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Abstract The notion of constellations is central to many occupational health theories; empirical research is nevertheless dominated by variable-centered methodologies. Guided by the job demands-resources framework, we use a person-centered longitudinal approach to identify constellations of job demands and resources (task-based and time-based) over time that predict changes in well-being. We situate our research in two dissimilar, but growing, industries in the United States—information technology (IT) and long-term care. Drawing on data collected over 18 months, we identify five patterned, stable constellations of job demands/resources using group-based multi-trajectory modeling: (1) high strain/low hours , (2) high strain/low hours/shift work , (3) high strain/long hours , (4) active (high demands , high control) , and (5) lower strain (lower demands , high control). IT workers are overrepresented in the lower-strain and active constellations, whereas long-term care providers are more often in high-strain constellations. Workers in the lower-strain constellation experience increased job satisfaction and decreased emotional exhaustion, work-family conflict and psychological distress over 18 months. In comparison, workers in high-strain job constellations fare worse on these outcomes, as do those in the active constellation. Industrial contexts matter, however: Compared with long-term care workers, IT workers' well-being is more at risk when working in the "high strain/long hours" constellation. As the labor market continues to experience structural changes, scholars and policy makers need to attend to redesigning the ecological contexts of work conditions to promote workers' well-being while taking into account industrial differences. Highlights • Job conditions are not independent but patterned; we identify five patterned, stable clusters of job demands and resources. • Workers in the lower-strain (both task- and time-based) constellation experience improved well-being over 18 months. • Workers in high-strain job constellations show declines in a variety of well-being outcomes over 18 months. • Industrial contexts affect distributions of job constellations and their well-being consequences. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between job strain and socio‐demographic characteristics, social support, job insecurity, use of patient assessment scales, and turnover of nursing staff in a Colombian hospital. Background: Nursing is an occupation with high probability of job strain. Use of patient assessment scales and turnover of nursing staff could increase exposure to psychosocial risk. Method: A cross‐sectional study of 222 nurses was conducted. A survey and the Job Content Questionnaire were used to obtain data at the individual level and free lists and institutional records were used at the hospital unit level. The associations of interest were evaluated with a logistic regression model with robust variance estimator. Results: Many nurses (50.9%) nurses reported job strain, which was positively associated with high use of patient assessment scales (OR = 2.73; 95% CI = 1.35–5.51) but negatively associated with social support (OR = 0.89; 95% CI = 0.80–0.98). Turnover was not statistically associated with job strain. Conclusion: Job strain among nurses was associated with a high use of patient assessment scales, but not with turnover of nursing staff. Implications for Nursing Management: The findings of this study suggest possible opportunities for managers to improve nursing processes, the work conditions of nursing staff, and the quality of institutions. [ABSTRACT FROM AUTHOR]

High prevalence of low back pain (LBP) has been reported among farmers. A number of contributing factors have been associated with LBP. However, predictors for LBP in this population are unknown. This longitudinally designed study aimed to identify the predictors of LBP in a sample of rubber farmers whose work involves heavy manual labor. Three hundred and twenty-seven rubber farmers, aged 18 to 70 years who reported no LBP in the previous year, were face-to-face interviewed and examined physically. The incidence of LBP was assessed monthly. The 12-month incidence of LBP in the cohort was 35%. Having a history of LBP (hazard ratio = 1.55, 95% confidence interval = 1.05-2.30) and an active job (hazard ratio = 1.98, 95% confidence interval = 1.16-3.40) were the predictors for the new onset of LBP in this sample. These 2 factors could therefore potentially be targeted to prevent or reduce the incidence of LBP in rubber farmers. [ABSTRACT FROM AUTHOR]

The Effort Reward Imbalance tool is a measure of psychosocial work characteristics used to identify work-related stress. The purpose of this study was to assess the reliability and validity of the Korean version of the effort-reward imbalance–short form (ERI-SF) in industrial workers. The Korean version of ERI-SF was tested among 250 blue-collar workers. The reliability, content validity, and construct validity with confirmatory factor analysis, as well as interaction terms were analyzed. Reliability assessed by Cronbach's alpha coefficients were satisfactory for all three subscales: effort 0.75, reward 0.74, and over-commitment 0.72. Confirmatory factor analysis showed an acceptable model fit with the three component theoretical structure (root mean square error of approximation = 0.07, comparative fit index = 0.84). Content validity was assessed with respect to a measure of perceived health. In addition, a significant synergistic interaction of ERI and over-commitment on job strain was found. In conclusion, the ERI-SF demonstrated good psychometric properties with Korean industrial workers. The ERI-SF is ideal for examining work-related stress in the workplace by occupational health professionals. This shorter version makes it easier to administer and score in the occupational health setting. [ABSTRACT FROM AUTHOR]

In comparison to their public and for‐profit counterparts, not‐for‐profit employees report experiencing higher work demands. Despite the harmful effects attributed to this important sector difference, few, if any, empirical studies in the not‐for‐profit literature have investigated how job‐related resources, such as control over one's job, help buffer work demands' strain‐inducing impact. The present study fills this important gap in the extant not‐for‐profit literature by testing a recently introduced nonlinear stressor‐strain model on a sample of 363 employees from two different types of not‐for‐profit human service agencies located in the city of New York. As hypothesized, the nonlinear demand by linear control interaction term was statistically and significantly associated with job strain in the predicted direction. Study data not only challenge the linear nature of Karasek's seminal demand‐control model, but are also the first to uncover this unique finding in a sample of not‐for‐profit human service employees. Implications for practice and theory are also discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The effort–reward imbalance (ERI) model includes the personal characteristic of overcommitment (OC) and the job-related characteristics of effort, reward, and ERI, all of which are assumed to play a role in an employee’s health and well-being at work. The aim of the present longitudinal study was to shed more light on the dynamics of the ERI model by investigating the basic hypotheses related to the role of OC in the model, ie, to establish whether an employee’s OC could be a risk factor for an increased experience of high effort, low reward, and high ERI at work. METHODS: The study was based on 5-wave, 8-year follow-up data collected among Finnish professionals in 2006 (T1, N=747), 2008 (T2, N=422), 2010 (T3, N=368), 2012 (T4, N=325), and 2014 (T5, N=273). The participants were mostly male (85% at T1) and the majority of them worked in technical fields. OC, effort, reward, and ERI were measured at each time point with the 23-item ERI scale. RESULTS: Three cross-lagged structural equation models (SEM) were estimated and compared by using full information maximum likelihood method: (i) OC predicted later experiences of effort, reward, and ERI (normal causation model), (ii) effort, reward, and ERI predicted later OC (reversed causation model), and (iii) associations in normal causal and reversed causal models were simultaneously valid (reciprocal causation model). The results supported the normal causation model: strong OC predicted later experiences of high effort, low reward and high ERI. CONCLUSIONS: High OC is a risk factor for an increased experience of job strain factors; that is, high effort, low reward, and high ERI. Thus, OC is a risk factor not only for an employee’s well-being and health but also for an increasing risk for perceiving adverse job strain factors in the working environment.

OBJECTIVE: We examined the association between job stress and leisure-time physical inactivity, adjusting for individual time-invariant attributes. METHODS: We used data from a Japanese occupational cohort survey, which included 31 025 observations of 9871 individuals. Focusing on the evolution of job stress and leisure-time physical inactivity within the same individual over time, we employed fixed-effects logistic models to examine the association between job stress and leisure-time physical inactivity. We compared the results with those in pooled cross-sectional models and fixed-effects ordered logistic models. RESULTS: Fixed-effects models showed that the odds ratio (OR) of physical inactivity were 22% higher for those with high strain jobs [high demands/low control; OR 1.22, 95% confidence interval (95% CI) 1.03–1.43] and 17% higher for those with active jobs (high demands/high control; OR 1.17, 95% CI 1.02–1.34) than those with low strain jobs (low demands/high control). The models also showed that the odds of physical inactivity were 28% higher for those with high effort/low reward jobs (OR 1.28, 95% CI 1.10–1.50) and 24% higher for those with high effort/high reward jobs (OR 1.24, 95% CI 1.07–1.43) than those with low effort/high reward jobs. Fixed-effects ordered logistic models led to similar results. CONCLUSION: Job stress, especially high job strain and effort–reward imbalance, was modestly associated with higher risks of physical inactivity, even after controlling for individual time-invariant attributes.

Abstract Background Numerous studies have reported an association between stressing work conditions and cardiovascular disease. However, more evidence is needed, and the etiological mechanisms are unknown. Elevated resting heart rate has emerged as a possible risk factor for cardiovascular disease, but little is known about the relation to work-related stress. This study therefore investigated the association between job strain, job control, and job demands and resting heart rate. Methods We conducted a cross-sectional survey of randomly selected men and women in Västra Götalandsregionen, Sweden (West county of Sweden) (n = 1552). Information about job strain, job demands, job control, heart rate and covariates was collected during the period 2001–2004 as part of the INTERGENE/ADONIX research project. Six different linear regression models were used with adjustments for gender, age, BMI, smoking, education, and physical activity in the fully adjusted model. Job strain was operationalized as the log-transformed ratio of job demands over job control in the statistical analyses. Results No associations were seen between resting heart rate and job demands. Job strain was associated with elevated resting heart rate in the unadjusted model (linear regression coefficient 1.26, 95 % CI 0.14 to 2.38), but not in any of the extended models. Low job control was associated with elevated resting heart rate after adjustments for gender, age, BMI, and smoking (linear regression coefficient −0.18, 95 % CI −0.30 to −0.02). However, there were no significant associations in the fully adjusted model. Conclusions Low job control and job strain, but not job demands, were associated with elevated resting heart rate. However, the observed associations were modest and may be explained by confounding effects.

Low-back pain (LBP) is one of the most prevalent health problems in occupational populations. Although still fiercely debated (1), several biomechanical factors have been consistently acknowledged as important risk factors for LBP, most notably heavy lifting, awkward back postures due to severe bending and rotating, and whole body vibration (2–4). In the quest to unravel the multidimensional origin of work-induced LBP, the jury is still out on the particular contribution of psychosocial factors at work. Some authors have reported that high psychosocial work demands is an independent risk factor of LBP (2), whereas others have noted that psychosocial factors, such as job strain, are more important in aggravation and slower recovery of LBP (5). Moreover, authors have also focused on job strain as a promoting factor of sickness absence among those with musculoskeletal complaints (6). The uncertainty as to the particular contribution of psychosocial factors to LBP undoubtedly partly stems from differences between the conceptual models used to unravel the temporal and causal relationships between these factors and LBP. In this issue of the Scandinavian Journal of Work, Environment & Health, Magnusson Hanson and colleagues address this topic with a novel approach by combining structural equation modelling (SEM) with a fixed-effects (FE) regression in a longitudinal study with four waves over a 6-year period (7). Although SEM models have not been very popular in epidemiology, in part due to the required assumptions (8), their ability to construct a quantitative causal diagram has a certain appeal. The most complex SEM model in the current article estimates the bidirectional associations between job strain and subsequent LBP in successive waves and between LBP and subsequent job strain (cross-lagged paths), while controlling for autocorrelation and adjusting for important confounders. In this approach, temporal and causal associations are investigated, and the presence of reversed causality can be refuted. The SEM model shows that job strain predicts occurrence and severity of LBP two years later. So far, so good, the reader will think. Isn’t this what we would have expected? Interestingly, the analysis also shows that an increase in LBP severity predicts later job strain! This may leave the reader dumbfounded. What is the cause and what is the consequence? Is this reversed association caused by unmeasured individual characteristics? Is this association a clear indication of common source bias since both variables are self-reports? The innovation in this article is that the authors have incorporated a FE regression into the SEM models. FE models provide an excellent solution for removing time-invariant confounding by using each person as his or her own control and focus solely on within-person change (9, 10). The essence of a FE model is that it relates change in exposure to change in health outcome within individuals, thereby controlling for all measured and unmeasured individual characteristics and other potential confounders (eg, aspects of work or home environment) that do not vary over time. This will remove, for example, common source (dependent misclassification) bias. The attractiveness of the FE approach has been illustrated in recent studies on mental health at work (11, 12). The SEM model and the SEM-FE model show different results. Whereas in the SEM model, bidirectional associations between job strain and LBP are identified, in the SEM-FE model these associations are no longer present. This intriguing difference in findings between analytical techniques requires careful interpretation. As the authors propose themselves, a first explanation may be that the SEM-FE model suggests that associations between job strain and LBP may be due to residual confounding by time invariant characteristics, such as the individual’s tendency to respond similarly to different questions in a questionnaire. An alternative explanation is that both models essentially present different information on the exposure–response relation between job strain and LBP. The FE component in the SEM-FE model only includes within-person effects whereby the effect of job strain on LBP is based only on those participants who experienced a change in exposure during the period of observation. In essence, this estimates the short-term effects of a change in job strain on the change in occurrence of LBP. The traditional SEM model, however, includes both within- and between-person effects and it may be hypothesized that cumulative exposure to high job strain over all waves during the study may increase the likelihood of having LBP. A third explanation relates to the study population in both analytical strategies. Whereas the traditional SEM model includes all workers who responded to the four consecutive questionnaires, the FE component only uses participants who experienced one or more changes in exposure status. As the authors reported, approximately 61% of all workers had a stable exposure to job strain and, hence, these workers do not contribute to the estimated within-person changes. This is certainly a limitation of a FE model; it will reduce power and generalizability compared to standard SEM models. The rapidly increased use of FE models in epidemiology is spurred in part by the debate on causal inference. The FE approach is valuable for optimizing causal inference but does not tell the whole story of an exposure–outcome relationship. It is well established, for example, that sustained exposure to high job strain is associated with a number of adverse health outcomes, such as mental health and cardiovascular disease, yet such sustained adverse exposure is not represented in a FE coefficient. The two main candidates for explaining differences between a FE model and statistical methods that include both within- and between-person variation (ordinary least squares, random effects regression) are bias and associations of short-term versus sustained exposure. Each of these approaches has their strengths and can be used in combination to answer complementary research questions (11). Magnusson Hanson and colleagues must be applauded for their innovative approach to analyse the associations between job strain and LBP. They demonstrate eloquently that the analytical choice has a profound impact on the results. This raises important questions on the validity of many observational studies on the influence of psychosocial factors on LBP. In this particular situation, the mundane statement that further research is needed is highly appropriate. The application of FE models in occupational epidemiology will offer new insights into temporal and causal associations between exposure and health effects.

We read with great interest the paper by Juvanhol et al (1) on the association between demand‒control model (DCM) components and blood pressure (BP) using the baseline data of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The authors reported a marginal, but positive cross-sectional association between job decision authority and systolic blood pressure (SBP) (0.59 mmHg, 95% CI 0.00–1.18) among non-users of anti-hypertensives from five universities and one research institute (2). And they claimed that (in the contemporary world of work), “the health benefits of increasing decision authority may not be as evident as in the historical context where the DCM was developed, which was characteristically one of industrialization and repetitive tasks.” We agree with the authors that, in principle, the associations between psychosocial working conditions and health outcomes should be examined and interpreted with a socioecological perspective with consideration of societal and organizational structures and contexts (3). However, we could not find any convincing structure- and context-based explanation of the authors for the positive association between decision authority and SBP, for example, one grounded in their in-depth understanding of detailed working conditions and contexts of the Brazilian workers at higher education institutes during 2008–2010. Instead, we have found serious weaknesses in their analyses and interpretations, which undermine their finding and claim. First, the authors should have tested effect modification by race/color or socioeconomic status (SES) in their analysis. As expected, high decision authority was initially negatively associated with SBP among both users and non-users of anti-hypertensives (model 1, table 3) and also after controlling for gender, age, and recruitment site (model 2). However, only when race/color, schooling and mother’s schooling were additionally included in their analysis (model 3), the direction of the association between decision authority and SBP changed from negative to positive among non-users of anti-hypertensives, while it substantially attenuated but remained negative among users of anti-hypertensives. Although the authors discussed these changes as a confounding effect of SES, it does not explain why the direction of the association was different between non-users and users of anti-hypertensives in model 3. In addition, there is a possibility of effect modification by race/color, schooling, or occupational class of their study participants (faculty and professional staff, technical and clerical workers, and unskilled workers) (2). The association between decision authority and SBP may differ by race/color or SES (education, income, or occupational class) (4,5). Furthermore, the job strain hypothesis of the DCM was not also tested in the study. Second, the authors should have tested the association between decision authority and SBP separately in normotensives and unmedicated hypertensives as well as medicated hypertensives. In their previous study (6), the authors demonstrated that BP distributions in the aforementioned three subgroups were very distinct to one another. Ignoring the distinct BP distributions between the two subgroups (normotensives and unmedicated hypertensives) in non-users of antihypertensives may have resulted in a bimodal BP distribution by a mix of two mononmodal distributions. Interestingly, in their quantile analysis, there was no significant association between decision authority and SBP in both ends of the SBP distribution among non-users of hypertensives that would more exclusively represent the SBP values of normotensives (the lower end) and unmedicated hypertensives (the upper end), respectively. Third, the authors should have examined the whole distribution of exposure (decision authority) in their analysis. They used a median-based low and high decision authority variable for analyses. However, using the dichotomous variable can result in a substantial information loss and sometimes, attenuate or distort the real association with health outcomes (7,8), particularly when the study population is not a random sample of general working populations. All participants in the ELSA-Brasil study worked for higher education institutes. And about 37% of them had postgraduate degrees. As a result, their study participants were characterized by relatively high job control and demands (6). In this situation, using a tertile- or quartile-based decision authority variable would be more appropriate for investigating the association between decision authority and BP, including a possible non-linear relationship. In fact, decision authority was non-linearly associated with a clinical cardiovascular health score of blood pressure, fasting plasma glucose, and total cholesterol in a recent study with the same ELSA-Brasil study data (8). Fourth, the marginal positive association between decision authority and SBP is also inconsistent with the finding of a previous study (8) with the same ELSA-Brasil study data in which high decision authority was positively associated with higher lifestyle cardiovascular health scores of diet, physical activity, smoking, and body mass index (higher scores mean better cardiovascular health). On the other hand, we would like to raise a question about the clinical implications of the marginal difference in the SBP, 0.59 mmHg between the low and high decision authority groups reported in the paper. Lastly, during the recent decades, the main principles of the 1918 Argentine Córdoba University Reform (university autonomy, co-government of all parties in universities, and no tuition from students) may have substantially eroded in Latin American countries (9) due to higher education policies with emphases on government control, privatization, efficiency, competitiveness, and partnerships with business. In this case, it would be more likely that many workers at higher education institutes (eg, non-tenure track, part-time faculty and researchers, clerks, janitors, and food-service workers) in Brazil, have suffered from low or decreasing rather than “excessive” decision authority on their tasks (10, 11). Given all the above, we think that the authors’ claim in the paper ‒ “excessive” decision authority of workers as a source of stress in workers at higher education institutes in Brazil ‒ is unsubstantiated and also misleading for societal and worksite efforts to improve workers’ cardiovascular health. We suggest that the authors have collaborative and concrete discussions and qualitative investigations with their study participants about the contemporary working conditions and health issues of the workers at higher education institutes in Brazil. We believe that such approaches will further shed light on the underlying reasons for the marginal, but positive association between decision authority and SBP, which may be hardly captured by statistical analysis alone.

Background: The Job Content Questionnaire (JCQ), which is based on the Demand–Control–Support model, is designed to measure the psychosocial characteristics of the respondent's work, and has been identified to predict health and psychological outcomes. The purpose of this study was to investigate the psychometric properties of this instrument and the subsequent adaptation of its scales to the population of Greek health workers. Methods: The Greek version of the JCQ was developed by using forward- and back-translation in accordance with the JCQ policy. The reliability and validity of the measure were investigated in a sample of health workers working in a hospital in Athens, Greece. The internal consistency of the scales was examined based on Cronbach α coefficients, and the validity was evaluated subjecting the items of the three main scales of the JCQ (decision latitude, psychological job demands, and social support) to exploratory and confirmatory factor analysis. Results: The reliability of the scales was found to be acceptable for all the scales, except for the skill discretion subscale. Confirmatory factor analysis confirmed a slightly modified version of the original construct including several items to more than one factor. Conclusion: Our findings suggest that the Greek JCQ is reliable and valid for investigating psychosocial job characteristics among Greek health workers.

The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache, speech disturbances). During her hospitalisation at the neurological unit ischemic stroke with transient mixed type aphasia was diagnosed. Magnetic resonance imaging (MRI) scan of the head revealed subacute ischemia. After an analysis of the accident circumstances, the employer’s post accidental team decided that ischemic stroke had been an accident at work, because it was a sudden incident due to an external cause inducing work-related traumatic stroke. As a primary cause tough stress and emotional strain due to the situation developed while attending the customer were acknowledged. During control medical check up after 5 months the patient was found to be fit for work, so she could return to work. However, it should be noted that such a check up examination of subjects returning to work after stroke must be holistic, including the evaluation of job predispositions and health education aimed at secondary prevention of heart and vascular diseases with special reference to their risk factors. Med Pr 2015;66(4):595–599

OBJECTIVE: This study aimed to investigate associations between work postures, lifting at work, shift work, work hours, and job strain and the risk of sick leave during pregnancy from 10–29 completed pregnancy weeks in a large cohort of Danish pregnant women. METHODS: Data from 51 874 pregnancies in the Danish National Birth Cohort collected between 1996–2002 were linked to the Danish Register for Evaluation of Marginalization. Exposure information was based on telephone interviews. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by Cox regression analysis, using time of first episode of sick leave as the primary outcome. RESULTS: We found statistically significant associations between all the predictors and risk of sick leave; for non-sitting work postures (HR_range 1.55–2.79), cumulative lifting HR_trend 1.29, 95% CI 1.26–1.31, shift work (HR_evening 1.90, 95% CI 1.73–2.09, HR_night 1.52, 95% CI 1.15–2.01), monthly night shifts HR_trend 1.12, 95% CI 1.11–1.14, increasing weekly work hours HR_trend 0.93, 95% CI 0.91–0.95 and high job strain HR 1.52, 95% CI 1.42–1.63. Some exposures influenced HR in either a positive or negative time-dependent way. CONCLUSION: Our results support previous findings and suggest that initiatives to prevent sick leave during pregnancy could be based on work conditions. Preventive measures may have important implications for pregnant women and workplaces.

OBJECTIVES: The present study aimed to investigate whether different dimensions of psychosocial stress, as measured by the job demand–control model (JDC), were associated with increased risks of ischemic stroke and coronary heart disease (CHD). METHODS: A cohort of 75 236 male construction workers was followed from 1989–2004. Exposure to psychosocial stress was determined by a questionnaire answered in 1989–1993. Events of ischemic stroke and CHD were found by linkage to the Swedish Causes of Death and National Patient registers. Hazard ratios (HR) were obtained from Cox regression models, adjusted for age, smoking habits, body mass index and systolic blood pressure. RESULTS: There were 1884 cases of CHD and 739 cases of ischemic stroke. Regarding ischemic stroke, no association was found between job demands [HR 1.12, 95% confidence interval (95% CI) 0.89–1.40, highest versus lowest quintile] or job control (HR 1.04, 95% CI 0.82–1.32, lowest versus highest quintile). Regarding CHD, job demands were associated to CHD (HR 1.18, 95% CI 1.02–1.37, highest vs. lowest quintile), but no consistent trend was seen among quintiles. The results were inconsistent in relation to job control. The division of JDC into four categories showed no significant associations with either ischemic stroke or CHD. CONCLUSIONS: This exploratory study showed no significant associations between psychosocial work environment and ischemic stroke, and the associations between job demands and control and CHD were inconsistent and weak. The combination of job control and job demand showed no significant associations with either ischemic stroke or CHD.

Objectives: This study measures the association between hospital staff’s job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units. Material and Methods: This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Results: Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer’s efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. Conclusions: If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented.

Introduction Modifications of hearth rate variability (HRV) constitute a marker of the autonomic nervous system (ANS) deregulation, a promising pathway linking job strain (JS) and cardiovascular diseases (CVD). The study objective is to assess whether exposures to recent and prolonged JS reduce time-domain HRV parameters on working days (WD) among CVD-susceptible nurses and whether the association also persists on resting days (RD). Material and methods 313 healthy nurses were investigated twice with one year interval to assess JS based on the demand-control and the effort-reward models. 36, 9 and 16 CVD-susceptible nurses were classified as low JS in both surveys (stable low strain – SLS), recent high JS (high JS at the second screening only-RHS) and prolonged high JS (high strain in both surveys-PHS), respectively. In 9, 7 and 10 of them, free from comorbidities/treatments interfering with HRV, two 24-h ECG recordings were performed on WD and RD. Differences in the time domain HRV metrics among JS categories were assessed using ANCOVA, adjusted for age and smoking. Results In the entire sample (mean age: 39 years, 83% females) the prevalence of high job strain was 38.7% in the second survey. SDNN (standard deviation of all normal RR intervals) on WD significantly declined among JS categories (p = 0.02), with geometric mean values of 169.1, 145.3 and 128.9 ms in SLS, RHS, PHS, respectively. In the PHS group, SDNN remained lower on RD as compared to the low strain subjects (142.4 vs. 171.1 ms, p = 0.02). Similar findings were found for the SDNN_Index, while SDANN (standard deviation of average RR intervals in all 5 min segments of registration) mean values reduced in the PHS group during WD only. Conclusions Our findings suggest that persistent JS lowers HRV time-domain parameters, supporting the hypothesis that the ANS disorders may play an intermediate role in the relationship between work stress and CVD.

Objectives: Days off, on call, night duty, working hours and job stress can affect physicians’ mental health, and support from supervisors and co-workers may have a buffering effect. This study elucidates whether job strain and job factors affect physicians’ mental health, and whether support from supervisors and co-workers has a protective effect on their mental health. Material and Methods: The subjects included 494 physicians. The Brief Job Stress Questionnaire (BJSQ) was used to evaluate job demand, job control and support. High job strain was defined as a combination of high job demand and low job control. Depressive symptoms were assessed using the Patient Health Questionnaire-9. The Maslach Burnout Inventory- General Survey was used to evaluate burnout. Possible confounder adjusted logistic regression analyses were performed to obtain odds ratios for depressive symptoms and burnout. Results: As per the analysis, high job strain had significantly higher odds ratios, and support from co-workers had significant protective odds ratios for depressive symptoms. High job strain and having only 2–4 days off per month (compared to > 8 days off per month) had significantly higher odds ratios, and support from co-workers had significant protective odds ratios for burnout. Conclusions: High job strain was related to depressive symptoms and burnout, and support from co-workers had a buffering effect on depressive symptoms and burnout. An inadequate number of days off was related to burnout. Assessment of job strain may be a good tool to measure physicians’ mental health, and a sufficient number of days off may be needed to prevent burnout.

Abstract: While there is evidence from nursing and medicine that transition to independent practitioner is challenging and has implications for patient care, there is little research exploring novice community pharmacists' (NCPs) transition. This study aimed to identify the challenges faced by NCPs at transition to independent practitioner and perceptions of the relative importance of these challenges. Nominal group discussions were held between November 2015 and April 2016, in North West England, with purposively sampled NCPs, early career pharmacists, work‐based preregistration tutors, and pharmacy support staff. In response to the question “What are the challenges faced by NCPs at transition?” participants individually wrote down and subsequently called out, in round‐robin fashion, then discussed, and broadly categorised challenges before ranking them in order of importance. Discussions were audio‐recorded with consent, transcribed, and analysed thematically. Twenty‐five participants from independent, supermarket, and small and large multiple pharmacies took part in five nominal group discussions. Challenges experienced through interacting with the workplace environment were identified as: (in order of importance) relationship management; confidence; decision‐making; being in charge and accountable; and adapting to the workplace. With the exception of disagreement between pharmacists and pharmacy support staff regarding whether adapting to the team was challenging for NCPs, all participants reported challenges experienced through interacting with the workplace environment. Challenges were described as inducing psychosocial stress, particularly because NCPs acquired immediate professional accountability, worked in isolation from experienced peers, and faced job‐related pressures. Interpretation of the findings suggests that the Karasek job‐demand‐control‐support (JDCS) model of occupational stress provides valuable insight about transition for NCPs. NCPs' jobs are classified as high strain, where high workplace demands coupled with NCPs' lack of control in being able to meet demands, together with isolation and lack of support, result in transition being characterised as causing isostrain, where the workplace becomes a “noxious” environment. [ABSTRACT FROM AUTHOR]

Background: Shift work and psychosocial stressors may contribute to higher metabolic syndrome (MetS) incidence. Few studies investigated whether the presence of both factors simultaneously has a synergic effect on risk of MetS. Methods: This cross‐sectional analysis used baseline data (2008‐2010) for 10 960 current workers from ELSA‐Brasil. Multiple logistic regression was used to estimate independent associations between shift work and job strain and MetS. An interaction between these factors was tested by including a multiplicative term in the final model. Results: Exposure to three‐shifts a week (that is, three 12 h shifts of work followed by 36 h of rest) and high job‐strain were independently associated with greater risk of MetS. We found no indication (P > 0.05) of interaction between working in shifts and job strain on MetS. Conclusions: Efforts to reduce job strain and shift work should be considered as part of a primary prevention strategy to reduce the risk of MetS. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to investigate which components of the demand--control model (DCM) are associated with blood pressure (BP) and ascertain whether these associations vary over the BP distribution. Methods We evaluated the baseline date of 11 647 current workers enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (2008-2010), a multicenter cohort study of 35-74-year-old civil servants. Job demands, skill discretion and decision authority were measured using the Brazilian version of the Demand--Control-- Support Questionnaire. The associations between DCM components and systolic and diastolic BP (SBP and DBP, respectively) were examined by gamma regression, indicated for modelling skewed continuous variables, and quantile regression. Tests were conducted for interaction with gender and use of antihypertensives. Results In the adjusted gamma models, no association was observed between DCM components and BP in the total study population. Among non-users of antihypertensives, high decision authority was marginally associated with an increase of 0.59 mmHg (95% CI 0.00-1.18) in SBP. In the quantile models, this association was found to be significant from quantiles 35-60. Further significant but inconsistent positive associations were observed between decision authority and DBP among users of antihypertensives (quantiles 5 and 10) and between skill discretion and SBP in the total study population (quantile 5). The results did not differ by gender. Conclusions Decision authority associates positively with SBP, but only in the central portion of the SBP distribution and among non-users of antihypertensives. No consistent associations were observed for skill discretion or job demands. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether chronic psychosocial work stressors (low job control, high job demands, job strain, low supervisor and coworker support, job insecurity, and long work hours) are longitudinally associated with suicidal ideation in a working population.Methods: Five-hundred seventy-eight workers (aged 34-69) were chosen for this analysis from those who participated in both project 1 (2004-2006 at baseline) and project 4 (2004-2009 at follow-up) of the Midlife Development in the United States II study. The median time interval between the two projects was 26 months (range 2-62 months).Results: About 11% of the workers reported suicidal ideation at follow-up, while 3% of them reported moderate/severe suicidal ideation at follow-up. After controlling for age, marital status, race, family history of suicide, and suicidal ideation at baseline, low skill discretion and job strain (a combination of low job control and high job demands) were associated with total suicidal ideation. After excluding those with suicidal ideation at baseline from analysis and further controlling for other work stressors, job strain was strongly associated with moderate/severe suicidal ideation: ORs, 4.29 (1.30-14.15) for quartile-based job strain and 3.77 (1.21-11.70) for median-based job strain. Long work hours (> 40 h/week vs. ≤ 40 h/week) also increased the likelihood for moderate/severe suicidal ideation: OR 4.06 (1.08-15.19).Conclusions: Job strain and long work hours were longitudinally associated with moderate/severe suicidal ideation. Increasing job control and ensuring optimal level of work demands, including 40 h or less of work per week may be an important strategy for the prevention of suicide in working populations. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 25‐30% of nursing personnel experience knee pain (KP). We sought to identify physical and psychosocial work exposures, and personal factors related to prevalent, incident, and persistent KP 5‐8 years after safe resident handing program (SRHP) implementation in nursing homes. Methods: Health and exposure information was obtained from worker surveys 5‐6 years (“F5”) and 7‐8 years (“F6”) post‐SRHP implementation. Prevalent KP correlates were examined at F5; persistent and incident KP predictors were analyzed at F6, utilizing robust Poisson multivariable regression. Results: F5 KP prevalence (19.7%) was associated with combined physical exposures, and with either high job strain or low social support, in separate models. Two‐year persistent KP was similarly associated with these psychosocial exposures. Being overweight was associated with KP in all analyses. Conclusions: The SRHP program did not eliminate knee physical loading, which should be reduced to prevent nursing home worker KP. Workplace psychosocial exposures (high job strain, low social support) also appeared germane. [ABSTRACT FROM AUTHOR]

This study offers an insight regarding seafarers' perceptions of factors of psychological distress on shipboard. To identify stressors on maritime workers, a cross-sectional survey was conducted targeting a population of workers of Italian shipping companies sailing across the world. The research aimed to investigate workers' demographic and professional characteristics and the ways they influence perception of job fatigue, using an Italian version of the Karasek questionnaire. Of the involved seafarers, 80.1% returned the questionnaire, yielding a mean level of perceived job demand of 32.8 points and a mean level of perceived decision latitude of 65.5 points; 37.2% of interviewees stated having a scarce level of decision latitude. The results of the multivariate logistic regression models allowed assessment of the seafarers' characteristics related to their perception of job strain. These results confirm the need for measures that prevent stress factors in maritime workers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prolonged work pressure can contribute to burnout. The Job-Demands Resources model (the health impairment process and the roles of job and personal resources in it) provides a framework for studying work pressure. OBJECTIVE: The study aims were to understand the experiences of employees in the career services and a teaching department of a school for vocational education regarding the following: A) work pressure; B) its negative consequences; and C) how job resources and D) personal resources play a role in the employees' experience of work pressure or in helping to cope with it. METHODS: A qualitative study based on 11 in-depth interviews with teachers (5) and supporting personnel (6) was performed at a Dutch organization for vocational education. The interviews were analyzed interpretatively. RESULTS: A) The teachers and supporting personnel generally experienced work pressure, which had both qualitative and quantitative aspects. B) The consequences included working overtime and lower job performance. Factors such as autonomy and social support from colleagues were C) job resources, and moving from idealism towards realism was D) a personal resource. CONCLUSIONS: Both the teachers and supporting personnel who were interviewed experienced work pressure and its related consequences, as well as job and personal resources. Work pressure may threaten the sustainable employability of these employees. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension. Methods The work stressors job strain, effort--reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models. Results Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61-0.81), 17.7% to two stressors (O/E=0.91-1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9-2.1-fold [95% confidence interval (CI) 1.7-2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0-1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4-4.7-fold (95% CI 2.4-8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9-2.5-fold (95% CI 1.1-4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6-1.9-fold (95% CI 1.3-2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0-1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings. Conclusions Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors. [ABSTRACT FROM AUTHOR]

Corporate sustainable innovation is a major driver of institutional change, and its success can be largely attributed to employees. While some scholars have described the importance of intrinsic motivations and flexibility to facilitate innovation, others have argued that constraints and extrinsic motivations stimulate innovation. In the context of sustainable innovation, we explore which employee work practices are more conducive to firm-level innovation in corporate sustainability. Our results, based on a sample of 4640 French employees from 1764 firms, confirm the positive impact of intrinsic motivations (through employee social interactions), and the negative impact of job strain (through high imposed work pace), on corporate sustainable innovation. We also find that extrinsic rewards, through pay satisfaction, counteract the negative effect of job strain to promote sustainable innovation. This indicates that intrinsic and extrinsic rewards can work in tandem to facilitate sustainable innovation. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study were to construct a job-exposure matrix (JEM) for psychosocial work factors of the job strain model, to evaluate its validity, and to compare the results over time.Methods: The study was based on national representative data of the French working population with samples of 46,962 employees (2010 SUMER survey) and 24,486 employees (2003 SUMER survey). Psychosocial work factors included the job strain model factors (Job Content Questionnaire): psychological demands, decision latitude, social support, job strain and iso-strain. Job title was defined by three variables: occupation and economic activity coded using standard classifications, and company size. A JEM was constructed using a segmentation method (Classification and Regression Tree—CART) and cross-validation.Results: The best quality JEM was found using occupation and company size for social support. For decision latitude and psychological demands, there was not much difference using occupation and company size with or without economic activity. The validity of the JEM estimates was higher for decision latitude, job strain and iso-strain, and lower for social support and psychological demands. Differential changes over time were observed for psychosocial work factors according to occupation, economic activity and company size.Conclusions: This study demonstrated that company size in addition to occupation may improve the validity of JEMs for psychosocial work factors. These matrices may be time-dependent and may need to be updated over time. More research is needed to assess the validity of JEMs given that these matrices may be able to provide exposure assessments to study a range of health outcomes. [ABSTRACT FROM AUTHOR]

Four decades of research on the influential demand-control (DC) model has yielded inconsistent and contradictory findings. The present study addressed this issue in two innovative ways. First, the DC model was integrated with conservation of resources theory. Next, this original theoretical synthesis was tested on 826 case managers from two different types of public human service agencies. Findings confirmed both hypothesized nonlinear demand by linear control interactions. Data not only make a new contribution to the human service literature, but also clarify forty years of conflicting DC research. Implications for human service workforce management and DC model theory are discussed. [ABSTRACT FROM AUTHOR]

Background: Previously documented elevated hypertension rates among Las Vegas hotel room cleaners are hypothesized to be associated with job strain. Methods: Job strain was assessed by questionnaire. Ambulatory blood pressure (ABP) was recorded among 419 female cleaners from five hotels during 18 waking hours. Multiple linear regression models assessed associations of job strain with ABP and pulse pressure for 18‐h, work hours, and after work hours. Results: Higher job strain was associated with increased 18‐h systolic ABP, after work hours systolic ABP, and ambulatory pulse pressure. Dependents at home but not social support at work attenuated effects. Among hypertensive workers, job strain effects were partially buffered by anti‐hypertensive medication. Conclusions: High job strain is positively associated with blood pressure among female hotel workers suggesting potential for primary prevention at work. Work organizational changes, stress management, and active ABP surveillance and hypertension management should be considered for integrated intervention programs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Enriched environment at work (EEW), in terms of high mental demands at work, may be of great relevance for preventative efforts against cognitive decline and dementia as previous studies have shown. Yet, there is the concern that high EEW mental demands may accelerate stress and cause burnout. OBJECTIVE: The aim of our study was to investigate how EEW mental demands are related to stress and burnout. METHOD: A convenience sample of employees in the city area of Leipzig, Germany, was asked to fill out the Copenhagen Burnout Inventory and indicate for each EEW mental demand the level experienced, demandingness, and stressfulness. RESULTS: Multivariate linear regression and structural equation modelling suggested that only some EEW mental demands were perceived as stressful when the level of the respective EEW mental demand was high. Higher stressfulness was associated with burnout symptoms – however, high levels of EEW mental demands were not significantly associated with burnout (neither directly nor indirectly). CONCLUSIONS: Our findings implied that subjectively perceived stressfulness seems to be a more relevant aspect than the actual level of the demand itself. However, further studies are necessary to validate our findings. [ABSTRACT FROM AUTHOR]

Objective: Obesity as well as job strain is increasing, and job strain might contribute to weight gain. The objective of the current study was to examine associations between longitudinal alterations in the components of job strain and subsequent weight gain.Design: The study was designed as a prospective cohort study with three questionnaire surveys enabling measurement of job-strain alterations over 6 years and subsequent measurements of weight gain after further 10 years of follow-up. ANCOVA and trend analyses were conducted. Job demands were measured as job busyness and speed, and control as amount of influence.Setting: Employed nurses in Denmark.Subjects: We included a sub-sample of 6188 female nurses from the Danish Nurse Cohort, which consisted of the nurses who participated in surveys in 1993, 1999 and 2009.Results: A linear trend in weight gain was seen in nurses who were often busy in 1999 between those who were rarely v. sometimes v. often busy in 1993 (P=0·03), with the largest weight gain in individuals with sustained high busyness in both years. Loss of influence between 1993 and 1999 was associated with larger subsequent weight gain than sustained high influence (P=0·003) or sustained low influence (P=0·02). For speed, no associations were found.Conclusions: Busyness, speed and influence differed in their relationship to subsequent weight gain. A decrease in job influence and a sustained burden of busyness were most strongly related to subsequent weight gain. Focus on job strain reduction and healthy diet is essential for public health. [ABSTRACT FROM AUTHOR]

Objectives: Stress is an important factor affecting the health of working population. While work exposures are determinants of levels of work and life stress, we do not know whether similar or different exposures are related to stress levels for men and women. This study aimed to formally examine male/female differences in the relationships between psychosocial work exposures and work and life stress in a representative sample of Canadian labour market participants. Methods: We used data from 2012 cycle of the Canadian Community Health Survey (CCHS), a representative population-based survey conducted by Statistics Canada. The sample was restricted to employed labour force participants working 15+ hours per week (N = 8328, 48% female). To examine the relationship between work exposures and work and life stress, we conducted path analyses. Psychosocial work exposures included social support, job insecurity, job control, and job strain. Differences between estimates for men and women were explored using multigroup analyses, constraining paths between male and female models to be equivalent and examining the impact on change in model fit. Results: Male/female differences were observed in the relationships between supervisor support and work stress levels as well as between job control, job insecurity, job strain, and life stress levels. Higher levels of supervisor support at work were associated with lower work stress among women, but not among men. Low job control had a direct protective effect on life stress for men but not for women, while high job strain had a direct adverse effect on life stress among women but not among men. Higher job insecurity was more strongly associated with higher life stress among men compared with women. The relationship between work stress and life stress was similar among men and women. Discussion: The findings of this study suggest that the relationships between psychosocial exposures and work and life stress differ for men and women. Our study also raised important questions about which work exposures are considered when assessing work stress, with level of job control not related to work stress but associated with levels of life stress among men. Conclusion: Our study highlights the role of psychosocial work environment for both work and life stress and suggests differences in the importance of specific psychosocial work dimensions for feelings of stress among men and women, and for work stress versus life stress. Future study designs should ensure that measures are included to better disentangle the relative contribution of social and biological factors in explaining these differences among men and women. [ABSTRACT FROM AUTHOR]

Purpose: Depression is a global health concern. High job demands, low job control, and the combination (high strain) are associated with depression. However, few longitudinal studies have investigated changed or repeated exposure to demands and control related to depression. We investigated how trajectories of exposure to job demands and control jointly influence subsequent depression.Methods: We included 7949 subjects from the Swedish Longitudinal Occupational Survey of Health, who completed questionnaires of perceived job demands and control, and depressive symptoms from 2006 to 2014. None of them were depressed between 2006 and 2012. Univariate and joint group-based trajectory models identified groups with similar development of demands and control across 2006-2012. Logistic regression estimated the risk for symptoms of major depression in 2014 according to joint trajectory groups.Results: The joint trajectory model included seven groups, all with fairly stable levels of demands and control over time. Subjects in the high strain and active (high demands and high control) trajectories were significantly more likely to have subsequent major depressive symptoms compared to those having low strain, controlling for demographic covariates (OR 2.15; 95% Cl 1.24-3.74 and OR 2.04; 95% CI 1.23-3.40, respectively). The associations did not remain statistically significant after adjusting for previous depressive symptoms in addition to demographic covariates.Conclusions: The results indicate that the levels of job demands and control were relatively unchanged across 6 years and suggest that long-term exposure to a high strain or active job may be associated with increased risk for subsequent depression. [ABSTRACT FROM AUTHOR]

Our study compares the motivations of Australian and German book publishers. The results demonstrate remarkable similarities, but also a significant difference regarding the effects of the publishers’ self-concept. In the German case the publishers with a dominant economic orientation are more proactive than the publishers with a dominant cultural orientation. In the Australian case, this correlation does not exist. The same difference holds for the relationship between the economic orientation and extrinsic motivation. We discuss these results and examine empirical evidence and theoretical suggestions to explain the differing findings. The data stem from surveys conducted in the two countries with responses of 196 (Germany) and 54 publishers (Australia). [ABSTRACT FROM AUTHOR]

Objectives There is now convincing evidence that psychosocial work stressors are linked to depression. Few studies, however, have tested if individual resources can buffer the longitudinal effects of psychosocial work stressors on depressive symptoms. This study investigates how two types of resources (internal and external resources) affect the association between psychosocial work stressors and depressive symptoms. Methods Data were obtained from the US Health and Retirement Study, with baseline information on psychosocial work stressors [job strain and effort–reward imbalance (ERI)] and on internal ("high mastery" and "low constraints") and external resources ("private social support") among initially healthy workers. This information was linked to elevated depressive symptoms two years later. The sample includes 5473 observations and we report relative risks (RR) and effect modification on the additive and multiplicative scale. Results Psychosocial stressors and low resources (internal and external) were both independently related to depressive symptoms. Individuals with both, psychosocial stressors and low resources, had the highest risk of developing elevated depressive symptoms (eg, RRERI-LowMastery 3.32, 95% CI 2.49–4.42; RRJobStrain-LowMastery 2.89, 95% CI 2.18–3.84). Yet, based on interaction analyses, only social support from friends buffered the association between work stressors and depressive symptoms. Conclusions Our findings have demonstrated that psychosocial stressors at work are related to mental health, and that in most cases this relationship holds true both for people with high and with low resources. Therefore, there is no clear indication that internal or external resources buffer the association between psychosocial work stressors and depressive symptoms. [ABSTRACT FROM AUTHOR]

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We investigated how work-related biomechanical exposure and job strain in midlife separately and jointly predicted back and degenerative musculoskeletal diseases (MSDs). A total of 6,257 employees participated in the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 and were followed up for 28 years. Risk ratios and the relative excessive risk due to interaction and 95% confidence intervals were modeled for separate and joint prediction estimates, respectively. After adjustment for confounders, job strain predicted degenerative MSDs among women after 4 and 11 years of follow-up. After 11 years, both exposures predicted both types of MSDs among men. Joint exposure predicted both types of MSDs after 4 years among women (for back MSDs, risk ratio (RR) = 1.58, 95% confidence interval (CI): 1.15, 2.18; for degenerative MSDs, RR = 1.59, 95% CI: 1.21, 2.07) and men (for back MSDs, RR = 1.50, 95% CI: 1.05, 2.15; for degenerative MSDs, RR = 1.61, 95% CI: 1.16, 2.22) and both types of MSDs after 11 years (for back MSDs, RR = 1.72, 95% CI: 1.21, 2.43; for degenerative MSDs, RR = 1.68, 95% CI: 1.25, 2.46) among men only, but the relative excessive risk due to interaction was not significant throughout. However, after 28 years, the separate and joint exposures did not predict MSDs. Workplace interventions should be focused on reducing job strain along with biomechanical exposure for possible prevention of MSDs in working life and around the time of retirement, but there may be other pathways of onset of MSDs in old age. [ABSTRACT FROM AUTHOR]