[Show abstract][Hide abstract] ABSTRACT: To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain among men and women in a general population.
Cohort study with a 4-year follow-up.
General population in Stockholm County, Sweden.
The study sample comprised 3938 men and 5056 women aged 18-84 from the Stockholm Public Health Cohort reporting occasional low back pain in the baseline questionnaire 2006.
Lifestyle factors and potential confounders were assessed at baseline. The lifestyle factors smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables were dichotomised using recommendations for a health-enhancing lifestyle and combined to form the exposure variable 'healthy lifestyle behaviour'. The exposure was categorised into five levels according to the number of healthy lifestyle factors met. The follow-up questionnaire in 2010 gave information about the outcome, long duration troublesome low back pain. Crude and adjusted binomial regression models were applied to estimate the association between the exposure and the outcome analysing men and women separately.
The risk of developing long duration troublesome low back pain among women with occasional low back pain decreased with increasing healthy lifestyle behaviour (trend test: p=0.006). 21% (28/131) among women with no healthy lifestyle factor (reference) experienced the outcome compared to 9% (36/420) among women with all four factors. Compared to the reference group, the risk was reduced by 35% (RR 0.65, 95% CI 0.44 to 0.96) for women with one healthy lifestyle factor and 52% (RR 0.48, 95% CI 0.31 to 0.77) for women with all four healthy lifestyle factors. There were no clear associations found among men.
Healthy lifestyle behaviour seems to decrease the risk of developing long duration troublesome low back pain among women with occasional low back pain and may be recommended to improve the prognosis.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ Open 12/2014; 4(12):e005713. · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study presents an investigation of first-time decisions regarding work injury annuity due to occupational disease. Focus is a number of potential underlying factors behind the gender gap, where women are disadvantaged, in the granting of work injury annuity.
All 99 subjects (80 men and 19 women) who met the conditions of long-lasting reduction of work ability due to occupational disease (not occupational accident) in the Swedish Work Injury Insurance Act and were granted work injury annuity in 2010, together with a random sample of 118 subjects (55 men and 63 women) who were denied annuity in the same year, were selected for analysis. Each subject's case file from the Social Insurance Agency was examined with regards to cause of disease, diagnosis and the Social Insurance Agency's management and decision making of claims. The data were analysed by logistic regression analysis.
Men had a higher probability of being granted work injury annuity than women for musculoskeletal disorders (OR 4.16), mental disorders (OR 7.93) and diseases in other diagnostic chapters (OR 3.65). After adjustment for age, country of birth, diagnosis, work exposure factors and decision support factors, the higher probability for men of being granted work injury annuity remained (full model: OR 2.67, 95% CI 1.20 to 5.94).
Actions are necessary in order to establish equitable and gender-neutral treatment of work injury insurance claims. There is a need for more detailed knowledge of exposures in female-dominated jobs and the relationship between these exposures and occupational disease.
Occupational and environmental medicine 10/2013; · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Work-related violence is one of the most serious threats to employee safety and health.
To ascertain the extent of self-reported violence or threats of violence at work in relation to the general health of public sector employees.
The study population comprised 9,611 female (83%) and male public employees in Sweden. A questionnaire based on items derived mainly from validated instruments was constructed to cover aspects such as health, lifestyle, and physical and psychosocial work conditions.
One in three employees reported work-related violence, with the highest proportions among psychiatric nurses (79%) and psychiatric attendants (75%). Work-related violence more often affected those who were < 45 years old, worked < 40 hours/week, worked nights, or reported poor health. Regardless of gender, age, hours of work, night work, and type of occupation, exposure to work-related violence was associated with less than good general health, and this relationship was strongest for psychiatric nurses (OR=3.19; 95% CI=1.28-7.98), medical doctors/dentists (OR=2.46; 95% CI=1.35-4.49), compulsory school teachers (OR=2.14; 95% CI=1.33-3.45), and other nurses (OR=1.87; 95% CI=1.23-2.84).
Work-related violence was frequently reported by employees in the most common public sector occupations, and it was associated withpoor health in both genders.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the sex specific influence of leisure time physical activity and BMI on recovery from persistent back pain in a general population. METHODS: The study population (n=1836) in this longitudinal cohort study consisted of participants reporting persistent back pain in the baseline questionnaire in 2002-2003. Data on leisure time physical activity, BMI and potential confounders were also collected at baseline. Information on recovery from persistent back pain (no back pain periods >= 7 days during the last 5 years) was obtained from the follow-up questionnaire in 2007. Log-binomial models were applied to calculate Risk Ratios with 95 percent Confidence Intervals (CI) comparing physically active and normal weight groups versus sedentary and overweight groups. RESULTS: Compared to a sedentary leisure time, all measured levels of leisure time physical activity were associated with a greater chance of recovery from persistent back pain among women. The adjusted Risk Ratios was 1.46 (95% CI: 1.06, 2.01) for low leisure time physical activity, 1.51 (95% CI: 1.02, 2.23) for moderate leisure time physical activity, and 1.67 (95% CI: 1.08, 2.58) for high leisure time physical activity. There were no indications that leisure time physical activity influenced recovery among men, or that BMI was associated with recovery from persistent back pain either among men or among women. CONCLUSIONS: Regular leisure time physical activity seems to improve recovery from persistent back pain among women.
BMC Public Health 04/2013; 13(1):385. · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sleep problems are common complaints in health care workers that can affect quality of life and productivity, both in patients and healthy individuals. This study evaluates the prevalence of low sleep quality in health care workers with no health issues or complaints of sleep problems.
In this cross-sectional study was conducted on healthy employees of a health care organization in Tehran. The presence of physical and mental health issues and satisfaction from their sleep quality was assessed by means of a self-administered questionnaire. Sleep quality was evaluated by the Persian version of the Pittsburgh Sleep Quality Index (PSQI). PSQI scores of 5 or less were considered as good sleep quality.
From 925 participants, 56.9% were good sleepers. There was a significant association between poor sleep quality and female sex, divorced, shift-working, and age; it was not associated with education level. Self-rated health (SRH) had a significant positive correlation with sleep quality.
Poor sleep quality is common in our study population and associated with a lower SRH. The high prevalence of poor sleep quality in a group of healthy non-complaining employees can be an important early sign of underlying physical or mental health issues. Providing screening and monitoring programs to detect the underlying health conditions and their consequent treatment can promote health and productivity of employees and improve society's health, both directly and indirectly.
Archives of Iranian medicine 02/2013; 16(2):100-3. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. METHODS: This study included migrants to Sweden since 1960 who were 28--47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. RESULTS: Nordic immigrants had increased risks for all investigated disorders and mortality, while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. CONCLUSIONS: Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.
BMC Public Health 10/2012; 12(1):845. · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The aim was threefold: 1) to describe the experiences of driving and implementing a workplace-based rehabilitation intervention in cooperation with the occupational health service (OHS); 2) to investigate which people received multimodal and/or vocational rehabilitation measures; 3) to find predictors of return to work (RTW).Participants: Altogether 779 employees on sick leave for 90 days or more with mainly musculoskeletal or psychological/stress-related problems, 90% women. Methods: The HAKuL model was introduced, implying an early team assessment at the OHS and good access to rehabilitation measures. The study is a prospective three-year study with a two-year follow-up. Results: The rehabilitation intervention encountered challenges. Counter-measures were taken to facilitate coordination and communication. People with musculoskeletal problems often received both multimodal and vocational rehabilitation. Vocational rehabilitation was advocated for people who were under 55 years of age, and for those with stress-related problems. The strongest predictive factors for RTW were: having received only vocational rehabilitation and being under 45 years of age. Conclusion: The HAKuL model can be used in a wider context, but the study shows the need for coordination between multiple stakeholders. Supervisors should pay attention to people who have musculoskeletal problems and are older, as soon as problems emerge.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Youth unemployment is an increasing problem for societies around the world. Research has revealed negative health effects of unemployment, and this longitudinal register-based cohort study examined the relationship between unemployment and later sickness absence, disability pension and death among youth in Sweden. METHOD: The study group of 199 623 individuals comprised all immigrants born between 1968 and 1972 who immigrated before 1990 (25 607) and a random sample of native Swedes in the same age-range (174 016). The baseline year was 1992, and the follow-up period was from 1993 to 2007. Subjects with unemployment benefit in 1990-91, disability pension in 1990-92, severe disorders leading to hospitalization in 1990-92 and subjects who emigrated during follow-up were excluded. RESULTS: Those who were unemployed in 1992 had elevated risk of ≥60 days of sickness absence (OR 1.02-1.49), disability pension (HR 1.08-1.62) and all except native Swedish women had elevated risk of death (HR 1.01-1.65) during follow-up compared with non-unemployed individuals. The risk of future sickness absence increased with the length of unemployment in 1992 (OR 1.06-1.54), and the risk of sickness absence increased over time. A larger part of the immigrant cohort was unemployed at baseline than native Swedes. Selection to unemployment by less healthy subjects may explain part of the association between unemployment and the studied outcomes. CONCLUSION: Unemployment at an early age may influence the future health of the individual. To a society it may lead to increased burdens on the welfare system and productivity loss for many years.
The European Journal of Public Health 08/2012; · 2.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Background. The present study is part of a 3-year longitudinal study on work and health among employees in the public sector in Sweden. The aim was to study associations between self-rated health (SRH) and financial situation, education, and managerial responsibility. Methods. Of the 9003 employees, 7533 answered the baseline questionnaires (84%). Altogether 9373 subjects received the follow-up questionnaire, and 6617 subjects responded (71%). In total 4240 completed the questionnaire on both occasions, and this group comprised the study population. SRH consisted of the response to a single question: 'In general, would you say your health is excellent, very good, good, poor, or very poor?' The health was investigated in terms of the development of health status in the 3-year follow-up. The exposure factors were: financial situation, education, and managerial responsibility. Odds ratios were analysed using logistic regressions. Results. Good financial situation and further education were predictors in maintaining good health and in avoiding poor health. The analysis also indicated the following determinants of sustained good SRH: having a good financial situation (OR 1.99 at baseline and OR 1.87 at follow-up), having a further education compared to lower education (OR 1.17 at baseline), and not having a worsening financial situation between baseline and follow-up (OR 0.53). Conclusion. Financial situation and educational level were important factors that influence the subjective perception of health.
Upsala journal of medical sciences 08/2012; · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to examine the relation between occupational and nonoccupational conditions and both incident
(IBLP) and chronic low back pain (CLBP), aswellasdepression, among women and men. Data from a4-year follow-up of a study group
consisting of 420 participants of both genders from the general Swedish population were analysed. Occupational risk indicators
were predictors for both ILBP and CLBP. Depression was not found to be a predictor for either IBLP or CLBP among women, but
was a predictor for CLBP among men. Among women, depression had some risk indicators in common with ILBP and appeared to be
a concurrent outcome rather than a risk indicator. Low back pain in 1993 was not a predictor for depression in 1997 in either
women or men. Occupational conditions are of relevance in relation to both incident and CLBP. Nonoccupational conditions were
stronger predictors for CLBP than for ILBP but had some predictive value also for ILBP.
International Journal of Behavioral Medicine 04/2012; 7(4):372-392. · 2.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Studies have shown associations between higher income and better health, but income has not been studied in relation to neck pain. The aims of this cohort study were to assess the sex-specific role of disposable income for onset and prognosis of neck pain in the general population and if economic stress influences such potential associations.
Two subcohorts were identified in the Stockholm Public Health Cohort with data from 2002. Cohort I (risk cohort) included persons without neck pain (n=8348). Cohort II (prognostic cohort) included persons with occasional neck pain during the previous 6 months (n=10 523). Both cohorts were assessed for long duration troublesome neck pain (LDNP) in 2007. Individual income was defined as aggregated annual family income in 2002 with each family member assigned a weighted consumption share, based on salary, pensions and social benefits. LDNP in 2007 was defined as having had troublesome neck pain lasting for three or more consecutive months the previous 5 years. Association between income and LDNP, considering potential confounding, was investigated by multivariable logistic regression. Economic stress was tested as effect modifier between income and LDNP.
In both cohorts, associations were found between lower income and a higher risk for LDNP. The results were similar between the sexes. Economic stress modified the associations in both cohorts.
Low income may be a risk as well as prognostic factor for developing LDNP. Furthermore, the results indicate that economic stress may be an underlying factor to consider when studying associations between income and neck pain.
Journal of epidemiology and community health 03/2012; 66(11):1063-70. · 3.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effect of health status on productivity has widely been studied and discussed in literature. Valid and reliable tools are needed to evaluate the levels of health and productivity and provide detailed information, before any intervention is implemented. World Health Organization Health and Work Performance Questionnaire (HPQ) is a widely used instrument in estimating the workplace costs of health problems in terms of reduced job performance, sickness absence, and work-related accidents and injuries.
To assess the reliability and validity of Persian version of HPQ in Iranian health care workers.
The questionnaire was translated to Persian and back translated. 102 health care workers completed the questionnaire. Absence and sick-leave data was extracted from administrative records.
Factor analysis revealed acceptable validity for the questionnaire in part A (health). Cronbach's alpha was >0.73 for all scales of Parts B (work) and C (demographic). Questions targeting days of absence and sick-leave had acceptable correlation with administrative records (Pearson's r >0.75), while questions on total hours worked showed lower correlation.
Persian version of HPQ can be considered a reliable and valid tool in Iranian health workers.
The international journal of occupational and environmental medicine. 01/2012; 3(1):33-8.
[Show abstract][Hide abstract] ABSTRACT: Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the long-term effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system.
Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires.
89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p < or = 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group.
Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.
Current Controlled Trials ISRCTN56954776.
[Show abstract][Hide abstract] ABSTRACT: To investigate the associations between smoking and alcohol consumption, and long-term sick leave due to unspecific back or neck pain among employees in the public sector.
A 3-year prospective cohort study.
Approximately 9000 persons in the public sector in Sweden were invited to participate. Of these, 7533 answered a questionnaire and 6532 were included in the study, classified as having "good health for working".
New periods of sick leave >or= 28 days were consecutively reported from the employers or the occupational health service during a period of 3 years. Rate ratios were estimated by means of Cox proportional hazard regression model.
Smoking was associated with an increased risk of long-term sick leave due to unspecific back or neck pain. Compared with people who have never smoked, "ever smokers" had a higher risk (rate ratio = 1.8, 95% confidence interval: 1.3-2.4). Alcohol consumption tended to be associated with a decreased risk, but the results were not statistically significant.
Our results suggest that smoking is a risk factor for long-term sick leave due to unspecific back or neck pain. Moderate alcohol consumption tends to have a protective effect, at least among women in the public sector.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 06/2009; 41(7):550-6. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Four-year prospective cohort study.
To find the incidence of sick leave because of neck and shoulder pain (NSP) in industrial workers, and its association with work and lifestyle risk factors.
Longitudinal studies to investigate NSP incidence and risk factors are rare, and even fewer have been conducted in middle- and low-income countries.
After inviting all full-time employees of an Iranian car manufacturing company with 18,031 employees to participate in a baseline study, they were followed for 4 years. New episodes of sick leave because of NSP have been calculated based on sickness absence registration between the years 2003 and 2007. The incidence was compared for participants and nonparticipants. The association between sick leave, physical, and psychosocial risk factors at work, and previous self-reported NSP, was calculated for the remaining population of baseline participants (12,184 employees) during a 4-year follow-up.
During a 4-year follow-up of study subjects for the remaining participants of the baseline study, the incidence of sick leave was 0.8% (98 sick leave cases in 12,184 employees). For nonparticipants this incidence was 4.2% (130 cases in 3127 employees). In the final regression model for sick leave cases, the remaining factors for potential physical risk factors were repetitive work and sitting positions at work; for psychosocial factors unattractive work was the only significant remaining factor.
The incidence of NSP based on sick leave is definitely very low compared with previous studies in high-income countries. This incidence varies between participants and nonparticipants. Risk factors for sick leave differ from risk factors for self-reported pain. A young population, job security, the insurance system, different health behaviors, and healthy worker bias, are all factors that may affect the results, and sick-leave as an outcome must be interpreted with more caution in middle- and low-income countries.
[Show abstract][Hide abstract] ABSTRACT: The aim was to identify psychosocial factors at work that promote positive changes in employee health and factors that prevent negative changes in employee health.
This study is part of a large longitudinal study and includes 1212 employees. Data for psychosocial work factors and self rated health was collected in 2000 and 2003. A modified Poisson regression was used to find factors of relevance for positive and negative changes in health.
A negative change in leadership, organizational commitment and reporting job strain increased the risk for negative change in health. Improved leadership and social climate increased the chance for positive changes in health.
By improving psychosocial factors at work, it is possible to promote employee health as well as prevent employee ill-health.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 03/2009; 51(2):195-203. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To predict sickness absence by three health check-up models.
A study group of 821 participants from the public sector in Sweden where three health check-up models were compared 1) the limited variable model including smoking, body mass index, blood pressure, and cholesterol, 2) the several variable model including smoking, waist-hip ratio, blood pressure, relation between low density lipoproteins and high density lipoproteins, serum triglycerides, and fitness test, and 3) Self-rated health measured by one single question. Sickness absence data during 1 year was delivered from the employer.
The three models served their purpose to predict sickness absence.
The self-rated health-model with one single question has as good quality in predestination as more complicated models. This may have an implication for cost-effective procedures in occupational health services.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 02/2009; 51(1):104-11. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the consequences of long-term sick leave (>28 days) on working situation, health and lifestyle among employees from the public sector in Sweden.
Employees in four county councils and two municipalities on long term sick leave on 1 November 2005 (n = 1,128) answered a questionnaire in February 2006. The response rate was 71.7%. Eighty seven per cent were still on sick leave when the questionnaire was answered: 54% part time and 33% full time.
Reporting positive consequences was rare but reporting negative consequences, such as effects on the development of salary, the possibilities of pursuing a career or to change to another job were common. Sick leave seemed to lead to a considerable loss of zest for work, even if the respondents were back in work full time. Regardless of the negative consequences at work, 92% of those on part-time sick leave believed that the part-time sick leave was good for them even if many thought it had negative consequences for employer and colleagues.
Long-term sick leave has negative consequences for the individual in work situations, even for those back at work full time. The development of salary and career seem to be most affected. The attitude towards part-time sick leave was positive and this result indicates that there is a potential for an increased degree of partial return to work in the group of people on long-term sick leave.
Scandinavian Journal of Public Health 01/2009; 37(1):50-6. · 3.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Accumulating evidence indicates that body weight, alcohol and smoking are associated with psoriasis. However, these factors have scarcely been investigated in relation to onset and disease activity at onset of psoriasis. A population-based case-control study was performed including 373 cases with onset of first-time plaque psoriasis within 12 months and matched healthy controls. Psoriasis activity was measured using the Psoriasis Area and Severity Index (PASI). Analyses were performed using conditional logistic regression. In multivariable analyses for each unit increment in body mass index, there was statistically significant 9% increased risk for psoriasis onset and 7% higher risk for increased PASI. Obesity (body mass index > or =30) compared with normal body weight was associated with a two-fold increased risk for psoriasis onset. Smoking was associated with a 70% increased risk for onset, but was not related to PASI. A positive association with alcohol drinking was observed among men, but not among women. No associations were observed for weight gain and use of smokeless tobacco. Our results indicate that excessive body weight and smoking are risk factors for onset of psoriasis and that higher body mass index increases the PASI of plaque psoriasis at onset.