC3633778  PMID: 22544379
Occupational asthma; Isocyanates; MDI, 4,4′-methylenediphenyl diisocyanate. (diphenylmethane-4,4′-diisocyanate); Specific IgE antibodies; Specific IgG antibodies; Immunological diagnosis; Albumin conjugates; Asthma diagnosis; Hypersensitivity pneumonitis; Isocyanate alveolitis
22.  Interpreting Epidemiological Evidence in the Presence of Multiple Endpoints: An Alternative Analytic Approach using the 9-Year Follow-up of the Seychelles Child Development Study 
Purpose
The potential for ill-informed causal inference is a major concern in published longitudinal studies evaluating impaired neurological function in children prenatally exposed to background levels of methyl mercury (MeHg). These studies evaluate a large number of developmental tests. We propose an alternative analysis strategy that reduces the number of comparisons tested in these studies.
Methods
Using data from the 9-year follow-up of 643 children in the Seychelles Child Development Study (SCDS), we grouped 18 individual endpoints into one overall ordinal outcome variable as well as by developmental domains. Subsequently, ordinal logistic regression analyses were performed.
Results
We did not find an association between prenatal MeHg exposure and developmental outcomes at 9 years of age.
Conclusion
Our proposed framework is more likely to result in a balanced interpretation of a posteriori associations. In addition, this new strategy should facilitate the use of complex epidemiological data in quantitative risk assessment.
doi:10.1007/s00420-009-0402-0
PMCID: PMC3330475  PMID: 19205720
methyl mercury; child development; risk assessment; Seychelles Child Development Study
23.  Physical job demands and related health complaints among surgeons 
Purpose
Surgeons’ poor physical health and high physical job demands might threaten good quality of care. We aimed to compare the prevalence of physical complaints of surgeons, their physical work ability and the physical job demands of surgeons with that of other hospital physicians.
Methods
All medical doctors (n = 958) of one academic medical center were invited to complete the online questionnaire to assess the physical work ability and the prevalence of regional musculoskeletal complaints. A purposive sample of 44 surgeons and 82 other hospital physicians were systematically observed during work to quantify the physical job demands for an average working day.
Results
More surgeons found their work to be physically strenuous (41 vs. 13 %, p < .000) and more were bothered by working in uncomfortable or exhausting postures (73 vs. 27 %, p < .001). Both groups reported that most of their physical complaints were in the neck (39 and 32 %) and arm regions (36 and 27 %). The majority of surgeons (86 %) and other hospital physicians (79 %) experienced difficulties coping with their job demands because of their physical state once a month or less. Compared with other hospital physicians, surgeons stand longer (4 vs. 3 h, p = .004) and perform fine repetitive movements longer (80 vs. 3 min, p < .001) during an average working day.
Conclusions
Exposure to several physical job demands that are perceived as uncomfortable and exhausting and the presence of physical health complaints reduce surgeons’ work functioning.
doi:10.1007/s00420-012-0763-7
PMCID: PMC3602608  PMID: 22456979
Musculoskeletal diseases; Occupational health; Physicians; Workload; Occupational exposure; General surgery
24.  Is cultural activity at work related to mental health in employees? 
Objective
To examine relationships between work-based cultural activities and mental employee health in working Swedes.
Hypothesis
A positive relationship between frequent cultural activity at work and good employee health was expected.
Research design
Random sample of working Swedish men and women in three waves, 2006, 2008 and 2010, on average 60 % participation rate.
Methods
A postal questionnaire with questions about cultural activities organised for employees and about emotional exhaustion (Maslach) and depressive symptoms (short form of SCL). Employee assessments of “non-listening manager” and work environment (“psychological demands” and “decision latitude”) as well as socioeconomic variables were covariates. Cross-sectional analyses for each study year as well as prospective analyses for 2006–2008 and 2008–2010 were performed.
Main outcome and results
Lower frequency of cultural activities at work during the period of high unemployment. The effects of relationships with emotional exhaustion were more significant than those with depressive symptoms. The associations were attenuated when adjustments were made for manager function (does your manager listen?) and demand/control. Associations were more pronounced during the period with low unemployment and high cultural activity at work (2008). In a prospective analysis, cultural activity at work in 2008 had an independent statistically significant “protective” effect on emotional exhaustion in 2010. No corresponding such association was found between 2006 and 2008.
Conclusions
Cultural activities at work vary according to business cycle and have a statistical association with mental employee health, particularly with emotional exhaustion.
Implications for future research
There are particularly pronounced statistical protective effects of frequent cultural activity at work on likelihood of emotional exhaustion among employees.
doi:10.1007/s00420-012-0762-8
PMCID: PMC3602637  PMID: 22456978
Emotional exhaustion; Depression; Self-rated health; Work stress; Cultural activity
25.  Validity of self-reports of knee-straining activities at work: a field study with 6-month follow-up 
Objectives
To measure short-term and long-term validity of self-reported duration of kneeling and squatting at work and to examine the possibility of differential misclassification due to knee complaints.
Methods
Work-related kneeling and squatting were analysed for 190 male subjects (mean age, 35.0 and SD, 11.5) in field by both measurements and questionnaires. Posture capturing was performed with an ambulatory measuring system (CUELA). Immediately after the measurement (t0), each participant was asked to estimate frequency and duration of five specific knee postures taken during the measurement period. After 6 months (t1), the survey was repeated (n = 125). Health status of all subjects was recorded by Nordic questionnaire. Statistical analysis was performed by using nonparametric tests, correlations, and Bland–Altman plots.
Results
At both time points, subjects were able to recall the occurrence of knee postures rather well (100.0–57.6 % agreement) but many of them failed in quantifying their knee load. We found poor-to-moderate correlations between measurements and self-reports for all examined postures in both surveys (0.23 < ρ < 0.63). The durations of knee postures were both over- and underestimated but overestimations predominated (t0, 74.7 % and t1, 87.2 % overestimations). High-exposed subjects seemed to misjudge their exposure to a greater extent than low-exposed ones, while knee complaints seemed to have no impact on the assessment behaviour.
Conclusions
As our study showed, self-reported knee loading may deviate widely from measured exposure. These limitations of self-reporting emphasise the arguments in favour of using objective data whenever possible, for example by complementing self-reported occurrence of knee postures with quantitative measurement data.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-012-0758-4) contains supplementary material, which is available to authorized users.
doi:10.1007/s00420-012-0758-4
PMCID: PMC3555247  PMID: 22426541
Exposure assessment; Method comparison; Kneeling and squatting; Field study; Knee pain

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