National Research Centre for the Working Environment

Objectives Previous studies have indicated that maternal occupational psychosocial stressors may affect the risk of asthma in the offspring, but their results are inconsistent. Maternal occupational ergonomic strain is associated with predictors of fetal lung development, including preterm birth and low birthweight; however, it is not known, whether ergonomic strain during pregnancy is a risk factor for asthma in offspring. The aim was to investigate maternal psychosocial stressors and ergonomic strain during pregnancy relative to the risk of offspring asthma. Methods Live- and firstborn singletons (1996–2018) and their mothers were identified from Danish nationwide registers. Job code at time of conception was assigned to each mother and linked with exposure estimates from job exposure matrices (JEMs) of psychosocial stressors and ergonomic strain. Diagnoses of childhood asthma were retrieved from the Danish National Patient Register. Incidence rate ratios (IRR) of asthma were estimated using Poisson regression; adjusted for maternal asthma, age at conception, socioeconomic position, and body mass index, and calendar year. Results Maternal employment in occupations with low decision authority (IRR: 1.08, 95% CI 1.00–1.16) and high ergonomic strain (IRR: 1.09, 95% CI 1.02–1.16) was associated with increased risk of asthma among male offspring. Largely similar, but less consistent, associations were observed among female offspring due to low decision authority. Conclusion We found a minor increased risk of asthma among offspring whose mothers worked in an occupation with low decision authority or high ergonomic strain, most pronounced among male offspring.

Introduction Cardiovascular health is a crucial aspect of overall health. The aim of this study was to estimate the prevalence of cardiovascular risk factors among children and adolescents during the COVID‐19 pandemic based on the Life's Essential 8 domains. Methods PubMed, Scopus and Web of Science were systematically searched until 24 February 2023. Studies had to meet the following criteria: (1) observational studies, (2) studies reporting proportion of selected risk factors, (3) studies involving children or adolescents, (4) studies that collected data during the COVID‐19 pandemic and (5) studies with representative samples. The outcomes included were diet, physical activity, nicotine exposure, sleep health, obesity, dyslipidaemia, diabetes and elevated blood pressure. Results Sixty‐two studies with 1 526 173 participants from 42 countries were included. Of these, 41 studies were used in the meta‐analyses. The overall pooled prevalence of risk factors in the behavioural domain was as follows: poor quality diet 26.69% (95% CI 0.00%–85.64%), inadequate physical activity 70.81% (95% CI 64.41%–76.83%), nicotine exposure 9.24% (95% CI 5.53%–13.77%) and sleep disorders 33.49% (95% CI 25.24%–42.28%). The overall pooled prevalence of risk factors in the health domain was as follows: obesity 16.21% (95% CI 12.71%–20.04%), dyslipidaemia 1.87% (95% CI 1.73%–2.01%), diabetes 1.17% (95% CI 0.83%–1.58%) and elevated blood pressure 11.87% (95% CI 0.26%–36.50%). Conclusions These results highlight the need for prevention strategies to maintain better cardiovascular health from an early age, particularly by increasing physical activity levels, sleep time and promoting the consumption of more fruits and vegetables.

Background To protect the safety and health of workers, national legislations often stipulate an upper limit to weekly working time. The purpose of the present study was to provide information that may facilitate the obtainment of evidence-based limits to weekly working time. Objective To estimate incidence rate ratios (RRs) of (i) hospital treatment or death due to accidental injuries, (ii) redeemed prescriptions for psychotropic drugs and (iii) redeemed prescriptions for antihypertensive drugs, respectively, as continuous functions of weekly working hours among employees in the general population of Denmark. Methods Baseline data on working time arrangements were obtained from the Danish Labor Force Surveys of 1999–2013. Follow-ups with a mean duration of 1.8, 4.0 and 6.6 years for accidental injuries, psychotropic drugs and antihypertensive drugs, respectively, were accomplished through national registers. Adjusted RRs were obtained through Poisson regression in the interval 32–80 weekly working hours (wwh). The reference (standard working hours) was set at 37 wwh. RR estimates were interpreted in accordance with a modified version of Monson’s guide to strength of associations, in which a RR in the open interval 0.83 to 1.2 is classified as ‘no association’ (too weak to be detected by observational studies). Results The estimated RRs as well as the upper and lower limits of their 95% confidence intervals lied within the no-association zone throughout the intervals 32–76, 32–64 and 32–69 wwh, for accidental injury, psychotropic drug use and antihypertensive drug use, respectively. The estimated RRs for psychotropic drug use decreased from 1.08 (95% CI: 1.03–1.13) at 32 wwh to 0.96 (0.93–0.99) at 45 wwh. They thereafter increased to 1.00 (0.95–1.06) at 55 wwh and 1.31 (1.08–1.63) at 80 wwh. The estimated RRs for accidental injury and antihypertensive drug use increased slowly from 1.00 at 37 wwh to 1.04 (0.88–1.24) and 1.11 (0.94–1.31), respectively, at 80 wwh. Conclusion These results suggest that, from a societal perspective, the effect of wwh on the rates of these types of morbidity is negligible throughout the interval 32–64 wwh.

Objectives This study aims to investigate (1) the microbial community composition by work characteristics and (2) the association between microbial genera level and inflammatory markers among recycling workers. Methods In this cross-sectional study, inhalable dust was collected with personal samplers from 49 production (86 samples) and 10 administrative workers (15 samples). Four groups of micro-organisms were identified down to species-level (aerobic and anaerobic bacteria, and fungi grown at 25°C and 37°C). Inflammatory markers were measured in serum collected at the end of the work shift. Microbial community composition was investigated using redundancy analysis and heatmaps. Associations between the most prevalent microbial genera and inflammatory markers were explored by mixed-effects regression. Results Community composition of all groups of micro-organisms except fungi (37°C) differed between production and administrative workers and by type of waste and season among the production workers. Overall, Bacillus , Staphylococcus , Aspergillus and Penicillium were the most prevalent genera. CC16 concentrations increased with Penicillium genus level, C reactive protein and serum amyloid A with Staphylococcus , interleukin 2 (IL-2) and tumour necrosis factor with Bacillus , and IL-8 with Aspergillus . IL-1B decreased with Staphylococcus genus level. Remaining analyses showed no statistically significant associations between microbial genera level and inflammatory markers. Conclusions Recycling workers are exposed to different compositions of microbial species than administrative workers depending on the type of waste handled and season. Specific systemic inflammatory effects were suggested for a limited number of microbial genera that need to be corroborated by future studies.

This work investigated the application of a reporter gene bioassay in assessing polycyclic aromatic hydrocarbon (PAH) exposure in trainee firefighters. In the PAH CALUX bioassay, the PAH-induced activation of the aryl hydrocarbon receptor in a reporter cell line is recorded by increased luminescence. A repeated measurement study was performed, collecting urine and skin wipe samples at two baseline sessions (spring and autumn) and after three firefighting sessions: one with wood fuel, one with gas fuel, and one without fire. The bioassay response was expressed as benzo[a]pyrene equivalents, which was compared to levels of 16 EPA criteria PAHs in skin wipe samples and 8 hydroxylated PAHs (OH-PAHs) in urine samples quantified by chromatography–tandem mass spectrometry techniques. Benzo[a]pyrene equivalents and PAH levels in skin wipes indicated larger exposure to PAHs during the wood session compared to the other sessions. The urine bioassay showed non-significant effect sizes after all sessions, whereas the chemical analysis showed increased OH-PAH levels after the gas session. The non-significant changes observed for the session without fire suggest a negligible exposure from contaminated gear. In conclusion, the bioassay response for skin wipes shows that trainee firefighters were exposed to higher levels of potentially toxic PAHs during the wood fire training session.

Background : There is a dearth of knowledge regarding the relationship between engaging in moderate and vigorous physical activity and long-term sickness absence (LTSA), particularly among various population subgroups such as individuals of different ages or body mass indices. We aimed to evaluate the prospective associations of moderate and vigorous leisure-time physical activity with the risk of LTSA in the general working population. Methods : A prospective cohort study with a 2-year register follow-up was conducted, where 68,222 representative workers from Denmark completed a questionnaire about work environment, lifestyle, and health. Data on LTSA (≥6 consecutive weeks of sickness absence) were obtained from the Danish Register for Evaluation of Marginalization. We used Cox regression for the statistical analysis, adjusting for relevant confounding factors. We also performed age- and BMI-stratified analyses. Results : In the fully adjusted model, 2 to 4 hours per week of moderate activity (hazard ratios [HR] = 0.87; 95% CI, 0.77 to 0.99) and ≥2 hours per week of vigorous activity reduced LTSA risk compared with no physical activity. However, 2 to 4 hours per week of vigorous activity (HR = 0.84; 95% CI, 0.76 to 0.91) provided the greatest risk reduction. In the total sample, the complete absence of vigorous activity was associated with increased risk of LTSA (HR = 1.13; 95% CI, 1.05 to 1.22). In stratified analyses, the results were consistent for workers <50 years (HR = 1.14; 95% CI, 1.03 to 1.26), ≥50 years (HR = 1.13; 95% CI, 1.02 to 1.26), and those with a BMI ≥ 25 (HR = 1.16; 95% CI, 1.06 to 1.28). The complete absence of moderate activity was not associated with LTSA. Conclusion : Vigorous leisure-time physical activity appears to be more important than moderate activity to prevent LTSA.

Background: Poor sleep and physical inactivity are lifestyle-related behaviors that impact cardiometabolic health, but there is limited insight into their combined association with cardiometabolic markers. Aims: This study investigated the joint association of device-measured sleep patterns (regularity and duration) and daily step counts with cardiometabolic biomarkers. Methods: Harmonized individual participant data of 12,223 adults (mean±SD age:54.6±9.5 years; 54.8% female) from the pooled Prospective Physical Activity, Sitting and Sleep consortium (ProPASS), comprising six cohorts with thigh-worn accelerometry data were analysed. Sleep regularity was assessed using the validated Sleep Regularity Index (SRI, range 0-100), quantifying day-to-day sleep consistency. We used generalized linear models to examine cross-sectional joint associations between sleep patterns, regularity (SRI tertiles ≤75.8, low; 75.8-84.5, medium; >84.5, high) and duration (<7h, short; 7-8h, adequate; >8h, long), and daily step counts (step tertiles <8488, low; 8488-11601, medium; >11601, high steps/day) with a composite cardiometabolic health score and individual biomarkers, including BMI, waist circumference, total cholesterol, HDL cholesterol, triglycerides, and HbA1c. Results: Lower sleep regularity, deviation from adequate sleep, along with lower step counts were adversely associated with the composite cardiometabolic health risk score. Compared to optimal sleep patterns (SRI>84.5 or 7-8h/day) and high step groups, low sleep regularity and short sleep duration were separately associated with the least favourable composite cardiometabolic health (z-score [95%CI] 0.32 [0.28,0.37] and 0.25 [0.21,0.29], respectively) among participants with low volume of steps. Low sleep regularity and low daily steps were jointly associated with higher BMI (2.98 [2.67,3.29] kg/m ² ), waist circumference (8.61 [7.81,9.4] cm), total cholesterol (0.15 [0.08,0.23] mmol/L), and lower HDL levels (0.17 [0.14,0.2] mmol/L), regardless of sleep duration. For short/long sleep duration and low daily step count, such associations were only evident in BMI and waist circumference. Conclusions: Our findings suggest that the potential deleterious associations of irregular or inadequate sleep duration with cardiometabolic health outcomes may be exaggerated by lower daily step counts. Future studies should examine the prospective joint association of sleep patterns and physical activity on cardiometabolic health.

BACKGROUND Blood pressure (BP)–lowering effects of structured exercise are well-established. Effects of 24-hour movement behaviors captured in free-living settings have received less attention. This cross-sectional study investigated associations between a 24-hour behavior composition comprising 6 parts (sleeping, sedentary behavior, standing, slow walking, fast walking, and combined exercise-like activity [eg, running and cycling]) and systolic BP (SBP) and diastolic BP (DBP). METHODS Data from thigh-worn accelerometers and BP measurements were collected from 6 cohorts in the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) (n=14 761; mean±SD, 54.2±9.6 years). Individual participant analysis using compositional data analysis was conducted with adjustments for relevant harmonized covariates. Based on the average sample composition, reallocation plots examined estimated BP reductions through behavioral replacement; the theoretical benefits of optimal (ie, clinically meaningful improvement in SBP [2 mm Hg] or DBP [1 mm Hg]) and minimal (ie, 5-minute reallocation) behavioral replacements were identified. RESULTS The average 24-hour composition consisted of sleeping (7.13±1.19 hours), sedentary behavior (10.7±1.9 hours), standing (3.2±1.1 hours), slow walking (1.6±0.6 hours), fast walking (1.1±0.5 hours), and exercise-like activity (16.0±16.3 minutes). More time spent exercising or sleeping, relative to other behaviors, was associated with lower BP. An additional 5 minutes of exercise-like activity was associated with estimated reductions of –0.68 mm Hg (95% CI, –0.15, –1.21) SBP and –0.54 mm Hg (95% CI, –0.19, 0.89) DBP. Clinically meaningful improvements in SBP and DBP were estimated after 20 to 27 minutes and 10 to 15 minutes of reallocation of time in other behaviors into additional exercise. Although more time spent being sedentary was adversely associated with SBP and DBP, there was minimal impact of standing or walking. CONCLUSIONS Study findings reiterate the importance of exercise for BP control, suggesting that small additional amounts of exercise are associated with lower BP in a free-living setting.

Objective Major organizational changes may be associated with both positive and negative uncertainty in working life. This study described the prevalence of organizational changes (reorganizations or round of layoffs) within different job functions in Denmark and investigated whether quality of the implementation process (measured as “information”, “involvement” and “consent”) was associated with employees’ expectations regarding retirement age. Methods A representative sample of older Danish employees ≥ 50 years (n = 12,269) replied to a questionnaire survey in 2020. In cross-sectional analyses, we compared employee’s expected retirement age being either not exposed to organizational changes or exposed to implementation processes of high, moderate or low-quality, respectively. Analyses were further stratified for job function: office work, work with people and work in the field of production. Results More than half (56%) of the employees had experienced organizational changes within the past 2 years, and 23% of those effected reported that the changes had led to considerations of earlier retirement. Organizational changes were most prevalent within office work, and least prevalent within the job function working with people. The analyses showed significantly lower expected retirement age when the implementation process had been of moderate (mean reduction of 0.45 years) or low quality (mean reduction of 0.71 years) compared to high quality implemented changes. Conclusions Experiences of organizational change processes of moderate or poor quality were associated with expectations of earlier retirement, while well implemented changes were not. This study underscores the importance of good implementation when changes at the organizational level are needed.

Background The worldwide prevalence of diabetes is increasing, particularly among older adults. Understanding the association between muscle strength and mortality in this population is crucial for developing targeted exercise recommendations. Objectives To assess the prospective association of muscle strength with mortality in older adults with diabetes. Methods From the Survey of Health, Ageing and Retirement in Europe (SHARE) study, spanning 28 countries, we included 16 149 diabetic adults aged 50 years and older (mean age 68.2 [standard deviation, SD, 9.2] years). Participants fulfilled two criteria: (1) diabetes diagnosis (ever) and (2) current use of diabetes medication. Muscle strength was assessed using handgrip dynamometry (unit: kg). Using time‐varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with all‐cause and cause‐specific mortality, controlling for various confounders. Results Over a mean follow‐up of 5.9 years (SD 3.8), 2754 participants died (17%). Using the median level of muscle strength as reference (30 kg), lower and higher levels were associated in a curvilinear fashion with higher and lower all‐cause mortality risk, respectively. The 10th percentile of muscle strength (17 kg) showed a hazard ratio (HR) of 1.65 (95% confidence interval (CI) 1.53–1.79). The 90th percentile (47 kg) of muscle strength showed a HR of 0.55 (95% CI 0.49–0.63). A somewhat similar pattern, with varying strength of associations, was seen for mortality due to cardiovascular disease (CVD), respiratory disease, severe infectious disease, digestive system disease and cancer. Conclusion Muscle strength is gradually and inversely associated with all‐cause and cause‐specific mortality risk in older adults with diabetes. As muscle strength is highly adaptable to resistance training at all ages, the present findings highlight the importance of improving muscle strength in older adults with diabetes.

Background Ageing is associated with a gradual loss of muscle strength, which in the end may have consequences for survival. Whether muscle strength and mortality risk associate in a gradual or threshold‐specific manner remains unclear. This study investigates the prospective association of muscle strength with all‐cause mortality in the oldest old. Methods We included 1890 adults aged ≥ 90 years (61.6% women, mean age 91.0 ± 1.5 years) from 27 European countries and Israel participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) study. Muscle strength was assessed using handgrip dynamometry (unit: kilogram). Using time‐varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with mortality, controlling for age, sex, smoking, BMI, marital status, education, geographical region and self‐perceived health. Results Over a mean follow‐up of 4.2 ± 2.4 years, more than half of the participants died (n = 971, 51.4%). The mean handgrip strength was 20.4 ± 8.0 kg for all participants, with men (26.7 ± 7.5 kg) showing significantly higher strength than women (16.4 ± 5.4 kg) (p < 0.001). Using the median level of muscle strength as reference (18 kg), lower and higher levels were associated in a gradual and curvilinear fashion with higher and lower mortality risk, respectively. The 10th percentile of muscle strength (10 kg) showed a hazard ratio (HR) of 1.27 (95% CI 1.13–1.43, p < 0.001). The 90th percentile (31 kg) showed an HR of 0.69 (95% CI 0.58–0.82, p < 0.001). Stratified for sex, the median levels of muscle strength were 26 kg for men and 16 kg for women. The 10th percentile of muscle strength showed HRs of 1.33 (95% CI 1.10–1.61, p < 0.001) at 15 kg for men and 1.19 (95% CI 1.05–1.35, p < 0.01) at 10 kg for women. The 90th percentile of muscle strength showed HRs of 0.75 (95% CI 0.59–0.95, p < 0.01) at 35 kg for men and 0.75 (95% CI 0.62–0.90, p < 0.001) at 23 kg for women. Sensitivity analyses, which excluded individuals who died within the first 2 years of follow‐up, confirmed the main findings. Conclusion Rather than a specific threshold, muscle strength is gradually and inversely associated with mortality risk in the oldest old. As muscle strength at all ages is highly adaptive to resistance training, these findings highlight the importance of improving muscle strength in both men and women among the oldest old.

Background Social anxiety disorder (SAD) is a long-term and overwhelming fear of social situations that can affect work, school, and other daily activities. Although cognitive behavioral therapy is effective, few seek treatment, and many who do start often drop out. This may be due to the component of exposure inherent to cognitive behavioral therapy, where the patient confronts feared stimuli outside the therapist’s office, which they otherwise try to avoid. As an alternative, research has explored the effectiveness of virtual reality (VR)–based exposure therapy with promising results. However, few studies have investigated the feasibility of VR tools using mixed methodologies before assessing their efficacy. Objective This study aims to assess the usability, feasibility, and presence of four 360° virtual environments and whether these were able to evoke anxiety in patients with SAD. Methods A total of 10 adult participants with SAD and 10 healthy controls were recruited for 1 experimental session (age range 21-32 y; 12/20, 60% male participants). Questionnaire and interview data were collected and analyzed. A mixed methods triangulation design was applied to analyze and compare the data. Results Participants with SAD experienced increased anxiety when exposed to VR, and environments were considered relevant and useful as an exposure tool. Participants with SAD reported significantly higher average anxiety levels (P=.01) and peak anxiety levels (P=.01) compared with controls during exposure; however, significant differences in anxiety when accounting for baseline anxiety levels were only found in 2 of 4 environments (P=.01, P=.01, P=.07, and P=.06). While presence scores were acceptable in both groups, participants with SAD scored significantly lower than controls. Qualitative analyses highlight this finding within the SAD group, where some participants experienced presence reduction due to being observed while in VR and in situations with reduced interaction in VR. Conclusions VR exposure with 360° videos seems to be useful as a first step of exposure therapy for patients with SAD. Future exploration in the clinical application of VR-based exposure for SAD, as well as means of increasing presence within the virtual environments, may be useful.

Background: ActiMotus, a thigh-accelerometer-based software used for the classification of postures and movements (PaMs), has shown high accuracy among adults and school-aged children; however, its accuracy among younger children and potential differences between sexes are unknown. This study aimed to evaluate the accuracy of ActiMotus to measure PaMs among children between 3 and 14 years and to assess if this was influenced by the sex or age of children. Method: Forty-eight children attended a structured ~1-hour data collection session at a laboratory. Thigh acceleration was measured using a SENS accelerometer, which was classified into nine PaMs using the ActiMotus software. Human-coded video recordings of the session provided the ground truth. Results: Based on both F1 scores and balanced accuracy, the highest levels of accuracy were found for lying, sitting, and standing (63.2-88.2%). For walking and running, accuracy measures ranged from 48.0 to 85.8%. The lowest accuracy was observed for classifying stair climbing. We found a higher accuracy for stair climbing among girls compared to boys and for older compared to younger age groups for walking, running, and stair climbing. Conclusions: ActiMotus could accurately detect lying, sitting, and standing among children. The software could be improved for classifying walking, running, and stair climbing, particularly among younger children.

Inhalation of nanosized metal oxides may occur at the workplace. Thus, information on potential hazardous effects is needed for risk assessment. We report an investigation of the genotoxic potential of different metal oxide nanomaterials. Acellular and intracellular reactive oxygen species (ROS) production were determined for all the studied nanomaterials. Moreover, mice were exposed by intratracheal instillation to copper oxide (CuO) at 2, 6, and 12 μg/mouse, tin oxide (SnO 2 ) at 54 and 162 μg/mouse, aluminum oxide (Al 2 O 3 ) at 18 and 54 μg/mouse, zinc oxide (ZnO) at 0.7 and 2 μg/mouse, titanium dioxide (TiO 2 ) and the benchmark carbon black at 162 μg/mouse. The doses were selected based on pilot studies. Post‐exposure time points were 1 or 28 days. Genotoxicity, assessed as DNA strand breaks by the comet assay, was measured in lung and liver tissue. The acellular and intracellular ROS measurements were fairly consistent. The CuO and the carbon black bench mark particle were potent ROS generators in both assays, followed by TiO 2 . Al 2 O 3 , ZnO, and SnO 2 generated low levels of ROS. We detected no increased genotoxicity in this study using occupationally relevant dose levels of metal oxide nanomaterials after pulmonary exposure in mice, except for a slight increase in DNA damage in liver tissue at the highest dose of CuO. The present data add to the body of evidence for risk assessment of these metal oxides.

Background : Poor health in passenger rail drivers, resulting from perceived highly sedentary work and leisure time, has implications for public safety. To date, no studies have described the physical behaviors of passenger rail drivers. This study aimed to characterize the physical behaviors of passenger rail drivers by investigating the volume, pattern, variation, and composition of behaviors at and outside of work. Methods : A convenience sample of 31 rail drivers (77% male, median age 51.0 [12.5] y) in South Australia wore an activity monitor on their right thigh for 8 days and completed a work logbook. Physical behaviors (sitting, standing, light-intensity physical activity, moderate- to vigorous-intensity physical activity [MVPA], and steps) were recorded for workdays and nonworkdays, and work and nonwork time on workdays. The volume, bouts, between-participants variation, and 3-way composition were compared across the 4 time periods. Results : Drivers sat for 10.6 (1.5) hours, did 76.3 (38.8) minutes of MVPA, and took 9727.3 (4088.4) steps daily. At work, drivers were sitting 369.3 (41.8) minutes (187.1 [54.2] min in prolonged bouts) and doing MVPA 31.7 (10.0) minutes. Between-participants variation in sitting time during work (11%) was lower than both nonwork on a workday (19%) and on a nonworkday (24%; P < .001). Compositions at work differed from nonwork on workdays ( F = 27.7, P < .001), as did compositions on workdays compared with nonworkdays ( F = 6.8, P = .002). Conclusions : Passenger rail drivers were highly sedentary, but also surprisingly active. At work, drivers were more sedentary and had lower variation in behaviors, suggesting work constraints play an important role. Therefore, work may be the most appropriate domain to intervene for promoting healthy physical behavior profiles among these passenger rail drivers.