Interaction Effects of Physical and Psychosocial Working Conditions on Risk for Sickness Absence: A Prospective Study of Nurses and Care Assistants in Sweden

Employees in health and social care are often simultaneously exposed to both physical and psychosocial challenges that may increase their risk for sickness absence. The study examines interaction effects of physical and psychosocial work conditions on the future risk for sickness absence among nurses and care assistants in Sweden. The study was based on 14,372 participants in any of the Swedish Work Environment Surveys conducted during the years 1993–2013 with linked register information on background factors and compensated sickness absence. Adjusted hazard ratio (HR), stratified by occupation, and measures of additive interaction effects were estimated. The combinations of high psychosocial job demands and heavy physical work and strenuous postures, respectively, significantly increased the risks for sickness absence among nurses (HR 1.43; CI 1.09–1.88 and HR 1.42; CI 1.16–1.74, respectively), as well as among care assistants (HR 1.51; CI 1.36–1.67 and HR 1.49; CI 1.36–1.63, respectively). The combinations of low job control and both heavy physical work (HR 1.44; CI 1.30–1.60) and strenuous postures (HR 1.42; CI 1.30–1.56) were also associated with excess risk for sickness absence among care assistants. We also found interaction effects among care assistants but not among nurses. The results indicate that the high sickness absence rate among care workers in Sweden can be reduced if the simultaneous exposures of high psychosocial and high physical challenges are avoided. Management policies for reduced time pressure, improved lifting aids, and measures to avoid awkward work postures are recommended. For care assistants, increased influence over work arrangements is likely to lower their sickness absence risk.

Back pain and regional disorders

Over 70% of people in industrialized countries suffer from low back pain at some time, and it is one of the main reasons for visits to physicians. Risk factors include heavy physical work, smoking, stress, depression, and job dissatisfaction. In more than 90% of cases the exact anatomical source of back pain cannot be determined, and the preferred diagnostic label is ‘non-specific low back pain’. Investigation should be restricted to patients with red flags and clinical suspicion of serious disease, with magnetic resonance imaging the best imaging modality for the diagnosis of lumbar disorders. In the absence of red flags, patients with acute low back pain should receive non pharmacological care as first treatment option including reassurance, advise to remain active, massage and spinal manipulation followed by non steroidal anti-inflammatory drugs and muscle relaxants if necessary.

Physical work environment factors affecting risk for disability pension due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and other occupations: a prospective, population-based cohort study

ObjectiveTo study the influence of physical work factors on the risks of future disability pension (DP) due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and all other occupations in the general working population in Sweden.MethodsThe prospective population study was based on representative samples of working individuals (n=79 004) aged 16–64, interviewed in the Swedish Work Environment Survey between 1993 and 2013. Information on diagnosed DP in 1994–2014 was gathered from the Social Insurance Agency’s database. The focus was on nursing professionals (registered nurses and midwives) and care assistants, for example, assistant nurses and hospital ward assistants. The outcome was DP, classified into two diagnostic groups. Associations between physical work factors and risk of DP were calculated using Cox regression with HR and 95% CI.ResultsPhysical work factors were associated with future DP after adjusting for sociodemographic conditions and psychosocial work factors among care assistants (n=10 175) and among all other occupations (n=66 253), but not among nursing professionals (n=2576). The increased risk among care assistants (n=197) exposed to heavy physical work was 66% (HR 1.66, 95% CI 1.39 to 1.97), and for those exposed to strenuous work postures (n=420) it was 56% (HR 1.56, 95% CI 1.35 to 1.80). Physical work indicators were mainly associated with musculoskeletal DP diagnoses among care assistants, but two indicators were significant also for mental diagnoses. An increased risk of DP was found among nursing professionals (n=102) exposed to detergents or disinfectants (HR 1.48, 95% CI 1.06 to 2.05), but not among care assistants.ConclusionsHeavy physical work and strenuous postures are predictors of future DP, particularly among care assistants and in the general working population. In order to reduce early exit from the workforce, efforts should be made to improve physical and ergonomic working conditions.

Exposure to heavy physical work from early to later adulthood and primary healthcare visits due to musculoskeletal diseases in midlife: a register linked study

ObjectivesTo examine whether exposure to heavy physical work from early to later adulthood is associated with primary healthcare visits due to cause-specific musculoskeletal diseases in midlife.DesignProspective cohort study.SettingNationally representative Young Finns Study cohort, Finland.Participants1056 participants of the Young Finns Study cohort.Exposure measurePhysical work exposure was surveyed in early (18–24 years old, 1986 or 1989) and later adulthood (2007 and 2011), and it was categorised as: ‘no exposure’, ‘early exposure only’, ‘later exposure only’ and ‘early and later exposure’.Primary and secondary outcome measuresVisits due to any musculoskeletal disease and separately due to spine disorders, and upper extremity disorders were followed up from national primary healthcare register from the date of the third survey in 2011 until 2014.ResultsPrevalence of any musculoskeletal disease during the follow-up was 20%, that for spine disorders 10% and that for upper extremity disorders 5%. Those with physically heavy work in early adulthood only had an increased risk of any musculoskeletal disease (risk ratio (RR) 1.55, 95% CI 1.05 to 2.28) after adjustment for age, sex, smoking, body mass index, physical activity and parental occupational class. Later exposure only was associated with visits due to any musculoskeletal disease (RR 1.46, 95% CI 1.01 to 2.12) and spine disorders (RR 2.40, 95% CI 1.41 to 4.06). Early and later exposure was associated with all three outcomes: RR 1.99 (95% CI 1.44 to 2.77) for any musculoskeletal disease, RR 2.43 (95% CI 1.42 to 4.14) for spine disorders and RR 3.97 (95% CI 1.86 to 8.46) for upper extremity disorders.ConclusionsTo reduce burden of musculoskeletal diseases, preventive actions to reduce exposure to or mitigate the consequences of physically heavy work throughout the work career are needed.

O6C.3 The association between long-term exposure from heavy physical work load and coronary heart disease in middle aged men

ObjectivesPrevious studies have shown conflicting results concerning the association between heavy physical work load and risk of coronary heart disease (CHD). The aim of this study was to investigate the association between long-term exposure to heavy physical work load in middle age and risk of CHD among Swedish men during almost 20 years of follow-up.MethodsThe study is based on a cohort of around 40 000 Swedish males, born 1949–51, with census information on occupation in 1985 and 1990 (at ages 34–41). Aspects of physical workload was estimated from job exposure matrices based on questions concerning heavy lifting, strenuous work postures, and physically strenuous work from the Swedish Work Environment Surveys 1989–97. Mean values for each physical exposure variable were assigned to over 300 occupational titles from the censuses conducted in 1985 and 1990. Only those 29 530 subjects who were in the same quintile of exposure both years were included in the analyses. Information on smoking behavior and body mass index (BMI) was collected at compulsory conscription for military training in 1969/70 (at 18–20 years of age), and follow up data on CHD (1457 cases) between the years 1991–2009.ResultsAn increased relative risk of CHD were found among workers in the quintiles with medium low (HR=1.36 CI95%=1.14–1.62), medium (HR=1.46 CI95%=1.23–1.74), medium-high (HR=1.62 CI95%=1.36–1.91), and high (HR=1.45 CI95%=1.22–1.71) exposure to heavy lifting at work compared with those in the quintile with low exposure to heavy lifting. After adjustment for smoking and BMI the risk estimates were somewhat lower but still significantly increased. Risk estimates of the same magnitude were seen for a number of other aspects of the physical work environment.ConclusionThere was an association between long-term exposure from heavy physical work load and CHD even after adjustement for smoking and BMI.

Pop-Q Components Comparison among Multiparous and Nulliparous Women

Objective: To compare the measurement of POP-Q components between multiparous and nulliparous women. Method: This study is a cross-sectional research conducted in several hospitals in Makassar during the period of June to October 2012, with 270 women as the subjects. Subjects were divided into three groups: nulliparous, parity 1-2, and parity 3 (multiparous). We analyzed the mean POP-Q components results between 3 groups using t-test, analysis of prolapse based on POP-Q components measurement, and analysis of correlation between risk factors with prolapse was done using Chi-square test. Result: There is a significant difference in POP-Q components measurement between multiparous and nulliparous women, consecutively for: Aa point -2.14 and -2.97 cm, Ba point -2.11 and -2.99 cm, C point -5.69 and -6.86 cm, gh 3.33 and 2.70 cm, pb 2.60 and 3.27 cm, TVL 8.65 and 9.06 cm, Ap point -2.35 and -2.93 cm, Bp point - 2.61 and -2.96 cm, D point -6.61 and -7.42 cm. In multiparous women, points Aa, Ba, C, D, Ap and Bp became more prolapsed, gh became longer, while pb and TVL became shorter. Conclusion: The proportion of prolapse is higher in multiparous women with significant associations with age, body mass index, education level, and history of heavy physical work, delivering a large baby and use of hormonal contraceptives. [Indones J Obstet Gynecol 2014; 4: 204-210] Keywords: multiparous women, nulliparous women, parity, POP-Q

Perceptions of Febrile Illness among Local People Living in Malaria Endemic villages in Central Hill Region of Nepal

Objective of this paper is to explore the perceptions of febrile illness among people living in malaria endemic areas of hill region. Qualitative data were collected from malaria endemic villages in Mahadevesthan VDC of Kavrepalanchok district through in-depth interviews and focus group discussions. Local people perceive febrile illnesses as common health problem. They classified febrile illnesses into sardi ko jwaro, dokh, lagu/laganiko jwaro and aulo jwaro. Fever occurring after engaging in heavy physical work is described as dagdi. Severe and complicated form of fever is interpreted as dokh in cultural meaning and typhoid as biomedical concept. Febrile illness which does not respond to biomedicine, but it is relieved by traditional ritual healing is labeled as lagani ko jwaro. Malaria fever is locally known as aul or aulo jwaro. People often avoid certain food such as sour curd, meat, egg, oily and spicy food during fever to prevent it from resulting in dokh (complicated fever). Herbal home remedy is rarely used in febrile illness. Now a day, local people interpret dokh as typhoid and aulo as malaria fever and seek medical treatment from local health institutions and private practitioners. Local perceptions of febrile illnesses such as dokh and aulo overlap with the biomedical concepts of typhoid and malaria fever due to interaction with both traditional healers and health care providers. DOI: http://dx.doi.org/10.3126/dsaj.v5i0.6359 Dhaulagiri Journal of Sociology and Anthropology Vol. 5, 2011: 121-42