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OBJECTIVE: The Scandinavian Journal of Work, Environment & Health (SJWEH) was established half a century ago. This paper provides an overview of research on musculoskeletal disorders (MSD) published over these 50 years. Three themes are described: risk assessment, interventions to prevent work-related MSD, and interventions to support work participation. Finally, implications for future research are highlighted. METHODS: A systematic literature search was performed for all papers on MSD published in SJWEH. Each paper was coded on several criteria including research topic, type of MSD, risk factor(s), and number of citations. Findings were tabulated, and discussions within the author team defined the main results and future research directions. RESULTS: The search resulted in 1056 papers, of which 474 were included. The most reported-on MSD was low-back pain (LBP, 18%) and the most reported-on work-related risk factors were physically demanding work (14%) and psychosocial factors (12%). Research has contributed to improving case definitions, refining work-related exposure criteria, and recognizing the varying importance of physical and psychosocial factors across different MSD. Research on the association between work-related risk factors and LBP continues to emerge. Effective interventions for prevention of MSD are characterised by sufficient exposure reduction, while supporting work participation requires integrating health care, with multidisciplinary actions directed at factors involving the worker, employer, and workplace. CONCLUSION: Research has provided valuable insights into risk assessment, interventions for preventing work-related MSD, and supporting work participation. Intervention studies remain warranted and new areas include adopting whole-system approaches to prevent work-related MSD and promoting the concept of musculoskeletal health.

In this study, we assessed whether the long-term decrease in sickness absences in Finland is explained by observed and unobserved compositional changes in the workforce. Utilizing register-based panel data on Finnish wage earners aged 30–62, we examined the annual onset of compensated sickness absence (granted after 10 weekdays) in the period 2005–2016. We applied random effects models adjusting for changes in the observed sociodemographic and occupational characteristics of the study population. We also applied fixed effects models, with corrections of the estimates for cohort ageing, to additionally account for the unobserved time-invariant characteristics of the study population over the years. Of the observed characteristics, increasing educational level partly explained the decreasing trend in sickness absences, and the further contribution of the occupational class was weak. Additionally, accounting for unobserved individual characteristics further explained the decreasing trend in sickness absences among those aged 30–47 years and led to a reverse increasing trend among those aged 48–62 years irrespective of sex and employment sector. Particularly for those over 47 years old, the decrease in sickness absences appeared to be more strongly influenced by compositional changes in characteristics that are established before fully entering the labour market — such as educational level as well as unmeasured individual characteristics that remain unchanged after childhood and early adulthood — than in the work environment or other factors contributing at working age. Sickness absence trends fluctuated during economic cycles, which did not appear to be explained by immediate changes in the observed or unobserved characteristics. Different mechanisms are likely to explain long-term sickness absence trends and trends around economic cycles. Attempts to improve work ability and labour market inclusion in long-term should rely more on increasing educational levels among the workforce and on interventions carried out early during the life course.

Introduction Shoulder pain is a substantial medical and socioeconomic problem in most societies, affecting the ability to work or carry out leisure time activities as well as subsequently influencing physical and psychological well-being. According to a nationwide survey in Finland, 27% of the population reported shoulder pain within the last 30 days. In clinical practice, imaging findings of structural abnormalities are typically thought to explain symptoms, even though such findings are also prevalent in asymptomatic individuals, particularly with increasing age. Overall, there is a paucity of high-quality evidence on the prevalence, clinical relevance and prognosis of ‘abnormal’ imaging findings of the shoulder.The aim of the Finnish Imaging of Shoulder (FIMAGE) study is fourfold: to assess (1) the prevalence of shoulder symptoms and the most common anatomical variants and imaging abnormalities of the shoulder; (2) the concordance between shoulder symptoms, function and imaging abnormalities; (3) the most important determinants of symptoms, function and imaging abnormalities; and (4) the course of shoulder complaints over 5 years.Methods The FIMAGE target population of 600 participants, aged 40–75 years, will be randomly selected from a nationally representative general population sample of 9922 individuals originally recruited for the Finnish Health 2000 Survey. On giving informed consent, the participants will be invited to a clinical visit that includes assessment of general health, shoulder symptoms, bilateral shoulder examination and imaging of both shoulders with plain radiography and MRI.Ethics and dissemination The study has been approved by the Institutional Review Board of the Helsinki and Uusimaa Hospital District. The findings will be published according to the Strengthening the Reporting of Observational Studies in Epidemiology criteria.Trial registration number NCT05641415.

OBJECTIVES: The use of part-time sickness absence (pSA) instead of full-time sickness absence (fSA) is known to increase work participation. Yet, its effect on the total length of working lives remains unclear. We carried out a quasi-experiment to assess the impact of using pSA versus fSA on the length of working lives. METHODS: We used a register-based 70% random sample of the working-age population living in Finland on 31 December 2007 to (i) form propensity-score-matched groups of users of pSA and fSA and (ii) calculate their working life expectancy (WLE) and working years lost (WYL). We applied the Sullivan method based on daily measured time spent at work and other labor market statuses, followed up over a four-year period until the end of year 2017. The study population consisted of private and public sector employees with SA due to mental and musculoskeletal disorders, ie, the diagnostic groups where pSA has been primarily used. RESULTS: Among both genders, the pSA group had a significantly higher WLE at age 30 than the fSA group, with larger differences seen in mental disorders compared to musculoskeletal diseases and in the private versus public sector. Overall, the pSA group had fewer WYL due to unemployment and disability retirement but more expected years working with partial disability benefits than the fSA group. CONCLUSIONS: Based on beneficial working career effects, the use of pSA instead of fSA should always be recommended for persons with mental or musculoskeletal disorders where feasible.

Objectives The use of part-time sickness absence (pSA) enables return to part-time work from full sickness absence. However, subsequent labour market outcomes of pSA users depend on various individual and work-related characteristics. We investigated labour market paths of private and public sector employees after having a pSA spell. Moreover, we examined individual and work-related factors associated with following them.Design Longitudinal register-based cohort study.Setting Finnish employed population.Participants 9896 receivers of partial sickness allowance aged 45–56 in the years 2010–2014.Outcome We constructed labour market trajectories based on the proportion of time spent in various labour market statuses measured over 3 years after the end of the pSA spell using multiresponse trajectory analysis. We then examined how different individual and work-related factors were associated with assignment to the different trajectory groups using logistic regression analyses.Results The majority of the pSA users followed paths where work participation was consistently elevated (Sustained Work group, 40.4%), or only slightly reduced (Slightly Reduced Work group, 31.6%). Moreover, more than 1/10th of the users followed a path where receiving partial work disability benefits became predominant (Partial Work Disability group, 12.5%). The rest followed paths where other non-employment (Other Non-Employed group, 7.8%) or full work disability (Full Work Disability group, 7.7%) became the prevailing status. Lower educational level and income predicted assignment to all other groups than the Sustained Work group. Additional predictors were identified, yet these differed between the trajectory groups.Conclusions The majority of the pSA users maintained a connection to working life, yet weaker working life paths were also identified. The paths were determined by various individual and work-related factors that can help health professionals and employers to better target support measures particularly towards individuals whose connection to working life is at risk to weaken after the use of pSA.

OBJECTIVE: We aimed to investigate the influence of unobserved individual characteristics in explaining the effects of work-related factors on full (fSA) and part-time sickness absence (pSA). METHODS: We used register-based panel data for the period 2005–2016 on a 70% random sample of the Finnish working-age population. The relationships between employment sector and occupational exposures (% exposed to physically heavy work and job control score based on job exposure matrices) and the annual onset of fSA and pSA were investigated among men and women. First, random effects (RE) models were applied controlling for observed sociodemographic factors and then fixed effects (FE) models that examine within-individual changes over time and thereby further account for unobserved time-invariant individual characteristics. RESULTS: In the RE analyses, public employment sector, physically heavy work and lower job control each increased the use of fSA and pSA among both genders. When unobserved individual characteristics were controlled for with the FE models, the effects on fSA attenuated. For pSA, the effects of employment sector and physical heaviness of work among women even reversed. The effect of lower job control on pSA remained especially among women. CONCLUSIONS: The role of individuals’ unobserved characteristics in explaining the effects of work-related factors on SA should not be neglected. The effects of work-related factors are likely to be overestimated when using traditional approaches that do not account for unobserved confounding, ie, selection of individuals with a high likelihood of SA into particular work environments.

Objectives The share of the overall working careers that is spent receiving disability benefits is unclear. We examined trends in full-time equivalent working life expectancy (FTE-WLE) among those with and without receiving a permanent full or partial disability pension in Finland, where certain amounts of work are allowed while receiving these pensions.Design Longitudinal register-based study.Setting Finnish population.Participants Nationally representative 70% samples of the working-age population.Outcome Using the Sullivan method, we examined annual FTE-WLE at age 45, truncated at age 63, in 2005–2018 by disability pension status. Full-time equivalent work participation was based on combined information on annual employment days and work income.Results Compared with those with no disability pension, disability pensioners had a larger relative (full and partial pensioners of both genders) and absolute (male partial pensioners) increase in the FTE-WLE between 2005 and 2018. In 2018, the FTE-WLE of both male and female full disability pensioners was around 3.5 months, being 6 months at its highest in musculoskeletal diseases. The FTE-WLE of partial disability pensioners was around 6.5 and 8 years among men and women, respectively, being around half of the corresponding expectancies of non-pensioners. The FTE-WLE of partial disability pensioners was considerable in musculoskeletal diseases and mental disorders and even higher in other diseases. Full disability pensioners spent a disproportionately large time in manual work, increasingly in the private sector, and partial pensioners in the public sector with lower non-manual and manual work, increasingly with the former. At the population level, the share of the FTE-WLE that is spent receiving a disability pension remained relatively small.Conclusions Increased work participation while receiving a disability pension is likely to have had important implications for prolonging individual working careers but only minor contribution to the length of working lives at the population level.

OBJECTIVE: This study investigates the impact of physical workload factors and occupational class on working life expectancy (WLE) and working years lost (WYL) in a sample of older Finnish workers. METHODS: A 70% random sample of Finns in 2004 was linked to a job exposure matrix for physical workload factors and register information on occupational class and labor market status until 2014. Transitions between being at work, time-restricted work disability, unemployment, economic inactivity, disability retirement, retirement and death were estimated. A multistate Cox regression model with transition-specific covariates was used to estimate the WLE and WYL at age 50 up to 63 years for each occupational class and physical workload factor for men and women (N=415 105). RESULTS: At age 50, male and female manual workers had a WLE of 10.13 and 10.14 years, respectively. Among both genders, manual workers had one year shorter WLE at age 50 than upper non-manual employees. This difference was largely attributable to unemployment (men: 0.60, women: 0.66 years) and disability retirement (men: 0.28, women: 0.29 years). Self-employed persons had the highest WLE (11.08 years). Men and women exposed to four or five physical workload factors had about one year lower WLE than non-exposed workers. The difference was primarily attributable to ill-health-related reasons, including disability retirement (men: 0.45 years, women: 0.53 years) and time-restricted work disability (men: 0.23, women: 0.33 years). CONCLUSIONS: Manual workers and those exposed to physical workload factors had the lowest WLE. The differences in WYL between exposure groups can primarily be explained by ill-health-based exit routes.

OBJECTIVE: Research on the effectiveness of vocational rehabilitation has focused on small and selected groups, lacked proper controls, or not captured dynamic changes in work participation. Using rich nationwide data on vocational rehabilitees and matched controls, long-term changes in work participation before and after vocational rehabilitation were examined to assess its effectiveness. METHODS: Representative Finnish register data were used to examine 3199 recently employed individuals aged 30–55 years with histories of musculoskeletal- and mental-related work disability starting vocational rehabilitation in 2008–2010 (intervention group), and 3199 propensity score matched non-rehabilitees (control group). Sociodemographic and work-related factors and detailed 3-year work disability and other labor market history were used for matching. Generalized estimation equations were used to examine differences in the proportion of time spent at work between periods before and after rehabilitation among the intervention and control group and the difference in these differences (DID). RESULTS: Vocational rehabilitation resulted in gains in work participation, the total 1-, 2-, and 3-year DID being 11.8 [95% confidence interval (CI) 10.0–13.7], 8.9 (95% CI 7.6–10.2), and 7.2 (95% CI 6.1–8.3) percentage points, respectively. Contrary to this overall pattern, larger DID was observed over the long term for those whose rehabilitation lasted >10 months. The DID was lowest among women with musculoskeletal diseases. CONCLUSIONS: Vocational rehabilitation after musculoskeletal- or mental-related work disability showed modest effectiveness on work participation. To promote sustained work participation after shorter rehabilitation (likely comprising workplace interventions) and faster work resumption after longer rehabilitation (likely comprising training), enhanced and complementary interventions should be considered.

OBJECTIVES: We analyzed social security costs based on an earlier quasi-experiment that compared work participation between partial sickness beneficiaries and a matched group of full sickness beneficiaries. METHODS: Utilizing a population-based 70% representative sample, 1878 persons with part-time sick leave (intervention group) due to musculoskeletal diseases or mental disorders at an early stage of work disability and their propensity-score-matched controls with full-time sick leave were followed for two years. The outcome was the difference (absolute and relative) in social security costs between the intervention and control groups during follow-up. Costs of sickness absence, vocational rehabilitation, unemployment, and retirement days were calculated from national administrative registers. RESULTS: A cost reduction of €2395 per person per year [95% confidence interval (CI) -2890– -1899) was observed in the intervention compared with the control group. The cost ratio was 0.512 (95% CI 0.511–0.513). The largest savings were attributable to differences in the costs of retirement and vocational rehabilitation. The savings were higher for the second compared with the first follow-up year. Costs were saved across both genders and diagnostic groups, however, savings for women with musculoskeletal diseases were lowest. CONCLUSIONS: Part-time instead of full-time sick leave, at the early stage of work disability due to musculoskeletal diseases or mental disorders, leads to considerable social security cost savings during two years, in correspondence with increased work participation and in addition to earlier reported health benefits. Part-time sick leave can be recommended from an economic perspective; however more consideration should be given to women with musculoskeletal diseases.

Abstract Background In higher income countries, work-related squatting and heavy lifting have been associated with increased arthritis risk. Here, we address the paucity of data regarding associations between arthritis and work-related physical stressors in lower- and middle-income countries. Methods Data were extracted from the Study on global AGEing and adult health (SAGE) Wave 1 (2007–10) for adults (aged ≥50 years) from Ghana, India, Russia and South Africa for whom detailed occupation data was available (n = 21,389; 49.2% women). Arthritis cases were identified using a symptom-defined algorithm (current) and self-reported doctor-diagnosis (lifetime). A sex-specific Job Exposure Matrix was used to classify work-related stressors: heavy physical work, kneeling/squatting, heavy lifting, arm elevation and awkward trunk posture. Using the International Standard Classification of Occupations, we linked SAGE and the Job Exposure Matrix. Logistic regression was used to investigate associations between arthritis and work-related stressors, adjusting for age (10 year age groupings), potential socioeconomic-related confounders, and body mass index. Excess exposure risk due to two-way interactions with other risk factors were explored. Results Doctor-diagnosed arthritis was associated with heavy physical work (adjusted odds ratios [OR] 1.12, 95%CI 1.01–1.23), awkward trunk posture (adjusted OR 1.23, 95%CI 1.12–1.36), kneeling or squatting (adjusted OR 1.25, 95%CI 1.12–1.38), and arm elevation (adjusted OR 1.66, 95%CI 1.37–2.00). Symptom-based arthritis was associated with kneeling or squatting (adjusted OR 1.27, 95%CI 1.08–1.50), heavy lifting (adjusted OR 1.33, 95%CI 1.11–1.58), and arm elevation (adjusted OR 2.16, 95%CI 1.63–2.86). Two-way interactions suggested excess arthritis risk existed for higher body mass index, and higher income or education. Conclusions Minimization of occupational health risk factors is common practice in higher income countries: attention should now be directed toward reducing work-related arthritis burden in lower- and middle-income countries.

OBJECTIVES: The aim of the study was to assess the effectiveness of the use of part-time sick leave at the early (first 12 weeks) stage of work disability due to mental disorder or musculoskeletal disease on sustained return to work (RTW) and overall work participation. METHODS: In a nation-wide register-based quasi-experimental study, we compared sustained RTW (ie, ≥28 consecutive days at work) and 2-year work participation between the part- and full-time sickness absence (SA) benefit groups (N=1878 in each group) using propensity-score matching. Persons who received partial or full SA benefit due to musculoskeletal diseases or mental disorders between January 1, 2010 and December 31, 2011 were eligible as cases or controls, respectively. RESULTS: A higher proportion showed sustained RTW after part- compared to full-time sick leave [absolute risk difference 8.0%, 95% confidence interval (95% CI) 5.3–10.9]. Moreover, the proportion of time at work was at a 10.5% higher level in the part- compared to full-time sick leave group. The prevalence of full disability retirement was almost three-fold among the full- compared to part-time sick leave group, whereas partial disability retirement was 4.5-fold more prevalent in the part- compared to full-time sick leave group. CONCLUSIONS: The use of part-time sick leave during the first three months of SA enhances RTW and overall work participation during two years among persons with mental disorders and musculoskeletal diseases. The prescription of part-time sick leave can be recommended at an early stage of work disability.

Abstract Background Retirement is a major life transition affecting health behaviors. The aim of this study was to examine within-individual changes in body mass index (BMI) during transition from full-time work to statutory retirement by sex and physical work characteristics. Methods A multiwave cohort study repeated every 4 years and data linkage to records from retirement registers. Participants were 5426 Finnish public-sector employees who retired on a statutory basis in 2000–2011 and who reported their body weight one to three times prior to (w−3, w−2, w−1), and one to three times after (w+1, w+2, w+3) retirement. Results During the 4-year retirement transition (w+1, vs. w−1) men showed decline in BMI, which was most marked among men with sedentary work (−0.18 kg/m2, 95% CI −.30 to −0.05). In contrast, BMI increased during retirement transition in women and was most marked among women with diverse (0.14 kg/m2, 95% CI 0.08 to 0.20) or physically heavy work (0.31 kg/m2, 95% CI 0.16 to 0.45). Physical activity during leisure time or commuting to work, alcohol consumption or smoking did not explain the observed changes during retirement transition. Conclusions In this study statutory retirement was associated with small changes in BMI. Weight loss was most visible in men retiring from sedentary jobs and weight gain in women retiring from diverse and physically heavy jobs.

Objectives To examine whether exposure to heavy physical work from early to later adulthood is associated with primary healthcare visits due to cause-specific musculoskeletal diseases in midlife.Design Prospective cohort study.Setting Nationally representative Young Finns Study cohort, Finland.Participants 1056 participants of the Young Finns Study cohort.Exposure measure Physical work exposure was surveyed in early (18–24 years old, 1986 or 1989) and later adulthood (2007 and 2011), and it was categorised as: ‘no exposure’, ‘early exposure only’, ‘later exposure only’ and ‘early and later exposure’.Primary and secondary outcome measures Visits due to any musculoskeletal disease and separately due to spine disorders, and upper extremity disorders were followed up from national primary healthcare register from the date of the third survey in 2011 until 2014.Results Prevalence of any musculoskeletal disease during the follow-up was 20%, that for spine disorders 10% and that for upper extremity disorders 5%. Those with physically heavy work in early adulthood only had an increased risk of any musculoskeletal disease (risk ratio (RR) 1.55, 95% CI 1.05 to 2.28) after adjustment for age, sex, smoking, body mass index, physical activity and parental occupational class. Later exposure only was associated with visits due to any musculoskeletal disease (RR 1.46, 95% CI 1.01 to 2.12) and spine disorders (RR 2.40, 95% CI 1.41 to 4.06). Early and later exposure was associated with all three outcomes: RR 1.99 (95% CI 1.44 to 2.77) for any musculoskeletal disease, RR 2.43 (95% CI 1.42 to 4.14) for spine disorders and RR 3.97 (95% CI 1.86 to 8.46) for upper extremity disorders.Conclusions To reduce burden of musculoskeletal diseases, preventive actions to reduce exposure to or mitigate the consequences of physically heavy work throughout the work career are needed.

BackgroundUnderstanding diverse labor market trajectories around vocational rehabilitation provides important insight into potential effectiveness of rehabilitation efforts. We examined factors associated with work participation trajectories before and after vocational rehabilitation.MethodsUsing nationwide Finnish register data of 7180 vocational rehabilitees, we constructed latent trajectory groups of work participation two years before and two years after their rehabilitation episode starting in 2008-2010. We plotted changes in labor market statuses in these groups and examined other associated factors using multinomial logistic regression.ResultsWe identified four trajectories based on work participation levels before and after vocational rehabilitation. The "High-Resumed" group (35.6%) typically returned to full duties. The "High-to-Negligible" group (20.7%) typically transitioned to full disability retirement or unemployment. Among the "Medium-Resumed" (25.5%) and "Longstanding Negligible" (18.3%) groups, work disability and unemployment were common before rehabilitation, but afterwards those assigned to the former group often returned to full or partial duties. Overall, older age, male gender, living in areas with lower employment rates, having lower education, being employed in the private sector, and having mental diagnoses were associated with the other three trajectories than the most favorable "High-Resumed" trajectory. Furthermore, certain industrial sectors, job exposures, and less common diagnoses further separated specific trajectories.ConclusionsWork participation trajectories around vocational rehabilitation are diverse, only partly dependent on initial levels of work participation, and determined by various individual and work-related factors. Future nationwide studies should assess the effectiveness of vocational rehabilitation taking into consideration both individual and work-related factors.

Forty years has passed since the first issue of the Scandinavian Journal of Work, Environment & Health. Over these four decades of rapid change in scientific publishing, the Journal has stabilized its position as the top international periodical in Occupational and Environmental Health. Our latest (2014) impact factor is 3.454, with a 5-year impact factor of 4.060. The journal now ranks 21st of 160 journals in the Public, Environmental and Occupational Health category of the Journal Citation Report – and the best among more than a dozen occupational health journals on the list. Authors refer to articles that are important for their own new research. But what makes an important publication in occupational health research? At the very least, it should be an innovative and high-quality publication. One paper alone is rarely responsible for societal impact, but a good one can further catalyze, support, or enhance our understanding of the elements of good practical solutions and cost-effective interventions. The aim of Scand J Work Environ Health has always been to promote good and impactful research in the field of occupational and environmental health and safety and increase knowledge through scientific publication. Over the years, although the goals of the Journal have remained unchanged, scientific focus, research methods, and academic publishing itself have undergone a monumental change. Looking back, the first paper published in the Journal in 1975 was a review by Anna Maria Seppäläinen (1) on the applications of neurophysiological methods in occupational medicine. At that time, neurophysiological methods were recommended for the research and diagnosis of vibration and exposure to, for example, insecticides, carbon monoxide, acrylamide, and lead. The first issues of the Journal were rich in exposure assessment methodology and toxicology. Likewise, there were many papers related to occupational medicine. In the third issue from the same year, however, a paper did emerge on sleep length and adaption to shift work among Swedish railroad workers (2), varying the content. A study of the distribution of the research topics of 85 “citations classics” (ie, papers with >100 citations) from 1950 to 1997 in five major occupational medicine journals (including Scand J Work Environ Health) revealed some interesting findings. While a few citations classics dealing with toxicology were published during each decade, classics concerning solvents appeared only during the 1970s and 1980s, and those dealing with work-related musculoskeletal disorders emerged in the 1980s and increased significantly in the decades thereafter (3). During the last ten years, the most popular topics in the Journal have been occupational epidemiology, musculoskeletal disorders, and psychosocial factors. These papers also performed better than average with respect to citations (especially psychosocial factors), while papers on, eg, toxicology and respiratory disorders have appeared less frequently and have also been less frequently cited (4). During the last two years (see the “top-cited articles” www.sjweh.fi/list_top_cited.php) , many well-cited papers have investigated key issues relating to present working life, factors predicting return-to-work (5, 6), decreased sickness absence (7, 8), longer work careers (9, 10), and higher productivity (7, 11) at work. The solutions studied were often practical interventions related to work modifications and working hours, but also changes in individual, social or lifestyle factors. The evolution of the Journal’s contents seems to reflect the current trends in general occupational safety and health (OSH) research policies (see eg, http://www.perosh.eu/research-priorities/). The Journal has come a long way in updating its expertise and focus areas but is still open to all relevant topics in the area of occupational and environmental health. Also toxicology, which the Journal initially targeted, is still an issue in today’s working life. Especially primary preventive interventions, such as the lowering of the permissible exposure limits, are important even if their cost-effectiveness can be shown only years later. In general, we believe the Journal’s future research topics must address questions that can contribute to the resolution of challenges facing today’s and tomorrow’s working life. To obtain new knowledge about effective treatments for diseases or prevention strategies, experimental epidemiological methods have been the traditional choice, and the randomized controlled trial (RCT) has been considered as the gold standard. The occupational health problems of today have multiple etiologies, and – to overcome these problems – complex interventions are often needed. Moreover, it is often not sufficient to target these interventions solely at the individual but rather also at the working environment. As has been described in the paper by Schelvis et al (12) in this issue of the Journal, the RCT or a cluster RCT may be a challenging design to adopt in current working life. Other experimental and observational epidemiological designs exist, some of which have been used in areas other than occupational health. These designs offer more flexibility and feasibility for the intervention and are not as sensitive to the loss of subjects in the groups that are followed. Some of the observational methods can effectively utilize routinely collected data, resulting in lower costs and reduced risks of attrition in the studied samples. Many of these designs require sophisticated statistical skills in the analysis of the data, putting demands on the continuing education of researchers in the field. As the authors recommend, researchers carrying out systematic reviews should broaden their inclusion criteria to include these alternative designs, and guidelines should be developed to improve the reporting of studies utilizing such approaches. The use of new designs offers a new platform to examine the effectiveness of workplace and societal interventions. To invite submissions to this area, the Journal will introduce a new section “Experimental and quasi-experimental studies (quasi-experiments)”, where reviewers will be invited to comment. If the scientific content of journals and research methods employed have changed, then the academic publishing landscape itself has been turned on its head. Such upheaval have been driven by technology but also by the increasing number of scholarly and scientific players around the world and concerns relating to the commercial influence on scientific knowledge. According to a 2015 report (13), globally there are up to an estimated 10 000 journal publishers, approximately 5000 of which are included in Scopus. Only 650 English-language publishers – mostly from trade and professional associations – produced 11 550 journals or close to half of the total journal output by title. By the end of 2014, an incredible 28 100 scholarly peer-reviewed journals were in circulation, growing at a rate of 3.5% per year and publishing about 2.5 million articles annually. The US continues to dominate with 23% of output, but China is not far behind (17%) followed by the UK (7%), Germany (6%), Japan (6%), and France (4%). The biggest area of change stems from the rapid growth of open access (OA) journals. Although they are difficult to define due to the multiple models employed (eg, “gold”, versus “hybrid”, versus green”), at the time of writing, the Directory of Open Access Journals listed 10 477 “gold” or 100% OA titles, from 134 countries, totaling close to 2 million articles (https://doaj.org/). Scand J Work Environ Health continues to be a “hybrid” journal, which means the Journal has “locked” and “unlocked” content. Authors or their supporting network can purchase OA for EUR1300 per article or some articles are awarded OA status based on merit (eg, Editor’s Pick, highly cited paper). In 2014, majority of all Scand J Work Environ Health content (including editorials, articles, letters, commentary etc) was OA. The Journal would be eager to “flip” to gold status but unfortunately institutions have been slow to take up NOROSH membership, which comprises OA publishing of all accepted papers from authors affiliated with the organization, and income from the author processing charge (APC) is not enough to cover the Journal’s costs. We are not alone in facing this challenge. Without sufficient scale and a low-cost approach, most smaller journals would have to charge APC of anywhere from $2500 to $10 000 to cover their costs (13). The challenge going forward is to lower costs and increase output without cutting corners or reducing quality. For a commercially independent journal like Scand J Work Environ Health, there is literally no room to maneuver on revenue. For this reason, we continue to focus on maintaining high quality standards, a responsive and meaningful editorial process, and rapid online publication of articles to attract the best content and the strongest reviewers in the OSH field. The real dilemma ahead is the trend of funders to insist that authors not only publish OA articles but that they publish them in “gold” journals and, one step further, that authors aim for “green” publishing where feasible. The “green” model is one where, at first sight, it appears like “nobody pays”. The author takes the accepted and post-peer-reviewed paper and self-archives it in a repository. According to the Directory of OA repositories, the number has grown from 128 in 2005 to 2900 in 2015 (13). And while the objective behind “green” publishing is commendable, there is always a price to pay at the end of the day, mostly it will be smaller quality journals like Scand J Work Environ Health who will lose subscribers and APC fees. Even the big commercial publishing houses are wary of the “green” trend but at least they have the financial clout, negotiating authority, and economies of scale to manage the pending crisis. For the time being, Scand J Work Environ Health continues to be flexible and, with the aim of ensuring accessibility to research, lifts the embargo and all copyright restrictions from articles two years from publication. It is our hope that a two-year embargo will become an accepted standard for “green” publishing. Eight years ago we concluded in an Editorial that “continuous improvements in quality, relevance, speed, and accessibility are needed to maintain the interest of future authors and subscribers” (14). At that time, we initiated a development strategy for the Journal that, compared to 2008, has almost doubled the impact factor (from 1.820 to 3.454), shortened greatly the average publication time, and increased accessibility through the rapid online publication and the promotion of OA. While the development of the journal continues to evolve, our focus today is on maintaining our high quality by extending and sharpening the Journal’s editorial expertise, the basic foundation of which is an active Editorial Board. In addition, our new strategic goal, is to be more open. Not only in terms of accessibility and increased free content, but also with respect to new authors and ideas, and members of NOROSH. We hope you will continue to support us on this journey as we navigate the unpredictable seas of academic publishing. We welcome your feedback and suggestions on how we can better serve all our stakeholders.

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.

OBJECTIVE: The aim of this study was to determine the effectiveness of face-to-face information for the treatment of mild low-back pain (LBP) in an occupational health (OH) setting. METHODS: We conducted a 48-month randomized controlled trial (RCT) with two 1:1 allocated parallel groups of forestry company employees. Eligibility criteria included permanent employment, age

Carpal tunnel syndrome (CTS) is a common nerve entrapment with a prevalence ranging between 2.7–4.9%, depending on the definition, in a representative adult population (1). Among a pooled analysis of US working populations, prevalence of electrodiagnostically verified CTS was 7.8% and incidence rate 2.3 per 100 person-years (2), while in an Italian working population the incidence rate was 1.4 per 100 person-years (3). The lifetime prevalence of carpal tunnel release (CTR) has been estimated at 3.1% and incidence rate at 1.73 per 1000 person-years in a normal population (4), and somewhat higher (3.35–2.98 per 1000 person-years during an eight-year follow-up) in a population of working age (5), suggesting that a considerable proportion of those with CTS undergo surgical treatment. CTR is an effective treatment to relieve the symptoms of CTS in both the short- and long-term (6). In this issue of the Scandinavian Journal of Work, Environment & Health, Newington et al’s systematic review (7) looked at return to work (RTW) times after CTR and reports a median RTW time of four weeks. This is in a good agreement with the Swedish recommendations for length of sickness absence after CTR (8). Only six studies reported information about the heaviness of work, and – quite expectedly – the RTW times were clearly longer for those with manual duties than non-manual duties, and the longest for those with heavy manual duties. In fact, we lack information about to what extent CTR is effective both as regards symptoms and resumption of work activities among those with heavy manual duties. As CTS can be considered in many jurisdictions as an occupational disease among workers with hand-intensive duties, some of those workers may have had their CTS compensated as an occupational disease under workers’ compensation and retrained to lighter duties after surgery. Change of occupation and retraining to lighter duties may lie behind the finding that those with workers’ compensation showed a longer RTW time compared with those without workers’ compensation or with another type of health insurance. Other processes may also delay RTW, such as litigation for compensation of CTS as an occupational disease. This difference between the compensation systems cannot therefore be directly interpreted as a result of a more generous compensation for sickness absence from the workers’ compensation system compared with a national or other insurance. Newington et al’s review is carefully conducted, transparent, and points out clearly that there is rather little well-documented evidence base on RTW times after CTR. Although a total of 56 studies were included, many of them reported only one summary estimate – often a mean – of the length of sickness absence duration or time to RTW. A minority reported a median, and only eight studies provided a range or interquartile range in addition. Moreover, a quarter of the studies did not even provide the number of persons that were included in their RTW analysis. A main reason for the poor documentation in the reviewed studies may be that the length of sickness absence or time to RTW has not been the primary outcome in most randomized controlled trials assessing the effectiveness of CTR. Even when time to RTW was reported, a very important aspect of sustainability of RTW was not considered. A recent review of RTW outcomes recommended to consider sustainability of RTW in the outcome, and suggested – based on recent studies on other outcomes – to use four weeks or 28 days as the criterion of sustainability (9). Indeed, a recent study from Finland reported a median time of 34 days for sustainable RTW (for 30 days) after CTR in the public sector (10). It would be interesting to know whether there is a difference between any RTW and sustainable RTW, however, so far, no study seems to have addressed this. With regard to recommendations for the length of sickness absence after CTR, time to sustainable RTW would serve as a better evidence base than any RTW. Work participation and long work careers are becoming critical for the sustainability of aging societies. CTR is a fairly common procedure, often carried out due to difficulties or inability to perform work duties. It is rather paradoxical that we know so little about the extent to which this procedure can restore work ability and enhance return to earlier or amended duties and not even how long it typically takes to return to work after CTR. Hopefully, this review will reach clinicians and researchers in both the occupational health and clinical community, such as surgeons, physical therapists, and occupational therapists, and motivate them to pay more attention to RTW to different types of duties after CTR and how to measure this important outcome.

Work modification is considered as an essential element in enhancing return to work (RTW) among persons with musculoskeletal problems (1) although systematic reviews have called for more studies (2) and pointed out that the net gain in sickness absence days has been only modest and economic effects uncertain (3). Loisel and his co-workers (4) showed for the first time that an occupational intervention – and especially an occupational intervention combined with a clinical intervention – was associated with a faster RTW compared with clinical intervention alone or usual care. The developed Sherbrooke model has been tested with a randomized controlled trial (RCT) in the Netherlands. Workers sick-listed for 2–6 weeks due to low-back pain (LBP) were first randomized into a workplace intervention or usual care, and those who had not returned to work by 8 weeks were further randomized to graded activity or usual care. Workplace intervention was shown to enhance RTW, whereas graded activity did not (5). Loisel has suggested that the subacute phase of low-back disability is the “golden hour” for prevention of further disability, when unnecessary measures can be avoided and focus can be placed on those with risk for prolonged disability (6). Van Duijn et al (7) calculated the potential gain in sickness absence days and the cost-benefits of hypothetical interventions based on information of RTW rates and effectiveness of various types of interventions. They concluded that only low-cost and quickly administered interventions (eg, workplace modifications) have the potential to be cost-beneficial at an early stage of disability, whereas the optimal time window for more complex interventions would be 8–12 weeks (7). Currently many healthcare providers agree that the Sherbrooke model has a sound basis. However, refraining at an early stage of disability from larger diagnostic procedures to arrive at a specific diagnosis at tissue level and medication believed to cure or alleviate a disease, and instead providing suitable workload through work modification to prevent further disability has not yet been adopted into medical practice. Prescribing work modification as a treatment is not straightforward either. In this issue of the Scandinavian Journal of Work Environment & Health, the Fassier et al paper (8) looks at the barriers and facilitators in the implementation of the Sherbrook model with a qualitative approach. Representatives of the healthcare, health insurance, and the workplace systems each identified barriers and facilitators that were structured in their external, organizational, and individual context. The authors note that, due to the existence of barriers at multiple levels (from workplace to broader systems), interventions that are limited to one particular level are unlikely to be successful. They draw attention to the importance of a systems approach in RTW interventions in order to address the interplay between local behavior and broader structural conditions. The result is that the implementation of the model is discussed in detail, demonstrating well the complexity of the issue and all phases where the implementation may fail. The healthcare providers – paid by time or “piece-rate” have to decide on a trade-off between diagnostic examinations and documentation, on the one hand, and searching and discussing solutions at the workplace, on the other. Adopting this kind of social role may be felt as a proper professional role for some but not all, and it may come at a cost to physician income. For the health insurance system, there is the challenge of keeping on track in order not to lose the appropriate time window for potentially effective interventions. At the workplace, crucial aspects are having enough competence in ergonomics and policies of work accommodation, providing responsibility, and maintaining well-functioning interpersonal collaborations. Goodwill and trust at all levels can facilitate RTW interventions (9). A component of achieving these conditions is understanding and acknowledging the roles and efforts of key individuals involved in the RTW process. For instance, the hidden but important role of co-workers in the success or failure of RTW is increasingly recognized at the workplace level (10, 11). An ongoing challenge to communication between stakeholders at various levels (eg, workplace, healthcare, insurance) is the privacy legislation common across jurisdictions that guards different parties from accessing medical information about the worker. Workers require privacy; at the same time, incomplete information for key decision-makers, such as workplace managers, can lead to misdirected rehabilitation approaches, especially when health conditions (such as poor mental health or chronic pain) are not immediately visible. As suggested by Fassier et al, patient disclosure is a practical solution implementable within current conditions. This also calls for good will and trust as it requires engaging the patient in planning the RTW process in a way that they feel confident about the procedural fairness with which their information will be handled by RTW parties (12, 13). In workplaces with rapid turnover of workers and supervisors, external expert advisers may be useful for providing workplaces with consistent and continuous support with RTW planning and processes (14). National health insurance and occupational legislation can support efforts to organize work modifications and enhance RTW. Indeed, changes have been made in the national legislation in several countries. For instance, the possibility to work part-time for a restricted period due to health reasons has existed in some Nordic countries for several years, and this has been recommended as the first option when considered as a safe alternative by the medical assessment in some of these countries. Assessments of the effects of partial sick leave have in general concluded that it enhances RTW and is well-received by its users (15). In Finland, the introduction of partial sickness benefit (to compensate for earnings losses due to part-time sick leave) was made as late as 2007. Assessed as a quasi-experiment with difference-in-differences and propensity score analyses, the use of partial sickness benefit was associated with a considerable increase in work participation (16). In Denmark, a national RTW program was launched in 2008, including provision of a tailored and multidisciplinary program with a RTW coordinator and extensive support for persons with work disability lasting >8 weeks and poor perspectives to resume work within the next 3 months. An RCT assessing the effect of this program in three municipalities found it to be effective in one but not the other municipalities (17). Similarly, the Norwegian Inclusive Working Life Program, taking place for the first time in 2001, was not found to reduce the overall long-term sickness absence rate in companies that had adopted the agreement (18). These somewhat contradictory results may indicate that decisions to prescribe sick leave or look for RTW alternatives may not be easily changed by legislation. Moreover, such legislation may require changes in attitudes among several stakeholders – especially those at the workplace – to be implemented in a way that bring about the expected result. A beginning point may be at the level of health policy changing how the work of physicians is organized and compensated so that incentives to participate in RTW processes are encouraged. The development and testing of the efficacy of the Sherbrooke model has represented a new way of thinking in disability prevention associated with LBP, putting forward the importance of the workplace context. At the same time, the role of medication and many other forms of conservative therapy as well as surgery have been redefined. This has resulted in revolutionary changes in the prevention and treatment of LBP, introducing work modification as both a preventive and therapeutic tool. LBP is multifactorial and can only partly be prevented. Preventing consequences of LBP (eg, work disability) has proven to be challenging – but rewarding when successful.

The prevalence of obesity has increased dramatically worldwide during the past three decades and has passed 30% of the adult population in both the US and UK. In the Nordic countries, more than 20% of adults are obese and more than 5% severely obese, with a body mass index >35 kg/m3 (1–3). The devastating impact of obesity on health is undisputed and spans common conditions such as diabetes, cardiovascular disease, cancer, osteoarthritis, major depression, adverse pregnancy outcomes and infertility (4, 5). Therefore the potential health impact of efficient preventive action in modern societies is tremendous. In this issue of the Scandinavian Journal of Work, Environment & Health, a series of papers address the relationship between obesity and the workplace, and the question is raised whether the workplace and occupational health professionals have a role to play in this context. Overweight and obesity basically reflect an imbalance between energy provision and expenditure or between intake of calories and physical activity. Although several new genetic determinants of obesity have been unravelled in the past few years (6), it is obvious that the greatly increasing occurrence of obesity during the past decades must have environmental and behavioral causes. In this issue, Pandalai et al (7) provide a systematic outline of interrelationships between obesity and workplace factors from a health perspective. First, changes in the occupational environment may directly contribute to the epidemic by causing overweight and obesity. Rapid shifts towards more sedentary work with less physical activity is an obvious risk factor, but as reviewed by Solovieva et al (8) there is also limited evidence that psychosocial factors, long work hours, and shift work may contribute to overweight and obesity (9, 10), but temporal trends of these potential risk factors are less obvious. Moreover, pre- and perinatal exposure to xenobiotics with the capacity to interfere with endogenous hormone signalling have been linked with the risk of developing diabetes and obesity later in life (11). It is a provocative thought that obesity could, to some extent, be a toxicological issue. Considering the overwhelming evidence of a general decline in workplace exposure to chemicals in the Western world, many researchers will doubt the plausibility that chemical exposures at work are important contributors to the obesity epidemic. Besides genuine causal factors in the workplace, Pandalai et al (7) also provide examples of how workplace exposures can modify the effects of other risk factors of obesity. Second, obesity is related to occupational health because it is a risk factor for injuries and preterm exit from the labor market. In this issue of the journal, Lin et al (12) provide compelling evidence from a large, longitudinal study in the US that obesity increases the risk of occupational injuries by some 25%. The authors acknowledge that the mechanisms leading to increased injury risk have not been well studied. The effects could be mediated by obesity-related conditions, such as sleep apnea leading to fatigue, osteoarthritis leading to physical limitations, or altered biomechanics leading to postural instability. While it would be most straightforward to attempt to prevent obesity, we also know that this is not easily achieved. Therefore, for effective prevention of injuries, we may need to consider and affect also the pathomechanical pathways. In addition to being a risk factor for accidents at the workplace, it is now well documented that obesity is related to preterm exit from work. In their meta-analysis of 28 prospective studies mostly performed in the Nordic and a few other European countries, Robroek et al (13) provide evidence that obesity is associated with a 50% higher risk of disability pension – a result that is not unexpected considering the known association between obesity and serious chronic disease. These data are corroborated by a new large prospective study from Finland also published in this issue of the journal. According to Roos et al (14), obesity was strongly related to all-cause disability in both genders with clear indications of an “exposure–effect” relationship: the severely obese were at a higher risk than obese, and obese were at higher risk than overweight persons. In the case of disability retirement as a result of musculoskeletal disease, the risk was more than doubled. Important in the context of preventive action, this study did not indicate that working conditions modify the risk of disability retirement. Apparently one needs to address obesity itself. But how is this accomplished from an occupational health point of view? In a paper on the co-occurrence of obesity and insomnia among employees and in workplaces, respectively, Oksanen et al observed a weak co-occurrence at the individual level but a strikingly strong co-occurrence of almost 60% at the workplace level (15). This workplace clustering of the two common and interrelated disorders may be taken as an argument for health promotion actions targeting these disorders at the work-unit rather than the individual level. Others provide less sophisticated arguments for preventive interventions targeting overweight and obesity at the workplace (16, 17). The occupational healthcare setting offers good opportunities to reach employees and promote more healthy behaviors (18, 19). Moreover, a Cochrane review of counselling and education programs aimed at lifestyle change in the general population did not demonstrate beneficial effects (20). However, the fact that there is no easy solution is demonstrated by one of the few published randomized controlled studies that examines effects of workplace interventions targeting overweight and obesity. In a controlled trial among Dutch occupational physicians, Verweij et al (21) did not find that an occupational health guideline, including repeated face-to-face counselling sessions to improve lifestyle, was more effective than usual care. The disappointing fact is that, at present, there is no evidence-based recommendable occupational health intervention targeting obesity. In conclusion, the papers in this thematic issue of the Scandinavian Journal of Work, Environment & Health demonstrate how, for several reasons, the obesity epidemic is an important issue in occupational health research and practice. Some occupational risk factors contribute to obesity, and obesity contributes to injuries and preterm exit from the labor market. It is also known that behavioral changes focusing on diet and physical activity are key factors to address. But at present it is not known if and how this knowledge can be utilized for preventive action at the workplace. This gap in knowledge defines a major research area that so far has been given far too little attention.

OBJECTIVES: Associations between psychosocial work environment and excess weight have not been systematically addressed. The aim of this systematic review was to summarize the published evidence for the associations of psychosocial factors at work and long work hours with weight-related outcomes . Methods We conducted a search of Medline and Embase for all original articles published up to September 2012 using predefined keywords. After excluding studies with a definite selection bias, we included 39 articles. RESULTS: About 60% of the studies reported at least one positive association between psychosocial factors at work and a weight-related outcome. However, 76% of the tested associations were found to be non-significant. Furthermore, the associations were rather weak. Studies of higher quality tended to observe associations more often than those of lower quality. Positive associations were found more frequently (i) among women versus men, (ii) in cross-sectional versus longitudinal studies, and (iii) for overweight or obesity versus other outcomes. About 70% of the studies reported positive associations between long work hours and weight-related outcomes. All four studies that evaluated the association between working overtime and weight gain (three longitudinal and one cross-sectional), showed a positive association among men and two of them also observed associations among women. CONCLUSIONS: We found evidence for weak associations between psychosocial factors at work and excess weight. Associations were observed between long work hours, working overtime, and weight gain, especially among men. More cohort studies among non-obese baseline participants using appropriate analytical methods based on an elaborated hypothetical model are needed.

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

OBJECTIVES: The purpose of this study was to assess the effects of early part-time sick leave on return to work (RTW) and sickness absence among patients with musculoskeletal disorders. Methods A randomized controlled trial was conducted in six occupational health units of medium- and large-size enterprises. Patients aged 18–60 years with musculoskeletal disorders (N=63) unable to perform their regular work were randomly allocated to part- or full-time sick leave. In the former group, workload was reduced by restricting work time by about a half. Remaining work tasks were modified when necessary, as specified in a “fit note” from the physician. The main outcomes were time to return to regular work activities and sickness absence during 12-month follow-up. RESULTS: Time to RTW sustained for ≥4 weeks was shorter in the intervention group (median 12 versus 20 days, P=0.10). Hazard ratio of RTW adjusted for age was 1.60 [95% confidence interval (95% CI) 0.98–2.63] and 1.76 (95% CI 1.21–2.56) after further adjustment for pain interference with sleep and previous sickness absence at baseline. Total sickness absence during the 12-month follow-up was about 20% lower in the intervention than the control group. Compliance with the intervention was high with no discontinuations of part-time sick leave due to musculoskeletal reasons. CONCLUSIONS: Early part-time sick leave may provide a faster and more sustainable return to regular duties than full-time sick leave among patients with musculoskeletal disorders. This is the first study to show that work participation can be safely increased with early part-time sick leave.

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

OBJECTIVE: The aim of this study was to assess prevalence, incidence, and persistence of carpal tunnel syndrome (CTS) and associated symptoms over a one-year period in a working population. METHODS: We conducted a one-year prospective study of 418 active workers in 12 worksites. Detailed health interviews, psychosocial questionnaires, and electrophysiological studies [ie, nerve conduction velocity (NCV) tests] were conducted at baseline and one-year follow-up. Individual-observed exposure assessments of wrist posture, hand activity, and hand forces were conducted. RESULTS: Prevalence of CTS cases at baseline was 10.8% [95% confidence interval (95% CI) 7.8–13.7%] on the dominant side and 6.0% (95% CI 3.7–87.3%) on the non-dominant side; CTS symptoms were 14.1% (95% CI 10.8–17.5%) and 11.0% (95% CI 8.0–14.0%), respectively. Incidence of CTS cases were 7.5% (95% CI 4.8–10.2%) and 5.6% (95% CI 3.3–7.9%), respectively. Higher proportions of subjects with current symptoms or positive electrophysiological test findings at baseline became CTS cases at one year compared to those with neither (28.6% and 13.9%, respectively, versus 0.5%). One-year persistence of CTS case status was 44.4% (95% CI 29.9–59.0%) for the dominant hand and 52.0% (95% CI 32.4–71.6) for non-dominant hand. There were significant differences at baseline between asymptomatic subjects and CTS cases with respect to higher job demands (P=0.027), lower job satisfaction (P=0.036), lower general health (P=0.0009), higher exposure to vibrating hand tool use (P=0.039), and greater time using a forceful power grip (P=0.035) among cases. CONCLUSIONS: CTS symptoms more than positive NCV test results alone appear to predict CTS at one year. Persistence of CTS at one year is high.

OBJECTIVES: The aim of this study was to investigate the effectiveness of an ergonomic intervention on productivity loss at work caused by upper-extremity disorders (UED). METHODS: Workers with medically verified UED were invited to participate. The intervention consisted of a physician contacting the worker’s supervisor and an occupational physiotherapist conducting an ergonomic assessment at the worksite. Before and after the intervention, the employees self-assessed UED-related productivity loss (ie, decreased quality and quantity of the daily work output). We tested for differences between groups at 8 and sub­sequently 12 weeks. We also applied generalized estimating equation (GEE) to analyze repeated measures data. RESULTS: Altogether 177 employees were randomized. The overall participation rate was 88%. At baseline, 54% of the intervention group and 58% of the control group reported productivity loss. The magnitude of productivity loss was 17% and 20%, respectively. At 8 weeks, both the proportion and magnitude of productivity loss were lower in the intervention than the control group, but the differences were statistically significant only at 12 weeks (proportion 25% versus 51%, magnitude 7% versus 18%, P=0.001 for both). Using GEE analyses, we also found the differences to be statistically significant (proportion 38% versus 52%, magnitude 12% versus 18%). The intervention only benefitted employees with 0–20% loss of productivity at baseline, not those with a higher initial productivity loss. CONCLUSIONS: Early ergonomic intervention, in addition to adequate medical care, is effective in preventing and restoring self-reported productivity loss associated with UED.

Previous research indicates that work modifications can effectively enhance return to work (RTW) at an early stage of work disability. We aimed to examine how occupational physicians (OPs) reason about recommending early return to work (RTW) with work modifications. Pre-defined propositions regarding the use of work modifications in promoting early RTW were discussed in four focus groups with altogether 11 Finnish OPs. Discussions were audio recorded, and the transcribed data were analyzed using qualitative content analysis. Five different rationales for supporting early RTW were identified: to manage medical conditions, to enhance employee well-being, to help workplace stakeholders, to reduce costs to society, and to enhance OP's own professional fulfillment. However, OPs identified situations and conditions in which early RTW may not be suitable. In addition, there were differences between the OPs in the interpretation of the rationales, suggesting variation in clinical practice. In conclusion, encouraging early RTW with work modifications was perceived by OPs as a meaningful task and, to a large extent, beneficial for employees and several stakeholders. However, this practice was not accepted without consideration to the RTW situation and context. If early RTW and work modifications are to be promoted, OPs should be offered education that addresses their views regarding this practice.

Sciatica or the sciatic syndrome is a common and often disabling low back disorder in the working-age population. It has a relatively high heritability but poorly understood molecular mechanisms. The Finnish population is a genetic isolate where small founder population and bottleneck events have led to enrichment of certain rare and low frequency variants. We performed here the first genome-wide association (GWAS) and meta-analysis of sciatica. The meta-analysis was conducted across two GWAS covering 291 Finnish sciatica cases and 3671 controls genotyped and imputed at 7.7 million autosomal variants. The most promising loci (p

Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967-1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26-1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967-1976. In conclusion, health problems-in particular mental problems-during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.

ObjectiveTo study the performance of a developed job exposure matrix (JEM) for the assessment of psychosocial factors at work in terms of accuracy, possible misclassification bias and predictive ability to detect known associations with depression and low back pain (LBP).Materials and methodsWe utilized two large population surveys (the Health 2000 Study and the Finnish Work and Health Surveys), one to construct the JEM and another to test matrix performance. In the first study, information on job demands, job control, monotonous work and social support at work was collected via face-to-face interviews. Job strain was operationalized based on job demands and job control using quadrant approach. In the second study, the sensitivity and specificity were estimated applying a Bayesian approach. The magnitude of misclassification error was examined by calculating the biased odds ratios as a function of the sensitivity and specificity of the JEM and fixed true prevalence and odds ratios. Finally, we adjusted for misclassification error the observed associations between JEM measures and selected health outcomes.ResultsThe matrix showed a good accuracy for job control and job strain, while its performance for other exposures was relatively low. Without correction for exposure misclassification, the JEM was able to detect the association between job strain and depression in men and between monotonous work and LBP in both genders.ConclusionsOur results suggest that JEM more accurately identifies occupations with low control and high strain than those with high demands or low social support. Overall, the present JEM is a useful source of job-level psychosocial exposures in epidemiological studies lacking individual-level exposure information. Furthermore, we showed the applicability of a Bayesian approach in the evaluation of the performance of the JEM in a situation where, in practice, no gold standard of exposure assessment exists.

OBJECTIVES: The aim was to construct and validate a gender-specific job exposure matrix (JEM) for physical exposures to be used in epidemiological studies of low back pain (LBP). MATERIALS AND METHODS: We utilized two large Finnish population surveys, one to construct the JEM and another to test matrix validity. The exposure axis of the matrix included exposures relevant to LBP (heavy physical work, heavy lifting, awkward trunk posture and whole body vibration) and exposures that increase the biomechanical load on the low back (arm elevation) or those that in combination with other known risk factors could be related to LBP (kneeling or squatting). Job titles with similar work tasks and exposures were grouped. Exposure information was based on face-to-face interviews. Validity of the matrix was explored by comparing the JEM (group-based) binary measures with individual-based measures. The predictive validity of the matrix against LBP was evaluated by comparing the associations of the group-based (JEM) exposures with those of individual-based exposures. RESULTS: The matrix includes 348 job titles, representing 81% of all Finnish job titles in the early 2000s. The specificity of the constructed matrix was good, especially in women. The validity measured with kappa-statistic ranged from good to poor, being fair for most exposures. In men, all group-based (JEM) exposures were statistically significantly associated with one-month prevalence of LBP. In women, four out of six group-based exposures showed an association with LBP. CONCLUSIONS: The gender-specific JEM for physical exposures showed relatively high specificity without compromising sensitivity. The matrix can therefore be considered as a valid instrument for exposure assessment in large-scale epidemiological studies, when more precise but more labour-intensive methods are not feasible. Although the matrix was based on Finnish data we foresee that it could be applicable, with some modifications, in other countries with a similar level of technology.