[Show abstract][Hide abstract] ABSTRACT: To inform case-definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9,150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The one-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs. 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs. 1.3) and poor mental health (PRR 1.3 vs. 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs. 61.7%). Our findings highlight important epidemiological distinctions between sub-categories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain which is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Multimorbidity research typically focuses on chronic and common diseases in patient and/or older populations. We propose a multidimensional multimorbidity score (MDMS) which incorporates chronic conditions, symptoms, and health behaviors for use in younger, presumably healthier, working populations.
Cross-sectional study of 372,370 Spanish workers who underwent a standardized medical evaluation in 2006. We computed a MDMS (range 0-100) based on the sex-specific results of a multicorrespondence analysis (MCA). We then used Cox regression models to assess the predictive validity of this MDMS on incident sickness absence (SA) episodes.
Two dimensions in the MCA explained about 80 % of the variability in both sexes: (1) chronic cardiovascular conditions and health behaviors, and (2) pain symptoms, in addition to sleep disturbances in women. More men than women had at least one condition (40 vs 15 %) and two or more (i.e., multimorbidity) (12 vs 2 %). The MDMS among those with multimorbidity ranged from 16.8 (SD 2.4) to 51.7 (SD 9.9) in men and 18.5 (SD 5.8) to 43.8 (SD 7.8) in women. We found that the greater the number of health conditions, the higher the risk of SA. A higher MDMS was also a risk factor for incident SA, even after adjusting for prior SA and other covariates. In women, this trend was less evident.
A score incorporating chronic health conditions, behaviors, and symptoms provides a more holistic approach to multimorbidity and may be useful for defining health status in working populations and for predicting key occupational outcomes.
No preview · Article · Nov 2015 · International Archives of Occupational and Environmental Health
[Show abstract][Hide abstract] ABSTRACT: Objective:
Examine the prevalence of musculoskeletal pain (MSP) in the six Spanish-speaking countries of Central America using a single standardized instrument, the First Survey on Working Conditions and Health in Central America in workers from all manual and non-manual labor sectors, using social security coverage as an indicator of formal versus informal employment.
The workers (n = 12 024) were surveyed in their homes. The age-adjusted prevalence of MSP during the previous month was calculated for pain in the back (upper, or cervical; middle, or thoracic; and lower, or lumbar) and arm joints (shoulder, elbow, and wrist). Prevalence was estimated by sex, occupation (manual or non-manual), economic sector (agriculture, industry, or services), and social security coverage. Poisson regression models were used to calculate the prevalence rates and 95% confidence intervals, with stratification by country and anatomical site.
By sites, the age-adjusted prevalence of cervical-dorsal MSP was the highest, especially in El Salvador (47.8%) and Nicaragua (45.9%), and lumbar MSP was less prevalent, especially in Panama (12.8%) and Guatemala (14.8%). After additional adjustments, the prevalence of MSP was higher in women and manual workers for all the sites and in all the countries. There were no differences in MSP in terms of social security coverage or sector of economic activity.
The high prevalence of MSP in Central America, regardless of sector of activity or social security coverage, indicates that the prevention of MSP should be a priority in occupational health programs in low- and middle-income countries, especially for women and manual workers.
No preview · Article · Nov 2015 · Revista Panamericana de Salud Pública
[Show abstract][Hide abstract] ABSTRACT: High-quality and comparable data to monitor working conditions and health in Latin America are not currently available. In 2007, multiple Latin American countries started implementing national working conditions surveys. However, little is known about their methodological characteristics.
To identify commonalities and differences in the methodologies of working conditions surveys (WCSs) conducted in Latin America through 2013.
The study critically examined WCSs in Latin America between 2007 and 2013. Sampling design, data collection, and questionnaire content were compared.
Two types of surveys were identified: (1) surveys covering the entire working population and administered at the respondent's home and (2) surveys administered at the workplace. There was considerable overlap in the topics covered by the dimensions of employment and working conditions measured, but less overlap in terms of health outcomes, prevention resources, and activities.
Although WCSs from Latin America are similar, there was heterogeneity across surveyed populations and location of the interview. Reducing differences in surveys between countries will increase comparability and allow for a more comprehensive understanding of occupational health in the region.
No preview · Article · Jun 2015 · International journal of occupational and environmental health
[Show abstract][Hide abstract] ABSTRACT: We evaluated the short-term effects of exposure to cleaning products on lung function and respiratory symptoms among professional cleaning women.
Twenty-one women with current asthma and employed as professional cleaners participated in a 15-day panel study. During 312 person-days of data collection, participants self-reported their use of cleaning products and respiratory symptoms in daily diaries and recorded their forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) three times per day using a handheld spirometer. We evaluated associations of cleaning product use with upper and lower respiratory tract symptoms using Poisson mixed regression models and with changes in FEV1 and PEF using linear mixed regression analyses.
Participants reported using an average of 2.4 cleaning products per day, with exposure to at least one strong irritant (eg, ammonia, bleach, hydrochloric acid) on 56% of person-days. Among participants without atopy, lower respiratory tract symptoms were associated with the use of hydrochloric acid and detergents. Measurements of FEV1 and PEF taken in the evening were 174 mL (95% CI 34 to 314) and 37 L/min (CI 4 to 70), respectively, lower on days when three or more sprays were used. Evening and next morning FEV1 were both lower following the use of hydrochloric acid (-616 and -526 mL, respectively) and solvents (-751 and -1059 mL, respectively). Diurnal variation in FEV1 and PEF increased on days when ammonia and lime-scale removers were used.
The use of specific cleaning products at work, mainly irritants and sprays, may exacerbate asthma.
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.
Full-text · Article · Apr 2015 · Occupational and environmental medicine
[Show abstract][Hide abstract] ABSTRACT: Objective:
To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors.
All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated.
We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32).
County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.
No preview · Article · Jan 2015 · Gaceta Sanitaria
[Show abstract][Hide abstract] ABSTRACT: Objective: Prevalence of chronic conditions is increasing. Previous research on multimorbidity (MMB) has mainly focused on patient and older populations, but studies in the workforce are scarce. MMB affects both quality of life and work ability. We estimated the effect of MMB on the incidence of sickness absence (SA).
Methods: Retrospective cohort study (2004-2008) of 372,370 workers. In 2006, a uniform questionnaire collected information on chronic conditions, health-related symptoms and behaviors, used to construct a sex-specific MMB score (MMBS) that ranged from 0 to 100.We categorized individuals with scores >0 into low, moderate and high MMB tertiles, in addition to a group with MMBS = 0.We fit a Cox model, adjusted for age, occupational social class and number of prior SA episodes, to estimate the effect of MMBS on incident SA episodes due to cardiovascular diseases (CVD), musculoskeletal (MS) and mental disorders (MD).Specific pathologies were also analyzed [ischemic diseases (ICD9 410-414); dorsopathies (ICD9: 742.2,724.3) and nonpsychotic MD (ICD9 296.2,296.3,300.xx,301.1,309.x,311)].All analyses were performed for both sexes.
Results: For SA due to CVD and MS men showed a trend of higher SA incidence risk from low [HR = 1.13(95%CI:0.80-1.59) for CVD; HR = 1.23(95%CI:1.07-1.42) for MS] to high MMBS [HR = 1.66(95%CI:1.26-2.19) for CVD; HR = 1.31(95%CI:1.15-1.47) for MS]. Ischemic episodes showed the same pattern [from HR = 2.23(95%CI:0.75-6.65) to [HR = 5.84(95%CI:2.34-14.54)]. Women had increased MD episodes for low MMBS [HR = 1.66(95%CI:1.27-2.17), whereas men for moderate and high MMBS [HR = 1.55(95%CI:1.15-2.07); HR = 1.43(95%CI:1.11-1.85)]. High MMBS was associated with greater incidence of dorsopathies [HR = 1.21(95%CI:1.01-1.47)] and nonpsychotic MD [HR = 1.46(95%CI:1.01-1.94)].
Conclusions: MMB increases the risk of incident SA episodes due to CVD, MS, MD and specific pathologies in both sexes. Future studies should focus on the impact of MMB on relevant occupational outcomes.
Key messages: Multimorbidity increases incident sickness absence affecting work ability and worker's productivity. Research should continue targeting the impact of multimorbidity on occupational outcomes.
[Show abstract][Hide abstract] ABSTRACT: We aimed to identify common elements in work sickness absence (SA) in Spain, Sweden and The Netherlands. We estimated basic statistics on benefits eligibility, SA incidence and duration and distribution by major diagnostics. The three countries offer SA benefits for at least 12 months and wage replacement, differing in who and when the payer assumes responsibility; the national health systems provide health care with participation from occupational health services. Episodes per 1000 salaried workers and episode duration varied by country; their distribution by diagnostic was similar. Basic and useful SA indicators can be constructed to facilitate cross-country comparisons.
Full-text · Article · Jun 2014 · The European Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: To operationalize a definition of long working hours that overcomes limitations of existing heterogeneous definitions and to examine the temporal trends of long working hours across worker characteristics in the US.
No preview · Article · Jun 2014 · Occupational and Environmental Medicine
[Show abstract][Hide abstract] ABSTRACT: Most frequently, multimorbidity measures available in the literature are heavily dependent on one outcome. We propose a method to construct a global multimorbidity score that incorporates chronic and non-chronic health conditions as well as health-related behaviours and symptoms, regardless of any specific outcome.
[Show abstract][Hide abstract] ABSTRACT: While sociodemographic and work-related factors are frequently studied as determinants of sickness absence (SA), health-related determinants have surprisingly received little attention. We examined the effect of multimorbidity and previous SA on the incidence and duration of future SA.
[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of fast food consumption on mean population body mass index (BMI) and explore the possible influence of market deregulation on fast food consumption and BMI.
The within-country association between fast food consumption and BMI in 25 high-income member countries of the Organisation for Economic Co-operation and Development between 1999 and 2008 was explored through multivariate panel regression models, after adjustment for per capita gross domestic product, urbanization, trade openness, lifestyle indicators and other covariates. The possible mediating effect of annual per capita intake of soft drinks, animal fats and total calories on the association between fast food consumption and BMI was also analysed. Two-stage least squares regression models were conducted, using economic freedom as an instrumental variable, to study the causal effect of fast food consumption on BMI.
After adjustment for covariates, each 1-unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/m(2) in age-standardized BMI (95% confidence interval, CI: 0.013-0.052). Only the intake of soft drinks - not animal fat or total calories - mediated the observed association (β: 0.030; 95% CI: 0.010-0.050). Economic freedom was an independent predictor of fast food consumption (β: 0.27; 95% CI: 0.16-0.37). When economic freedom was used as an instrumental variable, the association between fast food and BMI weakened but remained significant (β: 0.023; 95% CI: 0.001-0.045).
Fast food consumption is an independent predictor of mean BMI in high-income countries. Market deregulation policies may contribute to the obesity epidemic by facilitating the spread of fast food.
No preview · Article · Feb 2014 · Bulletin of the World Health Organisation
[Show abstract][Hide abstract] ABSTRACT: This paper estimates the pattern of private and public physician visits and hospitalisation by socioeconomic position in two countries in which private healthcare expenditure constitutes a different proportion of the total amount spent on health care: Britain and Spain. Private physician visits and private hospitalisations were quantitatively more important in Spain than in Britain. In both countries, the use of private services showed a direct socioeconomic gradient. In Spain, the use of public GPs and public specialists tends to favour the worst-off, but no significant differences were observed in public hospitalisation. In Britain, with some exceptions, no significant socioeconomic differences were observed in the use of public health care services. The different pattern observed in the use of public specialist services may be due to the high frequency of visits to private specialists in Spain.
[Show abstract][Hide abstract] ABSTRACT: Sickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The Cox conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration.
To overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders.
As expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM.
The CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases.
Full-text · Article · Sep 2013 · BMC Medical Research Methodology