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We identified factors protective of all-cause sickness absence (SA) among subjects with multisite musculoskeletal pain (MSP). The nationally representative source sample comprised 3420 actively working Finns aged 30 to 55 in year 2000 and alive at follow-up. Pain in 18 body locations was combined into four sites (neck, low back, upper limbs, and lower limbs). The baseline prevalence of MSP (pain in ≥ 2 sites) was 32%. Baseline data on sociodemographic factors, work ability, work, health, and lifestyle were gathered by questionnaire, interview, and clinical examination and linked with national registers on all-cause SA (periods lasting ≥10 workdays) for 2002 to 2008. Based on trajectory analysis, 74% of those with MSP had a low and 26% a high probability of SA. In logistic regression analysis, younger age, male sex, and professional occupational group were inversely associated with SA. Allowing for these, good physician-assessed work ability, physically light work, possibility to adjust workday length, encouraging workplace atmosphere, no problems with working community or mental stress, normal weight, and no sleep disorders were predictive of lower SA rates (odds ratios between 0.47 and 0.70). In a final stepwise model adjusted for age, sex, and occupational group, no exposure to lifting (odds ratio 0.58, 95% confidence interval 0.39-0.85) and to repetitive hand movements (0.57, 0.39-0.83), possibility to adjust workday length (0.73, 0.53-0.99), and normal weight (0.59, 0.40-0.87) were inversely associated with SA. In conclusion, several modifiable factors related to work and lifestyle were found as predictive of lower rates of longer SA among occupationally active subjects with MSP.

Background/objectives: Occupational psychosocial stress has been identified as a risk factor for obesity, whereas dietary habits have a key role in weight control. We examined whether dietary habits modify the association between occupational psychosocial factors and waist circumference., Subjects/methods: Data comprised 31-year-old men (n=2222) and women (n=2053) in the Northern Finland Birth Cohort 1966. Waist circumference was measured and data on occupational psychosocial factors (demands, control and social support) and other characteristics were obtained through questionnaires. Healthy and unhealthy diet indices were constructed according to the current dietary guidelines. Associations were examined using analysis of variance adjusted for body mass index at age 14, basic education level, leisure-time physical activity, alcohol consumption, smoking, stress-related eating behaviour and parity., Results: Among men, high job demands and high job control were associated with greater waist circumferences, and there were interactions between unhealthy diet and job demands (P=0.043) and job control (P=0.036) in relation to waist circumference. The waist of men with high demands or high control and low consumption of unhealthy foods (red/processed meat, hamburgers and pizzas, fried potatoes, sugar-sweetened soft drinks and white bread) was smaller than that of men with high demands or high control and high consumption of such foods. No associations were found among women., Conclusions: A diet based on the current dietary guidelines seems to cancel out the adverse effects of occupational psychosocial factors on waist circumference among young men. Longitudinal studies are needed to assess the risks for obesity-related diseases arising from psychosocial work environments and dietary habits.

Objective: To examine the associations between occupational psychosocial factors and obesity among 31-year-olds, adjusting for adolescent body mass index, physical strenuousness of work, and adverse health behaviors (ie, stress-related eating/drinking, leisure-time physical inactivity, smoking, and high alcohol consumption)., Methods: The study population comprised 2083 men and 1770 women from the Northern Finland Birth Cohort 1966. Obesity was defined as a body mass index of 30.0 kg/m or more. Psychosocial exposures were defined in terms of demands, control, and social support at work., Results: Among men, high job demands and low worksite social support were independently associated with obesity. Among women, stress-related eating/drinking and physical inactivity seemed to promote obesity. Body mass index at age 14 was an important predictor of obesity for both sexes., Conclusions: In workplace obesity prevention programs, it might be beneficial to improve the psychosocial work environment and promote healthy behaviors simultaneously.

Objective: We studied predictors of sickness absences (SA) due to musculoskeletal pain over two years among 386 municipal female kitchen workers., Methods: Pain and SA periods (no/yes) due to pain in seven sites during the past three months were assessed at 3-month intervals over two years by questionnaire. Age, musculoskeletal pain, multisite pain (pain in ≥3 sites), musculoskeletal and other somatic diseases, depressive symptoms, physical and psychosocial workload, body mass index, smoking, and leisure-time physical activity (LTPA) at baseline were considered as predictors. Trajectory analysis and multinomial logistic regression were used., Results: Three trajectories of SA emerged, labelled as "none" (41% of the subjects), "intermediate" (48%), and "high" (11%). With the "none" trajectory (no SA) as reference, pain in all musculoskeletal sites excepting the low back predicted belonging to the "intermediate" [odds ratio (OR) 1.82-2.48] or "high" (OR 2.56-3.74) trajectory adjusted for age; multisite pain predicted membership of the "intermediate" [OR 2.15, 95% confidence interval (95% CI) 1.38-3.34] or "high" (OR 4.66, 95% CI 2.10-10.3) trajectories. In a mutually adjusted final model, smoking (OR 2.12, 95% CI 1.22-3.69), multisite pain (OR 1.87, 95% CI 1.15-3.02), and overweight/obesity (OR 1.71, 95% CI 1.08-2.72) predicted belonging to the "intermediate" trajectory, while depressive symptoms (OR 3.57, 95% CI 1.57-8.10), musculoskeletal diseases (OR 3.18, 95% CI 1.37-7.37), and multisite pain (OR 2.72, 95% CI 1.15-6.40) were associated with the "high" trajectory., Conclusion: Along with the number of pain sites and musculoskeletal diseases, attention to depressive symptoms, smoking, and overweight/obesity is needed to tackle SA related to musculoskeletal pain.

We studied the number of musculoskeletal pain sites as a predictor of sickness absence during a 7-year follow-up among a nationally representative sample (the Health 2000 survey) of occupationally active Finns 30 to 55years of age (3420 subjects who did not retire or die during the follow-up). Baseline data (questionnaire, interview, clinical examination by a physician) were gathered in 2000 to 2001 and linked with information from national registers on annual compensated sickness absence periods (⩾10workdays) covering the years 2002 to 2008. Pain during the preceding month in 18 body locations was inquired and combined into 4 sites (neck, upper limbs, low back, lower limbs). Demographic factors, BMI, smoking, leisure-time physical activity, sleep disorders, physical and psychosocial workload, and chronic diseases were assessed. Four distinct sickness absence trajectories emerged, labeled as Low (59% of the subjects), Ascending (21%), Mixed (11%), and High (9%). In multinomial logistic regression, the odds ratios (ORs) for belonging to the High vs. the Low trajectory increased with the number of pain sites, being 2.1 for single-site pain, 2.6 for 2 pain sites, 2.9 for 3 pain sites, and 4.1 for 4 pain sites, after adjustment for chronic diseases, demographic and lifestyle factors, and workload. The confidence intervals of the ORs did not include unity. The adjusted ORs for belonging to the Ascending trajectory were 1.1, 1.3, 1.7, and 1.7, respectively. As the number of pain sites was a strong independent predictor of work absenteeism, early screening of workers with multisite pain and interventions to support work ability seem warranted., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Objective: Previously we reported that early part-time sick leave enhances return to work (RTW) among employees with musculoskeletal disorders (MSD). This paper assesses the health-related effects of this intervention., Methods: Patients aged 18-60 years who were unable to perform their regular work due to MSD were randomized to part- or full-time sick leave groups. In the former, workload was reduced by halving working time. Using validated questionnaires, we assessed pain intensity and interference with work and sleep, region-specific disability due to MSD, self-rated general health, health-related quality of life (measured via EuroQol), productivity loss, depression, and sleep disturbance at baseline, 1, 3, 8, 12, and 52 weeks. We analyzed the repeated measures data (171-356 observations) with the generalized estimating equation approach., Results: The intervention (part-time sick leave) and control (full-time sick leave) groups did not differ with regard to pain intensity, pain interference with work and sleep, region-specific disability, productivity loss, depression, or sleep disturbance. The intervention group reported better self-rated general health (adjusted P=0.07) and health-related quality of life (adjusted P=0.02) than the control group. In subgroup analyses, the intervention was more effective among the patients whose current problem began occurring <6 weeks before baseline and those with ≤30% productivity loss at baseline., Conclusions: Our findings showed that part-time sick leave did not exacerbate pain-related symptoms and functional disability, but improved self-rated general health and health-related quality of life in the early stage of work disability due to MSD.

Objectives: We reviewed work histories of manual handling of loads >20 kg in relation to hip osteoarthritis by age, exposure and work participation., Methods: A nationally representative sample of 3110 Finnish men and 3446 women aged 30-97 was recruited. Diagnosis of hip osteoarthritis was based on standardised clinical examination by trained physicians. Previous exposure to physically loading work was evaluated through interviews. Logistic regression was used to estimate associations between work factors and hip osteoarthritis., Results: 1.9% of men and 2.1% of women had hip osteoarthritis. Almost half the men and a quarter of the women had recurrently handled heavy loads at work. Subjects who had manually handled loads >20 kg had a 1.8-fold increased risk of hip osteoarthritis compared to non-exposed references, when age, body mass index, traumatic fractures and smoking were accounted for. Results were similar for men (OR 2.0; 95% CI 1.0 to 4.0) and women (1.8; 1.1 to 2.8). In a sub-analysis of subjects with hip replacement, the OR was 1.7 (1.0 to 2.9). Risk increased first after 12 years' exposure: among men it was 2.2 (0.8 to 5.9) for 13-24 years' exposure, and 2.3 (1.2 to 4.3) for >24 years' exposure. Among women it was 3.8 (1.7 to 8.1) for 13-24 years' exposure. Work participation among men aged <60 years with hip osteoarthritis was 20% lower compared with subjects without osteoarthritis., Conclusions: A work history of manual handling of loads >20 kg showed a strong association with hip osteoarthritis in all age groups except the youngest.

Study Design: Population-based cross-sectional study of clinically assessed low back syndromes., Objective: To investigate whether exposure to professional car driving, either alone or in combination with strenuous physical work is associated with clinically defined sciatica or other clinically diagnosed chronic low back syndromes., Summary of Background Data: Several studies have found an association between professional driving and back disorders, but drivers' histories of heavy physical work tasks has rarely been taken into account., Methods: The nationally representative sample comprised of 2323 men aged 30 to 64 (the Health 2000 Survey). The diagnoses of sciatica and chronic low back syndromes were based on a standardized clinical examination by specially trained physicians. Life-long exposure to professional car driving and to physically demanding work was assessed retrospectively via interviews. Logistic regression was used to estimate the risk of clinical chronic low back syndromes related to these exposures, and the risks were presented with odds ratios (OR) with 95% confidence intervals (95% CI)., Results: The prevalence of physician-diagnosed sciatica was 5.4% and that of other chronic low back syndromes 4.0%. Professional car driving in general was associated with sciatica at an OR of 1.42 (95% CI 0.92-2.18) and with other chronic low back syndromes at an OR of 1.31 (0.80-2.16), after adjustment of covariates and strenuous physical work. Exposure to driving without exposure to physical work was not associated with the outcomes, whereas driving in combination with strenuous physical work increased the risk for sciatica threefold (3.22; 1.86-5.59), and that of low back syndromes twofold (2.08; 1.12-3.87)., Conclusion: The increased risk of low back disorders related to professional car driving is more likely due to strenuous work tasks rather than to driving itself.

Objectives: The aim of this study was to assess the effect of an ergonomic intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders., Methods: In this randomized controlled study, subjects aged 18-60 years (N=177) seeking medical advice due to upper-extremity symptoms were included if their symptoms, or the exacerbation of symptoms, had started <30 days prior to the medical consultation and immediate sick leave was not required. Workplace ergonomic improvements were made in the intervention group. Data on symptoms and sickness absences were gathered during one-year follow-up., Results: Pain intensity, pain interference with work, leisure time, or sleep did not differ between the intervention and control group during the one-year follow-up. During the first three months of follow-up, the percentage of employees with sickness absence due to upper-extremity or other musculoskeletal disorders did not differ between the intervention (N=89) and control (N=84) group, but the total number of sickness absence days in the intervention group was about half of that in the control group (mean 6.2 versus 9.8 days for upper-extremity disorder and 6.0 versus 11.5 days for upper-extremity and other musculoskeletal disorders combined). During 4-12 months of follow-up, the percentage of employees with sickness absence due to upper-extremity disorder (10.1% versus 16.7%, P=0.20) or upper-extremity and other musculoskeletal disorders combined (20.2% versus 32.1%, P=0.07) was lower in the intervention than the control group., Conclusions: Our findings suggest that an early ergonomic intervention reduces sickness absence due to upper-extremity or other musculoskeletal disorders.

Objectives: Musculoskeletal pain often occurs at multiple sites concurrently. The aim of this study was to examine the associations between multi-site pain and self-rated work ability and retirement plans among actively working people., Methods: The Health 2000 Survey was carried among a representative sample of Finnish adults. Musculoskeletal pain during the preceding month in the lower back, neck or shoulders, upper extremities, hips and lower extremities, and work ability and intentions to retire early were assessed. Subjects were also clinically examined. Analyses were restricted to 30-64-year-old subjects actively working during the preceding 12 months who provided information on work ability outcomes (population-weighted number of subjects=4087). Log-binomial regression was used to estimate prevalence ratios of reduced work ability., Results: Single-site pain was reported by 33% of subjects, 20%, 9% and 4% reported pain in two, three and four sites, respectively, and 8%-15% reported poor work ability. Every fifth person had thought about retiring early. Age- and gender-adjusted risks of poor physical work ability and own prognosis of poor future work ability increased from 2 for single-site pain to 8 for pain at four sites. Risks remained considerably elevated after adjustment for various covariates, including clinical musculoskeletal disorders and functional capacity. Poor current work ability was most affected by multi-site pain at older age (50-64 years) and intentions to retire early at age 40-49 years., Conclusions: Co-occurring pain is a considerable threat to work ability. Workers with multi-site pain may benefit from targeted preventive measures to sustain their work ability. Future studies should also consider multi-site pain as an important risk factor for reduced work ability.

Study Design: Cross-sectional study with retrospectively assessed work determinants., Objective: To study the association between the history of physically demanding work and sciatica, among the occupationally active, and among persons of working age who are not occupationally active., Summary of Background Data: Few studies have examined the association of physically loading work with sciatica, and studies concerning women are scarce., Methods: A nationally representative sample of The Health 2000 survey comprised 4811 Finns aged 30 to 64, which we further stratified into 2 groups based on working status during the preceding 12 months. The diagnosis of sciatica was based on characteristic symptoms and a standardized clinical examination by physicians trained for the purpose. Life-long exposure to physically demanding work tasks was assessed retrospectively by interview., Results: A total of 3.8% of working subjects and 7.9% of nonworking subjects had sciatica; men more often than women. In the multivariable logistic regression models, a history of physically demanding work in general was associated with sciatica among men. The risk increased with the length of exposure for the first 20 years (OR: 1.85; 95% CI: 1.17-2.91 for 1-10 years and 2.67; 1.61-4.43 for 11-20 years of exposure), but decreased thereafter. When analyzing manual handling of heavy objects, bending, and kneeling separately, odds ratios for these factors were high for both working and nonworking men. However, they remained at the borderline of statistical significance among working men. None of the physical work exposures were associated with sciatica among working women, whereas a long history of handling heavy objects and bending were related to sciatica among nonworking women., Conclusion: Physically demanding work in general is a risk factor for sciatica among men. Sciatica may be a significant cause of premature health-related selection out of the heavy work among both genders.

Longitudinal studies observing working conditions and weight gain are rare. We aimed to study whether weight gain can be predicted by working conditions or changes in them in a 28-year follow-up. The study population consisted of working-aged industrial employees (n = 449). Data on height and weight were collected in clinical examinations in 1973, 1983 and 2001, and information on working conditions by questionnaires. We analysed the impact of changes in physical strain, temporal requirements and indicators of mental strain at work in 1973 and 1983 on weight changes using analysis of variance, logistic regression analysis and linear mixed longitudinal growth model. The latter was done to account for individual variation in temporal weight change over the study period. Weight gain was prominent in the data and about a third of the participants gained at least 15 kg by the final survey. Changes in physical strain and temporal requirements including working overtime hours among men, and experiencing increased working pace among women, were associated with greater mean weight gain and major weight gain. Job efforts and increasing mental strain showed weak associations with weight gain in men. Changes in the physical strain and temporal requirements seem to predict weight gain but working conditions were in general mostly weakly associated with weight gain in this cohort of initially young adults. The results highlight the importance of stable working hours and reasonable workload on healthy weight.

Background: Low back disorders are among the most common health problems in industrialized societies. We examined the relationship between occupational exposures and severe lumbar intervertebral disc disorders (LIDD)., Methods: Information on inpatient care for LIDD (ICD-10: M51.1-51.9) in Finnish hospitals during 1996 was linked with the 1995 Population Census, and based on occupational title with the Finnish Job Exposure Matrix and the Occupational Lifestyle Matrix. There were 3,863 individuals hospitalized due to LIDD among occupationally active Finns. Poisson regression analyses were made with the total occupationally active population as reference., Results: In a multivariate analysis in women, accident risk, job control, and three-shift work were associated with hospitalization, together with age, education, personal income, and average body mass index (BMI) by occupation. In men, accident risk and job control were associated with hospital admissions, allowing for age, education, and income., Conclusions: Accident risk and job control increased the risk of hospitalization for LIDD in both sexes. Three-shift work and BMI were also predictive of hospital admission among women., (Copyright 2004 Wiley-Liss, Inc.)

Objectives: The variation in hospital admission rates was studied for back disorders by industry and occupational title among gainfully employed Finns., Methods: Admissions to Finnish hospitals in 1996 among 25- to 64-year-olds, based on the Hospital Discharge Register, were linked with sociodemographic data from the 1995 population census for the following primary diagnoses [International Classification of Diseases, 10th revision (ICD-10)]: all back disorders (M40.0-54.9; N (individual patients) 7,253), lumbar intevertebral disc disorders (M51.0-M51.9, N = 3,863), and other common back disorders (ICD-10: M47.1-47.2, M47.8-47.9, M48.0, M54.1, M54.3-54.5, M54.8-54.9; N = 2,433), with the total occupationally active workforce (same age range and gender) as reference. Age-standardized hospitalization rate ratios (SRR) were calculated., Results: The highest SRR values for hospitalization for any back disorder were found for fishing (SRR 195), "other" mining and carrying (SRR 168), and sewage and refuse disposal (SRR 152) among the men and water transport (SRR 158), wood product (SRR 149) and pulp, paper and paper product (SRR 145) manufacturing among the women. Computer activities (SRR 44) among the men and insurance and pension funding (SRR49) among the women had the lowest SRR values. The occupations reindeer breeders and herders (SRR 495), agricultural workers (SRR 232), and paper product workers (SRR 205) among the men and plastic product (SRR 233), laundry (SRR 224), and agricultural (SRR 219) workers among the women had the highest SRR values. The lowest SRR values were observed for upper white-collar employees in public administration [men (SRR 40) and women (SRR 61)]., Conclusions: Hospitalization rates for back disorders were high for several physically strenuous industries and occupations.