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Objective Little is known about the long-term prognosis for employees with suspected work-related mental health problems. Are they employed 5 years after consulting a department of occupational medicine in Denmark, or do they have no or low labor-market attachment? The aim of the study was to examine long-term employment status among patients referred to Danish departments of occupational medicine in the period 2000–2013 due to suspected work-related mental health problems.Methods The study includes data from the Danish Occupational Medicine Cohort. 17,900 patients aged 16–67 were included. All patients were referred to a department of occupational medicine in Denmark from 2000–2013 due to suspected work-related mental health problems. Register data was extracted 5 years prior to study inclusion and until 5 years after study inclusion. Information on 13 potential risk factors for negative labor market attachment was included. The primary outcome of this study was positive work status, defined as being at work or at education, maternity or parental leave.Results Preliminary results showed that approximately 85% of all patients from 2–5 years prior to study inclusion had positive work status. The proportion declined to 30% at the year of study inclusion and increased to approximately 50% of the patients 1 year after inclusion after which practically no further increase was seen. Within the subgroups of patients diagnosed with depression or PTSD only 40% and 30% had positive work status 5 years after study inclusion respectively. Besides, preliminary results indicated that diagnosis, sick leave status at inclusion time and previous work participation, were strong independent prognostic markers of work participation at 5-years of follow up.Conclusion We found a profoundly reduced long-term employment status among patients referred to departments of occupational medicine in Denmark due to suspected work-related mental health problems, particularly among patients diagnosed with PTSD or depression. AbstractObjective Little is known about the long-term prognosis for employees with suspected work-related mental health problems. Are they employed 5 years after consulting a department of occupational medicine in Denmark, or do they have no or low labor-market attachment? The aim of the study was to examine long-term employment status among patients referred to Danish departments of occupational medicine in the period 2000–2013 due to suspected work-related mental health problems.Methods The study includes data from the Danish Occupational Medicine Cohort. 17,900 patients aged 16–67 were included. All patients were referred to a department of occupational medicine in Denmark from 2000–2013 due to suspected work-related mental health problems. Register data was extracted 5 years prior to study inclusion and until 5 years after study inclusion. Information on 13 potential risk factors for negative labor market attachment was included. The primary outcome of this study was positive work status, defined as being at work or at education, maternity or parental leave.Results Preliminary results showed that approximately 85% of all patients from 2–5 years prior to study inclusion had positive work status. The proportion declined to 30% at the year of study inclusion and increased to approximately 50% of the patients 1 year after inclusion after which practically no further increase was seen. Within the subgroups of patients diagnosed with depression or PTSD only 40% and 30% had positive work status 5 years after study inclusion respectively. Besides, preliminary results indicated that diagnosis, sick leave status at inclusion time and previous work participation, were strong independent prognostic markers of work participation at 5-years of follow up.Conclusion We found a profoundly reduced long-term employment status among patients referred to departments of occupational medicine in Denmark due to suspected work-related mental health problems, particularly among patients diagnosed with PTSD or depression.

Objective The long-term prognosis for employees with work-related stress, depression or PTSD is unclear. We aim to investigate if these conditions represent a temporary setback or a decline towards long-term poor health.Methods From the Danish Occupational Medicine Cohort we included patients referred 2000–2012 with mental disorders (N=17.900) to Departments of Occupational Medicine across Denmark. From nation-wide registries we obtained data on general health care service utilization (GP contacts) and specialized mental health care (incident private practice psychiatrist/psychologist care and psychiatric hospital care) for five years after/before the index-date of referral. Results are presented as utilization 5 years before referral (index-year -5), the year on either side of referral (index-year -1 and +1) and five years after referral (index-year +5).Results General health care utilization increased from 7 median GP contacts in index-year -5 rising sharply to 12 in index-year -1 and 10 in index-year +1, then declining gradually to 8 in index-year +5. Incident private practice psychiatrist/psychologist care was 4.5% among patients in index-year -5 rising to 13.6% in index-year -1, 19.8% in index-year +1, declining to 7.4% in index-year +5. Incident psychiatric hospital care was 1.4% in index-year -5 rising to 5.6% in index-year -1, 8.6% in index-year +1, then declining to 4.7% in index-year +5.Conclusions General health care utilization was elevated in the years surrounding referral, then declined to levels comparable to five years prior to referral. From a relatively low incidence, mental health care utilization increased 4–6 fold in the years around referral, then declined to levels 2–3 fold higher than five years before referral. This could indicate that work-related mental disorders represent a temporary setback for most patients, but for some becomes a decline towards long-term poor mental health. Further analyses will seek to identify at-risk groups from demographic, occupational and health-related prognostic factors.

Objective Danish departments of occupational medicine currently receive about 9,000 patients each year referred due to suspected work-related disorders. In Denmark and internationally there is a lack of follow-up studies investigating the long-term prognosis of employees with work-related disorders. The purpose of this cohort is to facilitate long-term prognostic studies.Methods The cohort was created through The Danish National Patient Register and comprises all patients seen in Danish Departments/units of Occupational Medicine from 2000–2018 (N= 145,390). Numerous register data are included in the database from five years prior to time of inclusion until 2018. Examples of register data are; information on work, sickness absence and disability as well as number and type of contacts to health services, hospital admissions, income, education, type of occupation, social status, death and cause of death. Job Exposure Matrices (JEMs) on physical and psychosocial work exposure, life styles and other matrices are also available. The cohort will be updated with new patients regularly.Results Currently the cohort comprises seven major groups: musculoskeletal (n=51.056), mental health (n=28.212), lung (N=12.274), skin (N=6.544), nervous system (N=5.513), cancer (N=1.566), and others (n=40.225). Preliminary analyses across groups suggest that the labor market attachment has been high among the majority (about 75%) of patients during the years prior to the year of inclusion. However, results indicate that the main diagnostic groups, with the exception of skin patients, do not return to comparable levels of labor market attachment during the years following referral and diagnosis.Conclusions The Danish Occupational Medicine Cohort is an open source dataset available to researchers interested in long-term follow-up on patients with work-related disorders. Preliminary analyses indicate most diagnostic groups do not return to prior levels of labor market attachment during the years following referral and diagnosis from a department of occupational medicine.

We aimed to evaluate associations between vocational computer use and 1) ulnar neuropathy, and 2) ulnar neuropathy- like symptoms as distinguished by electroneurography. We identified all patients aged 18-65 years, examined at the Department of Neurophysiology on suspicion of ulnar neuropathy, 2001-2007. We mailed a questionnaire to 546 patients with ulnar neuropathy, 633 patients with ulnar neuropathy-like symptoms, and three community referents per case, matched on sex, age, and primary care centre. From a Job Exposure Matrix we extracted estimates of daily hours of computer use. The analysis was performed by conditional logistic regression.There were a negative association between daily hours of computer use and the two outcomes of interest. Participants who reported their elbow to be in contact with their working table for 2 hours or more during the workday had an elevated risk for ulnar neuropathy (OR=2.16, 95 % CI; 1.06-4.44).The two outcomes were not associated with daily hours of computer use. Findings suggested specific effects of pressure on the elbow, and might be an explanation for the overweight of left-sided outcomes in this primarily right-handed group. Preventive efforts would then be straightforward by providing appropriate arm support for the left arm and elbow. We aimed to evaluate associations between vocational computer use and 1) ulnar neuropathy, and 2) ulnar neuropathy- like symptoms as distinguished by electroneurography. We identified all patients aged 18–65 years, examined at the Department of Neurophysiology on suspicion of ulnar neuropathy, 2001–2007. We mailed a questionnaire to 546 patients with ulnar neuropathy, 633 patients with ulnar neuropathy-like symptoms, and three community referents per case, matched on sex, age, and primary care centre. From a Job Exposure Matrix we extracted estimates of daily hours of computer use. The analysis was performed by conditional logistic regression.There were a negative association between daily hours of computer use and the two outcomes of interest. Participants who reported their elbow to be in contact with their working table for 2 hours or more during the workday had an elevated risk for ulnar neuropathy (OR=2.16, 95 % CI; 1.06–4.44).The two outcomes were not associated with daily hours of computer use. Findings suggested specific effects of pressure on the elbow, and might be an explanation for the overweight of left-sided outcomes in this primarily right-handed group. Preventive efforts would then be straightforward by providing appropriate arm support for the left arm and elbow.

Some peope react to smells or chemicals at levels far below toxicological thresholds with nonspecific symptoms, fear and social isolation. They may be diagnosed with multiple chemical sensitivity. There is no empirical evidence indicating that this condition is explained by toxicological mechanisms, even though a number of theories have been proposed. The authors of this review conclude that this is a functional condition. These patients need information and treatment in accordance with this fact. Instead of being advised how to avoid exposure to chemicals, they should be properly trained in appropriate confrontation with the chemicals encountered in everyday life.

There appears to be a lack of evidence concerning the effect of rehabilitation programmes for the long-term sick. More focus in this area would supplement an approach that has been directed toward process evaluation of rehabilitation programmes. It was the purpose of this study to shed light on individual factors and health care and social welfare-related factors, which play a role for the outcome of rehabilitation programmes. In connection with a participatory, action-oriented outpatient rehabilitation program, a questionnaire survey was performed among the programmes participants ("clients"). Questionnaires were completed before the rehabilitation programme's start, at the end of the 8-week programme, and at the 9-months follow-up. Among 389 clients, 271 (69.7%) participated in the study at baseline as well at the 9-months follow-up. The majority of 212 participants were on sick leave--6.6% for more than 1 year. The remainder had been transferred to receiving social benefits after having exceeded the time limit for being sick-listed. A plan of action for active rehabilitation, which was made at the end of the 8-week rehabilitation programme, was only poorly fulfilled after 9 months, 48% were still on sick leave or social benefits at this time. Individual background variables, as well as psychological well-being, mental health, pain level, and pain coping, seemed to have little effect on the outcome of rehabilitation, whilst clients' own evaluations of competence and ability of the involved health care professionals were found important for a positive outcome of the programme. Especially stable relations to a single General Practitioner (GP), who took good care of the patient in the form of giving good information about health and social possibilities, and an empathic attitude toward these hard-pressed clients, were important factors. The odds ratio for a nonbeneficial outcome of the rehabilitation programme, among those who had changed GP and reported poor case treatment by the GP, was 3.9 (95% CI; 1.3-11.9). Additional findings were an association between a desire to go on early retirement pension, higher age, and self-estimated poorer health at baseline, and actual status as pensioner 9 months after the programme. Predictors of a beneficial outcome from the 8-week rehabilitation programme included good and comprehensive care-taking in particular by the clients' GP. The presence of a high level of symptoms and complaints of pain and stress had no effect on the outcome of rehabilitation in this cohort.

AIMS: To assess the importance of physical and psychosocial risk factors for lateral epicondylitis (tennis elbow). METHODS: Case-referent study of 267 new cases of tennis elbow and 388 referents from the background population enrolled from general practices in Ringkjoebing County, Denmark. RESULTS: Manual job tasks were associated with tennis elbow (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.9 to 5.1). The self reported physical risk factors "posture" and "forceful work" were related to tennis elbow. Among women, work involving performing repeated movements of the arms was related to tennis elbow (OR 3.7, CI 1.7 to 8.3). Among men, work with precision demanding movements was related to tennis elbow (OR 5.2, CI 1.5 to 17.9). Among both males and females, the results for work with hand held vibrating tools were inconsistent, partly because of few exposed subjects. A physical strain index was established based on posture, repetition, and force. The adjusted ORs for tennis elbow at low, medium, and high strain were 1.4 (CI 0.8 to 2.7), 2.0 (CI 1.1 to 3.7), and 4.4 (CI 2.3 to 8.7). Low social support at work, adjusted for physical strain, was a risk factor among women (OR 2.4, CI 1.3 to 4.6). CONCLUSION: Results indicate that being a new case of tennis elbow is associated with non-neutral postures of hands and arms, use of heavy hand held tools, and high physical strain measured as a combination of forceful work, non-neutral posture of hands and arms, and repetition. Furthermore, tennis elbow among women was associated with low social support at work. The results for precision demanding movements and for vibration were less consistent

OBJECTIVES: To assess the occurrence and persistence of two restrictively defined neck-shoulder disorders among sewing machine operators. To assess factors associated with the development of neck-shoulder disorder and prognostic factors for remaining a case, when disorders were already present. METHODS: In an initial group of 243 sewing machine operators, 178 were followed up for 2 years. At baseline and at 1 and 2 years follow up the participants underwent a clinical examination of the neck and arms and filled in a questionnaire about current musculoskeletal complaints. Clinical criteria for two main neck-shoulder disorders were defined: rotator cuff tendinitis and myofascial pain syndrome. A baseline control group consisted of 357 women with varied non-repetitive work. RESULTS: At baseline the overall prevalence of myofascial pain syndrome and rotator cuff tendinitis was 15.2% and 5.8% among sewing machine operators compared with 9.0% and 2.2%, respectively, among controls. The presence of the disorders was strongly associated with a self perception of poor general health. Although myofascial pain syndrome showed a U shaped association with years as a sewing machine operator, rotator cuff tendinitis was absent among the newest recruits and present among 15% of the women with more than 20 years as a sewing machine operator. Besides years as a sewing machine operator, the risk of having a neck-shoulder disorder at baseline was significantly associated with high stress (prevalence ratio (PR)=2.54; 95% confidence interval (95% CI) 1.28 to 5.05) when adjusted for age, body mass index, smoking, living alone with children, job strain, and social support from colleagues and supervisors. Only one of 13 participants with rotator cuff tendinitis at baseline recovered during follow up. Myofascial pain syndrome showed a much more fluctuating tendency. Low social support (RR 3.72; 95% CI 1.22 to 11.30) and smoking (RR 3.93; 95% CI 1.33 to 11.58) were associated with the development of neck-shoulder disorders, which was also associated with neck-shoulder pain score and living alone with children. CONCLUSION: Rotator cuff tendinitis showed a higher degree of persistence than myofascial pain syndrome. Both disorders highly influenced the perception of general health. Women who lived alone with children, were smokers, or experienced low support from colleagues and supervisors had a higher risk of contracting a neck-shoulder disorder