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Objectives Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality. Methods A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality. Results We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87–1.15] and females (HR 0.95, 95% CI 0.82–1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88–1.49). Conclusions While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.

BackgroundAlthough recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored.ObjectiveTo examine the associations between personal, workplace psychosocial and biomechanical factors and incident work disability among workers with CTS.MethodsBetween 2001 and 2010 five research groups conducted coordinated prospective studies of CTS and related work disability among US workers from various industries. Workers with prevalent or incident CTS (N=372) were followed for up to 6.4 years. Incident work disability was measured as: (1) change in work pace or work quality, (2) lost time or (3) job change following the development of CTS. Psychosocial factors were assessed by questionnaire. Biomechanical exposures were assessed by observation and measurements and included force, repetition, duty cycle and posture. HRs were estimated using Cox models.ResultsDisability incidence rates per 100 person-years were 33.2 for changes in work pace or quality, 16.3 for lost time and 20.0 for job change. There was a near doubling of risk for job change among those in the upper tertile of the Hand Activity Level Scale (HR 2.17; 95% CI 1.17 to 4.01), total repetition rate (HR 1.75; 95% CI 1.02 to 3.02), % time spent in all hand exertions (HR 2.20; 95% CI 1.21 to 4.01) and a sixfold increase for high job strain. Sensitivity analyses indicated attenuation due to inclusion of the prevalent CTS cases.ConclusionPersonal, biomechanical and psychosocial job factors predicted CTS-related disability. Results suggest that prevention of severe disability requires a reduction of both biomechanical and organisational work stressors.

Hotel room cleaners are a vulnerable population at risk for cardiovascular disease. To evaluate their workload heart rate (HR), % heart rate reserve (%HRR), blood pressure (BP), metabolic equivalent (MET), and energy expenditure (EE) were measured over two workdays and two off-workdays. The mean age was 45.5 (SD 8.2) years with a mean 10.4 (SD 7.8) years of work experience. Mean average and peak HR, %HRR, MET, and EE were significantly higher during a workday than an off-workday for the entire work shift, first and last hour of work. Mean average HR and %HRR saw the largest increase between the lunch and post-lunch interim. One-fourth of subjects exceeded the recommended 30% HRR threshold for 8-hour shifts. Some workers experienced a substantial increase in HR and DBP over a workday indicating physiologic fatigue and thus may be at increased risk for cardiovascular disease and premature death due to excessive physical work demands.

Several studies have suggested that a ‘physical activity (PA) paradox’ may exist—that is, the well documented beneficial health effects of leisure-time physical activity (LTPA) are not found for occupational physical activity (OPA). A BJSM editorial has outlined potential explanations for such a paradox.1 A recent systematic review has provided some empirical evidence that men, but not women, engaging in high (compared with low) level OPA have an 18% (95% CI 5% to 34%) increased risk of all-cause mortality.2 Nonetheless, the existence of this paradox has been questioned in a discussion paper by Professor Roy Shephard.3 Below we expand on three limitations this discussion paper raised and suggest a research agenda for generating more conclusive evidence regarding this paradox. The current evidence originated from certain regions including Scandinavia, Spain, Iran and Israel. It was suggested that this restricted geographical representation weakens the evidence. However, relatively good working conditions in western European and Scandinavian countries could attenuate the negative health effects of OPA. Studies from countries with higher work demands and/or higher environmental temperatures are likely to provide evidence for even larger negative health effects. Apart from physical work demands, other factors (eg, LTPA or socioeconomical gradients) may also vary between countries and may have an impact on the association between OPA and health. The restricted origin of evidence also raises the possibility …

Aims The aim of this study was to investigate the independent associations of occupational (OPA) and sport physical activity (SpPA) and job strain on the incidence of coronary heart disease (CHD) events, and to explore their interplay. Methods The study sample included 3310 25–64-year-old employed men, free of CHD at baseline, recruited in three population-based and one factory-based cohorts. OPA and SpPA, and job strain were assessed by the Baecke and the Job Content Questionnaires, respectively. We estimated the associations between different domains of physical activity and job strain with CHD, adjusting for major risk factors using Cox models. Results During follow-up (median=14 years), 120 CHD events, fatal and non-fatal, occurred. In the entire sample, a higher CHD risk was found for high job strain (hazard ratio=1.55, 95% confidence interval: 1.05–2.31). The joint effect of low OPA and high job strain was estimated as a hazard ratio of 2.53 (1.29–4.97; reference intermediate OPA with non-high strain). With respect to intermediate OPA workers, in stratified analysis when SpPA is none, low OPA workers had a hazard ratio of 2.13 (95% confidence interval: 1.19–3.81), increased to 3.95 (1.79–8.78) by the presence of high job strain. Low OPA–high job strain workers take great advantage from SpPA, reducing their risk up to 90%. In contrast, the protective effect of SpPA on CHD in other OPA–job strain categories was modest or even absent, in particular when OPA is high. Conclusions Our study shows a protective effect of recommended and intermediate SpPA levels on CHD risk among sedentary male workers. When workers are jointly exposed to high job strain and sedentary work their risk further increases, but this group benefits most from regular sport physical activity.

BACKGROUND Research regarding the effects of occupational physical activity on health remains inconsistent. We analyzed the association of occupational physical activity with all-cause and cardiovascular disease (CVD) mortality. METHODS We analyzed two cohorts with baseline assessments from 1977 to 1993 ("National Research Program 1A" (NRP1A) and "MONItoring of trends and determinants in CArdiovascular disease" [MONICA]) and mortality follow-up until 2015 using adjusted Cox regression models. RESULTS We included 4396 NRP1A participants (137 793 person-years of follow-up, 1541 deaths) and 5780 MONICA participants (135 410 person-years, 1158 deaths). All-cause mortality was higher for men in the high compared with the low occupational physical activity category according to NRP1A (hazard ratio [HR] 1.25, 95% confidence intervals [CI] 1.05-1.50). CVD mortality was higher for men in the moderate compared with the low occupational physical activity category according to MONICA (HR, 1.41; 95% CI, 1.03-1.91). Results for women were not statistically significant. CONCLUSIONS We observed higher total and CVD mortality risks in men with higher occupational physical activity but inconsistent results for women and across cohorts.

BACKGROUND Effort-reward imbalance (ERI) was hypothesized to be associated with ambulatory blood pressure (ABP) and pulse pressure (PP) among female hotel room cleaners. METHODS ERI, ABP, and PP were assessed among 419 cleaners from five hotels during 18 waking hours. Adjusted linear regression models were used to assess associations of ERI with ABP and PP during 18-hours, work hours, and after work hours. RESULTS There was a pattern of higher ERI being associated with higher 18-hour systolic ABP and 18-hour PP although the results were imprecise. An increase of ERI by half its range was associated with a 1.6 mmHg (95% CI, -1.6-4.7) increase in 18-hour systolic blood pressure (SBP) and a 0.7 mmHg (95% CI, -1.1-2.5) increase in 18-hour PP. An increase in rewards by half its range was associated with a 2 mmHg decrease in after-hours SBP (-2.2, 95% CI, -5.4-1.0) and after-hours PP (-1.9, 95% CI, -3.8-0.0). Among females 45 years or older, ERI was associated with 2.1 and 2.2 mmHg increase in 18-hour and work hours diastolic ABP, respectively, compared to a 0 mmHg change in 18-hour and work hours diastolic ABP in younger women. The number of dependents at home attenuated the association. CONCLUSIONS ERI was positively associated with ABP, particularly SBP, and the association was modified by age and the number dependents at home, although the estimates were imprecise. Workplace interventions that integrate stress management and active ABP surveillance appear warranted. However, larger studies with Latina women need to confirm our results.

Objectives Recent meta-analyses suggest a physical activity health paradox: high levels of occupational physical activity (OPA) increase cardiovascular disease (CVD) risk, while leisure-time physical activity (LTPA) decreases risk. However, studies of women and cerebrovascular disease are limited. This report examines physical activity effects on stroke and transient ischemic attack (TIA) among working women in the United States. Methods OPA history, health status, and lifestyle were assessed by baseline interviews of 31 270 employed Sister Study participants aged 35-74 years. OPA was assessed at six intensity levels (lowest: "mostly sitting"); the highest three were combined as "high intensity work." Independent OPA and LTPA effects on 6-year cerebrovascular disease incidence were estimated in adjusted Cox proportional hazard models. Results Stroke (N=441) and TIA (N=274) risk increased with more standing and higher intensity work at current and longest held job. Compared with mostly sitting, high intensity work at the current job increased TIA risk by 57%25 [hazard ratio (HR) 1.57, 95%25 confidence interval (CI) 1.04-2.38]. High intensity OPA at the longest held job increased risk for stroke by 44%25 (HR 1.44; 95%25 CI 1.08-1.93). Among women with CVD, sitting and standing equally, especially at the current job, increased risks up to two-fold (TIA HR 1.98, 95%25 CI 1.10-3.55) compared with mostly sitting at work. LTPA showed inverse associations. Conclusions Higher intensity levels of OPA increased stroke and TIA risks, while LTPA decreased risks; results corroborate the physical activity health paradox for women and cerebrovascular disease. More standing at work increased cerebrovascular disease risks, especially for women with CVD.

ObjectiveHigh levels of occupational physical activity (OPA) increase heart rate, blood pressure (BP) and the risk of hypertension. Older workers may be more vulnerable to high levels of OPA due to age-related degeneration of the cardiovascular system and cardiorespiratory fitness. This study investigates the association of relative aerobic workload (RAW) with resting BP and examines if this relation is moderated by age.DesignCross-sectional epidemiological study.SettingData were collected among employees of 15 Danish companies in the cleaning, manufacturing and transport sectors.Participants2107 employees were invited for participation, of these 1087 accepted and 562 (42% female and 4% non-Westerns) were included in the analysis based on the criteria of being non-pregnant, no allergy to bandages, sufficient amount of heart rate data corresponding to ≥4 work hours per workday or 75% of average work hours, and no missing outcome and confounder values.Primary and secondary outcome measuresThe primary outcome measure was BP.ResultsHeart rate reserve was estimated from ambulatory 24-hour heart rate measures covering 2.5 workdays per participant (SD 1.0 day). Age significantly moderated the association between RAW and BP. Mean intensity and duration of high RAW (≥30% heart rate reserve) showed positive associations with diastolic BP and negative associations with pulse pressure (PP) among participants ≥47 years old. Tendencies towards negative associations between RAW and BP were seen among participants ConclusionsMean intensity and duration of RAW increased diastolic BP among participants ≥47 years old. Negative associations with PP may be due to healthy worker selection bias. Prevention of hypertension should consider reductions in RAW for ageing workers.

Excessive sitting and standing are proposed risk factors for cardiovascular diseases (CVDs), possibly due to autonomic imbalance. This study examines the association of objectively measured sitting and standing with nocturnal autonomic cardiac modulation. The cross-sectional study examined 490 blue-collar workers in three Danish occupational sectors. Sitting and standing during work and leisure were assessed during 1&ndash, 5 days using accelerometers. Heart rate (HR) and heart rate variability (HRV) were obtained during nocturnal sleep as markers of resting autonomic modulation. The associations of sitting and standing still (h/day) with HR and HRV were assessed with linear regression models, adjusted for age, gender, body mass index, smoking, and physical activity. More sitting time during leisure was associated with elevated HR (p = 0.02), and showed a trend towards reduced HRV. More standing time at work was associated with lower HR (p = 0.02), and with increased parasympathetic indices of HRV (root mean squared successive differences of R-R intervals p = 0.05, high-frequency power p = 0.07). These findings, while cross-sectional and restricted to blue-collar workers, suggest that sitting at leisure is detrimental to autonomic cardiac modulation, but standing at work is beneficial. However, the small effect size is likely insufficient to mitigate the previously shown detrimental effects of prolonged standing on CVD.

Objectives It remains unclear whether different types of shift work impose similar risks for cardiovascular events in middle-aged workers, especially those with pre-existing ischaemic heart disease (IHD). This study investigated the relations between different shift types and incident acute myocardial infarction (AMI) among men with and without pre-existing IHD, respectively. Methods We analysed data on 1891 men, aged 42–60 years at baseline, in the prospective Kuopio Ischemic Heart Disease Risk Factor Study cohort, using Cox proportional hazard models with adjustment for demographic, biological, behavioural and psychosocial job factors. We evaluated the associations of baseline shift work with 20-year incidence of AMI, and their modification by pre-existing IHD, using both stratified analysis and models with product terms between shift work and IHD. Results Travelling work (at least 3 nights per week away from home) was strongly positively associated with AMI among men with IHD (HR=2.45, 95% CI 1. 08 to 5.59) but not among men without (HR=0.93, 95% CI 0.43 to 2.00). No clear associations were found between other types of shift work and AMI for both men with and without IHD. On both additive and multiplicative scales, baseline IHD status positively modified the association of travelling work with AMI (relative excess risk for interaction=3.23, 95% CI −0.50 to 6.97, p for multiplicative interaction=0.044). Conclusions We found mixed results for the associations between different types of shift work and AMI among those with and without pre-existing IHD. Future research should investigate these associations and effect modification for a broad spectrum of work schedules.

ObjectiveRecent evidence suggests the existence of a physical activity paradox, with beneficial health outcomes associated with leisure time physical activity, but detrimental health outcomes for those engaging in high level occupational physical activity. This is the first quantitative systematic review of evidence regarding the association between occupational physical activity and all-cause mortality.DesignSystematic review with meta-analysis.Data sourceA literature search was performed in electronic databases PubMed, Embase, CINAHL, PsycINFO and Cochrane.Eligibility criteria for selecting studiesWe screened for peer reviewed articles from prospective studies assessing the association of occupational physical activity with all-cause mortality. A meta-analysis assessed the association of high (compared with low) level occupational physical activity with all-cause mortality, estimating pooled hazard ratios (HR) (with 95% CI).Results2490 unique articles were screened and 33 (from 26 studies) were included. Data from 17 studies (with 193 696 participants) were used in a meta-analysis, showing that men with high level occupational physical activity had an 18% increased risk of early mortality compared with those engaging in low level occupational physical activity (HR 1.18, 95% CI 1.05 to 1.34). No such association was observed among women, for whom instead a tendency for an inverse association was found (HR 0.90, 95% CI 0.80 to 1.01).ConclusionsThe results of this review indicate detrimental health consequences associated with high level occupational physical activity in men, even when adjusting for relevant factors (such as leisure time physical activity). These findings suggest that research and physical activity guidelines may differentiate between occupational and leisure time physical activity.

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

Physical activity (PA) is well documented to improve health. However, this documentation is restricted to leisure time physical activity (LTPA; eg, sports, recreation and transportation). Increasing evidence shows that occupational physical activity (OPA) does not improve health.1 Actually, OPA can be detrimental. These contrasting health effects of LTPA and OPA constitute the so-called PA health paradox.2 For a considerable fraction of the adult population, work constitutes the main setting for PA. Workers in many occupations, such as construction, cleaning, refuse collection, elderly care, farming and manufacturing, are physically active for large parts of their working days, for most of the year. Despite this PA at work, these and other manual workers have relatively poor health. Many epidemiological studies document that high OPA increases the risk for cardiovascular disease (CVD) and mortality outcomes, even after extensive adjustments for other risk factors including socioeconomic status, LTPA and other health behaviours.1 This increased risk from high OPA has been shown to be particularly pronounced among workers with low job resources, low cardiorespiratory fitness3 or pre-existing …

Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12months post-injury. Participants self-reported they had not received a depression diagnosis 1year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12months was 50.3% (95% CI 44.9-55.7%). At 12months, 24.7% (95% CI 20.1-29.3%) of workers exhibited high levels. Over 12months, 49.7% (95% CI 44.3-55.1%) had low levels at all 3 interviews, 14.5% (95% CI 10.7-18.2%) had persistently high levels, and 25.6% (95% CI 20.9-30.3%) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12months was 6.0% (95% CI 2.7-9.3%). For workers with high baseline levels, 36.1% (95% CI 27.9-44.3%) exhibited persistent high symptoms at 6 and 12months, while 38.4% (95% CI 30.1-46.6%) experienced low levels at 6 and 12months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8% (95% CI 7.7-29.8%) self-reported receiving a depression diagnosis by 12months and 29.2% (95% CI 16.3-42.0%) were receiving treatment at 12months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12months post-injury. While symptoms appear to improve over time, the first 6months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.

Summary of the comparison of theoriginal and alternative scales inrelation to CVDRF Out of 245 comparisons, 50 (20%) showed a differencegreater than twofold (change above 200%). The greatestchange was a 54-fold difference between the alternativecategoricaloperationalizationofhighjobstrain(ref.category:lowstrain)andbloodcholesterollevels(model2).Changeindirectionofassociationbetweenscaleshappenedin12.6%ofcases. Although the original scales yielded more statisticallysignificant results than alternative scales (34% vs. 16% ofcases,respectively),thealternativescalesresultedmoreoften(61%ofcases)ineffectchangesmoreindirectionofexpectedrelationshipsaccordingtopreviousresearch(i.e.,indicatingadetrimental effect of adverse PJF on CVDRF). Differencesbetween the original and alternative decision latitude scaleswerenotasprominentastheonesfoundforthepsychologicaldemands scale (see Supplementary Appendix 4 for a moredetailed description of the comparison between scales). DISCUSSION Our study of 2,330 Mexican workers in eight worksitesprovidedsomesupportfortherelationshipswehypothesizedbetween PJF and cardiovascular risk factors: High job strainwas associated with reduced leisure-time physical activity.Workers reporting isostrain showed higher odds of smokingand lower odds of leisure-time physical activity. Socialsupport seemed to protect against high blood cholesterollevels, overweight/obesity, smoking, and reduced leisure-timephysicalactivity.Ontheotherhand,somepsychosocialwork factors (e.g., decision latitude, job strain, and jobinsecurity) showed unexpected associations with diastolicblood pressure and some adiposity measures.

Introduction New evidence suggests a physical activity (PA) health paradox, with positive health outcomes associated with high intensity leisure-time PA (LTPA), but negative health outcomes for those engaging in high intensity occupational PA (OPA). The aim of this study was to examine this paradox by systematically reviewing evidence on the association between high OPA and all-cause mortality. Methods A systematic search of the literature was performed screening for eligible (peer-reviewed articles on prospective studies. Meta-analyses were performed assessing the association of high (compared to low) intensity OPA and all-cause mortality in males and females, estimating pooled hazard ratios (HR) with 95% confidence intervals (95% CI). Results 2060 unique articles were screened of which 28 (from 24 studies with 2 88 264 participants) were included. We statistically pooled information from 19 studies, showing that males with high intensity OPA had a higher risk of early mortality than those with light intensity OPA (HR [95% CI]: 1.24 [1.03 1.49). Such an association was not observed for females (0.88 [0.75 1.03]). Conclusion These findings support the PA health paradox, with levels of high intensity OPA being associated with ill-health (for males). An explanation for this finding may be the nature of OPA, involving sustained demanding tasks, causing chronically elevated blood pressure and heart rate responses. Males may be more prone than females because of gender differences in OPA, with males more likely to work in higher intensity occupations. Future research (preferably using objectively measured OPA) should further explore these potential mechanisms.

BACKGROUND This study explores the effects of occupational (OPA) and leisure time physical activity (LTPA) on mortality relative to cardiorespiratory fitness and pre-existing coronary heart disease (CHD). METHODS Associations between OPA, measured as energy expenditure (kcal/day) and relative aerobic workload (%VO2 max), LTPA, and 22-year mortality among 1891 Finnish men were assessed by Cox regression models stratified by CHD and adjusted for 19 confounders. RESULTS In fully adjusted models, each 10% of relative aerobic workload increased all-cause mortality by 13% and CHD mortality 28% (P

ObjectivesWe examined associations between parental occupational chemical exposures up to 10 years before conception and the risk of sporadic retinoblastoma among offspring.MethodsIn our multicentre study on non-familial retinoblastoma, parents of 187 unilateral and 95 bilateral cases and 155 friend controls were interviewed by telephone. Exposure information was collected retroactively through a detailed occupational questionnaire that asked fathers to report every job held in the 10 years before conception, and mothers 1 month before and during the index pregnancy. An industrial hygienist reviewed all occupational data and assigned an overall exposure score to each job indicating the presence of nine hazardous agents.ResultsWe estimated elevated ORs for unilateral and bilateral retinoblastoma among offspring of fathers who were exposed to polycyclic aromatic hydrocarbons or paints in the 10 years before conception. However, only for exposure to paints did confidence limits exclude the null for bilateral disease (OR: 8.76, 95% CI: 1.32 to 58.09). Maternal prenatal exposure to at least one of the nine agents was related to increased risk of unilateral disease in their children (OR: 5.25, 95% CI: 1.14 to 24.16). Fathers exposed to at least one of the nine agents and who were ≥30 years of age were at increased risk of having a child diagnosed with bilateral retinoblastoma (OR: 6.59, 95% CI: 1.34 to 32.42).ConclusionsOur results suggest a role for several hazardous occupational exposures in the development of childhood retinoblastoma.

Objectives This study investigated the relationship between different work schedules and progression of carotid atherosclerosis, an early indicator of cardiovascular disease (CVD). Methods We studied 621 men, aged 42–60 years, in the prospective Kuopio Ischemic Heart Disease Risk Factor Study cohort. Using multivariable regressions adjusting for 22 covariates including total time worked during follow-up, we evaluated the associations of baseline work schedules with 11-year progression of ultrasonographically assessed carotid intima-media thickness (IMT), and their variation by preexisting CVD. Results Standard daytime work, weekend shifts, and evening/night/rotating shifts were associated with 31%, 37%, and 33% increases in IMT, respectively. Compared to daytime workers, weekend workers experienced a faster progression of carotid atherosclerosis [relative change ratio (RCR) = 1.05, 95% CI: 1.00–1.09)]. This ratio was higher among men who had preexisting CVD. Conclusions Weekend shifts, more than standard daytime work, appear to accelerate carotid atherosclerosis progression among middle-aged Finnish men, especially those with pre-existing CVD. Am. J. Ind. Med. 58:1–13, 2015. © 2014 Wiley Periodicals, Inc.

Background The aims of this study were to compare job demand-control (JDC) and effort-reward imbalance (ERI) models in examining the association of job stress with work-related musculoskeletal symptoms and to evaluate the utility of a combined model. Methods This study analyzed cross-sectional survey data obtained from a nationwide random sample of 304 intensive-care unit (ICU) nurses. Demographic and job factors were controlled in the analyses using logistic regression. Results Both JDC and ERI variables had strong and statistically significant associations with work-related musculoskeletal symptoms. Effort-reward imbalance had stronger associations than job strain or iso-strain with musculoskeletal symptoms. Effort-reward imbalance alone showed similar or stronger associations with muscusloskeletal symptoms compared to combined variables of the JDC and ERI models. Conclusions The ERI model appears to capture the magnitude of the musculoskeletal health risk among nurses associated with job stress at least as well and possibly better than the JDC model. Our findings suggest that combining the two models provides little gain compared to using effort-reward imbalance only. Am. J. Ind. Med. 57:214–221, 2014. © 2013 Wiley Periodicals, Inc.

BACKGROUND:: Nursing is known as an occupation with high risk of musculoskeletal injury. Nurses' perceptions about the risk of injury may have a role in preventing such injury. OBJECTIVES:: The aim of this study was to investigate how nurses perceived the risk of musculoskeletal injury from work and identify factors associated with their risk perception. METHODS:: In a cross-sectional study using a postal survey, 361 critical care nurses reported on risk perception, physical workload, psychosocial job factors, safety climate, musculoskeletal symptoms, and safe work behavior. RESULTS:: Of all critical care nurse respondents, 83% perceived that they were more likely than not to have a musculoskeletal injury within 1 year. On average, nurses perceived the risk of musculoskeletal injury as lower to themselves than to coworkers. This more positive perception of risk to self had stronger correlations with symptom experiences. Multiple linear regression analysis revealed that higher risk perception of injury was associated with greater job strain, greater physical workload, lack of availability of lifting devices or lifting teams, and more symptoms. DISCUSSION:: Study findings indicated that most critical care nurses were concerned about their ergonomic job risks. Their risk perceptions about musculoskeletal injury risk were affected by physical work exposures, psychosocial job stressors, and experience with musculoskeletal symptoms, but not by perceived workplace safety climate. The findings underscore the need for management efforts to improve physical and psychosocial working conditions and create a safe work environment. Language: en

Author(s): Korshoj, Mette; Krause, Niklas; Clays, Els; Sogaard, Karen; Krustrup, Peter; Holtermann, Andreas | Abstract: ObjectiveHigh occupational physical activity (OPA) increases cardiovascular risk and aerobic exercise has been recommended for reducing this risk. This paper investigates the effects of an aerobic exercise intervention on 24-hour ambulatory blood pressure (ABP) among cleaners with high OPA.MethodsHundred and sixteen cleaners between 18 and 65 years were randomized. During the 4-month intervention period, the aerobic exercise group (AE) (n = 57) performed worksite aerobic exercise (2 × 30 minutes/week), while the reference group (REF) (n = 59) attended lectures. Between-group differences in 4-month ABP changes were evaluated by intention-to-treat analysis using a repeated-measure 2 × 2 multiadjusted mixed-models design.ResultsRelative to REF, 24-hour ABP significantly increased in AE: systolic 3.6 mm Hg (95% confidence interval (CI) 1.6-5.7) and diastolic 2.3 mm Hg (95% CI 0.9-3.8). Cleaners with high aerobic workload exhibited particularly high 24-hour ABP increases: systolic 6.0 mm Hg (95% CI 2.4-9.6), and diastolic 3.8 mm Hg (95% CI 1.3-6.4).ConclusionAerobic exercise increased 24-hour ABP among cleaners. This adverse effect raises questions about the safety and intended benefits of aerobic exercise, especially among workers with high OPA and a demanding aerobic workload. http://www.controlled-trials.com/ISRCTN86682076. Unique identifier ISRCTN86682076.Clinical trial registrationTrial Number ISRCTN86682076.

IntroductionWhile regular exercise has been shown to alleviate the motor symptoms of Parkinson's disease (PD), it remains unclear whether a physically active lifestyle may prevent PD.MethodsTo examine physical activities across the lifespan and risk of PD, we relied on data from a population-based case-control study that enrolled 357 incident PD cases and 341 controls. We assessed physical activity levels via self-report of (1) overall physical activity (PA) over 4 age periods; (2) competitive sports; and (3) occupational histories.ResultsPD risks were lower comparing the overall PA highest quartile (moderate to vigorous activities ≥180 metabolic equivalent task-hours/week (MET-h/wk)) with the lowest quartile (

Objectives: This study aimed to disentangle the interplay between occupational physical activity (OPA) and leisure-time physical activity (LTPA) in affecting cardiovascular health by examining: (i) interactions between OPA and LTPA and their combined effect on 20-year incidence of acute myocardial infarction (AMI) and (ii) the effect of OPA on AMI that is mediated through LTPA. Methods: We analyzed data on 1891 men, aged 42–60 years at baseline, from the prospective Kuopio Ischemic Heart Disease Risk Factor Study. OPA was measured as relative aerobic strain (RAS), accounting for workers’ cardiorespiratory fitness. Averaged 12-month LTPA and potential confounders were assessed by questionnaires. Analyses were stratified by the presence of ischemic heart disease (IHD) at baseline. Results: We found potential multiplicative, but not additive, interactions between OPA and LTPA among men with IHD. The multivariable Cox model, adjusted for age, education, smoking, alcohol consumption, psychosocial job factors, and participation in an unrelated drug trial, showed that high OPA positively predicted AMI at low LTPA levels for both men with and without IHD: hazard ratio (HR) 1.27 [95% confidence interval (95% CI) 0.96–1.68] and HR 1.59 (95% CI 0.99–1.68), respectively. The combination of high OPA and low LTPA constituted the group associated with the highest risk for AMI, irrespective of IHD status. LTPA was not independently predictive of AMI and did not mediate the impact of OPA on AMI. Conclusions: LTPA interacted with OPA on the multiplicative scale only. LTPA did not mediate the effect of OPA on AMI., published version, peerReviewed

Noncompliance with labor and occupational health and safety laws contributes to economic and health inequities. Environmental health agencies are well positioned to monitor workplace conditions in many industries and support enhanced enforcement by responsible regulatory agencies. In collaboration with university and community partners, the San Francisco Department of Public Health used an observational checklist to assess preventable occupational injury hazards and compliance with employee notification requirements in 106 restaurants in San Francisco's Chinatown. Sixty-five percent of restaurants had not posted required minimum wage, paid sick leave, or workers' compensation notifications; 82% of restaurants lacked fully stocked first-aid kits; 52% lacked antislip mats; 37% lacked adequate ventilation; and 28% lacked adequate lighting. Supported by a larger community-based participatory research process, this pilot project helped to spur additional innovative health department collaborations to promote healthier workplaces.

PURPOSE: The relationship between occupational physical activity (OPA) and mortality has mainly been studied among males and shows conflicting results. This study examines this relationship in a cohort of both male and female workers. METHODS: OPA was determined by 4 self-reported questions in a representative sample of 5,839 Danish workers aged 18-59 years at baseline. A 19-year follow-up on mortality was assessed by linkage with the national death registry. Gender-stratified Cox regression models were used to determine the effect of high OPA on all-cause mortality while controlling for age, BMI, smoking, alcohol consumption, doctor-diagnosed disease, influence at work, and social class. RESULTS: Two hundred and sixty-two males (8.6%) and 174 females (6.2%) died during follow-up. Being in the highest quartile of OPA predicted an increased risk for all-cause mortality among male workers (HR: 1.79, CI: 1.19-2.70), but not among female workers (HR: 0.99, CI: 0.65-1.49) compared with workers in the lowest quartile of OPA. Among females, indications of a u-shaped relationship between occupational physical activity and all-cause mortality were found. CONCLUSIONS: The findings indicate that high occupational physical activity increases the risk for all-cause mortality among male workers. Future studies need to further examine gender differences in the effects of OPA on mortality.

OBJECTIVE: Workplace studies have linked hand/wrist tendinosis to forceful and repetitive hand exertions, but the associations are not consistent. We report findings from a prospective study of right wrist tendinosis among blue-collar workers. METHODS: Workers (N=413) at four industries were followed for 28 months with questionnaires and physical examinations every 4 months to identify incident cases of right wrist tendinosis. Exposure assessment of force and repetition were based on field measurements and video analysis to determine repetition rate and the percent time (% time) in heavy pinch (>1 kg-force) or power grip (>4 kg-force). All exposure variables were measured at the level of the individual and task. For workers responsible for >1 task, a time-weighted average exposure was calculated based on task hours per week. A proportional hazards model was used to assess the relationship between exposures and incidence of wrist tendinosis. RESULTS: During the 481 person-years of follow-up, there were 26 incident cases of right wrist tendinosis [incidence rate (IR) 5.40 cases per 100 person-years]. Adjusting for age, gender, and repetition, wrist tendinosis was associated with % time spent in heavy pinch [hazard ratio (HR) 5.01, 95% CI 1.27–19.79). Composite exposure measure American Conference of Industrial Hygienists Threshold Limit Value (ACGIH-TLV) for hand activity level (HR 3.95, 95% CI 1.52-10.26) was also associated with the outcome for the medium-exposure group using video-based total repetition rate. CONCLUSIONS: The workplace factors predicting wrist tendinosis were time-weighted average values of % time spent in heavy pinch and the ACGIH-TLV for Hand Activity Level. The % time spent in power grip was not a significant predictor, nor were any measures of repetition. An exposure−response relationship was observed for the % time spent in heavy pinch. These findings may improve programs for preventing occupational wrist tendinosis.

Objective We examined disparities in workers’ occupational health experiences. Methods We surveyed 941 unionized Las Vegas hotel room cleaners about their experiences with work-related pain and with employers, physicians, and workers’ compensation. Data were analyzed for all workers and by ethnicity, language, and immigrant status. Results Hispanic and English as second language (ESL) workers were more likely than theircounterparts to report work-related pain and, along with immigrant workers, to miss work because of this pain. Hispanic, ESL, and immigrant workers were not consistently at a disadvantage with regard to their own responses to work-related pain but were so with respect to reported responses by workers’ compensation, physicians, and employers. Conclusions Thereareindicationsofdisparitiesinoccupationalhealthexperienceswithin thisjobtitle.Theuseofdifferentgroupclassifications,whileimplyingdifferentmechanisms, produced similar results. Am. J. Ind. Med. 53:960‐975, 2010. ! 2010 Wiley-Liss, Inc.

Background Hotel employees have higher rates of occupational injury and sustain more severe injuries than most other service workers. Method OSHA log incidents from five unionized hotel companies for a three-year period were analyzed to estimate injury rates by job, company, and demographic characteristics. Room cleaning work, known to be physically hazardous, was of particular concern. Results A total of 2,865 injuries were reported during 55,327 worker-years of observation. The overall injury rate was 5.2 injuries per 100 worker-years. The rate was highest for housekeepers (7.9), Hispanic housekeepers (10.6), and about double in three companies versus two others. Acute trauma rates were highest in kitchen workers (4.0/100) and housekeepers (3.9/100); housekeepers also had the highest rate of musculoskeletal disorders (3.2/100). Age, being female or Hispanic, job title, and company were all independently associated with injury risk. Conclusion Sex- and ethnicity-based disparities in injury rates were only partially due to the type of job held and the company in which the work was performed. Am. J. Ind. Med. 53:116–125 2010. © 2009 Wiley-Liss, Inc.

Background Restaurant workers have among the highest rates of work-related illness and injury in the US, but little is known about the working conditions and occupational health status of Chinese immigrant restaurant workers. Methods Community-based participatory research (CBPR) was employed to study restaurant working conditions and worker health in San Francisco’s Chinatown. A community/academic/health department collaborative was formed and 23 restaurant workers trained on research techniques and worker health and safety. A worker survey instrument and a restaurant observational checklist were collaboratively developed. The checklist was piloted in 71 Chinatown restaurants, and the questionnaire administered to 433 restaurant workers. Results Restaurantworkers,togetherwithotherpartners,madesubstantialcontributions to construction of the survey and checklist tools and improved their cultural appropriateness. The utility of the checklist tool for restaurant-level data collection was demonstrated. Conclusions CBPR holds promise for both studying worker health and safety among immigrantChineserestaurantworkersanddevelopingculturallyappropriateresearchtools. A new observational checklist also has potential for restaurant-level data collection on worker health and safety conditions. Am. J. Ind. Med. 2010 Wiley-Liss, Inc.

Objective The literature on psychosocial job factors and musculoskeletal pain is inconclusive in part due to insufficient control for confounding by biomechanical factors. The aim of this study was to investigate prospectively the independent effects of effort–reward imbalance (ERI) at work on regional musculoskeletal pain of the neck and upper extremities of call center operators after controlling for (i) duration of computer use both at work and at home, (ii) ergonomic workstation design, (iii) physical activities during leisure time, and (iv) other individual worker characteristics. Methods This was a one-year prospective study among 165 call center operators who participated in a randomized ergonomic intervention trial that has been described previously. Over an approximate four-week period, we measured ERI and 28 potential confounders via a questionnaire at baseline. Regional upper-body pain and computer use was measured by weekly surveys for up to 12 months following the implementation of ergonomic interventions. Regional pain change scores were calculated as the difference between average weekly pain scores pre- and post intervention. Results A significant relationship was found between high average ERI ratios and one-year increases in right upper-extremity pain after adjustment for pre-intervention regional mean pain score, current and past physical workload, ergonomic workstation design, and anthropometric, sociodemographic, and behavioral risk factors. No significant associations were found with change in neck–shoulder or left upper-extremity pain. Conclusions This study suggests that ERI predicts regional upper-extremity pain in ­computer operators working ≥20 hours per week. Control for physical workload and ergonomic workstation design was essential for identifying ERI as a risk factor.

Objectives: To estimate prevalence, incidence, and course of depressive symptoms and prevalence of mental health treatment following a workplace injury, and to estimate the association between depressive symptoms and return-to-work (RTW) trajectories. Method: In a prospective cohort study, workers filing a lost-time compensation claim for a work-related musculoskeletal disorder of the back or upper extremity were interviewed 1 month ( n = 599) and 6 months ( n = 430) postinjury. A high level of depressive symptoms was defined as 16 or more on the self-reported Center for Epidemiologic Studies—Depression (CES-D) Scale. The following estimates are reported: prevalence of high depressive symptom levels at 1 and 6 months postinjury; incidence, resolution, and persistence of high depressive symptom levels between 1 and 6 months; and prevalence of self-reported mental health treatment and depression diagnosis at 6 months postinjury. Results: Prevalence of high depressive symptom levels at 1 month and 6 months postinjury were 42.9% (95% CI 38.9% to 46.9%) and 26.5% (95% CI 22.3% to 30.7%), respectively. Among participants reporting high depressive symptom levels at 1 month postinjury, 47.2% (95% CI 39.9% to 54.5%) experienced a persistence of symptoms 6 months postinjury. By 6 months, 38.6% of workers who never returned to work or had work disability recurrences had high depressive symptom levels, compared with 17.7% of those with a sustained RTW trajectory. At 6–month follow-up, 12.9% (95% CI 5.8% to 20.1%) of participants with persistently high depressive symptom levels self-reported a depression diagnosis since injury and 23.8% (95% CI 14.7% to 32.9%) were receiving depression treatment. Conclusions: Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.

Excellent palliative care is available for patients with advanced lung cancer. Whether the same services are available for those with nonmalignant respiratory disease is less clear. A questionnaire was sent to 210 named respiratory physicians, each representing a major hospital in England, Wales, and Northern Ireland. A total of 107 replies were received; the response rate was 51.0%. Respondents cared for patients with chronic obstructive pulmonary disease, asbestosis, and diffuse parenchymal lung disease but only a third had responsibility for cystic fibrosis. Physicians were supported by a mean of 3.4 respiratory nurse specialists per department and 73.8% had a specialist lung cancer nurse. In only 16 cases (20.3%) did that nurse extend care to those with nonmalignant disease. Only a minority reported easy access to hospice in-patient care or day care. About 21.5% of the respondents had formal policies in place for care of patients with chronic respiratory disease nearing the end of life, but 87.9% of respondents had no formal process for initiating end of life discussions with those with terminal respiratory illness. Patients with advanced nonmalignant respiratory disease have less universal access to specialist palliative care services than do those with malignant lung disease, and in the majority of hospitals there is no formalized approach to end of life care issues with patients with chronic lung disease.

Objectives: The aim of this intervention study was to determine the effects of an alternative mouse and/or a forearm support board on the change in upper body discomfort scores and the development of incident musculoskeletal disorders. Methods: This randomised controlled intervention trial followed 206 engineers for one year. Participants were randomised to receive (1) a conventional mouse only, (2) an alternative mouse only, (3) a forearm support board, or (4) an alternative mouse plus forearm support board. Outcome measures included weekly upper body discomfort scores and incident musculoskeletal disorders. Results: During the study, 42 participants were diagnosed with an incident musculoskeletal disorder. The group that received the forearm support board experienced a reduction in their right upper extremity discomfort (beta-coefficient −0.35, 95% CI −0.67 to −0.03) in comparison to those who did not receive a forearm board. The group that received the alternative mouse had a protective, but non-significant (p = 0.20), effect on incident cases of right upper extremity musculoskeletal disorders (HR 0.57, 95% CI 0.24 to 1.34) and a non-significant reduction in neck/shoulder discomfort (beta-coefficient −0.23, 95% CI −0.056 to 0.10) in comparison to those who received a conventional mouse. Conclusions: In engineers who use a computer for more than 20 h per week, a forearm support board may reduce right upper extremity discomfort attributed to computer use.

Objectives This study prospectively assessed the effects of occupational physical activity on atherosclerosis progression. Methods This population-based prospective study of ultrasonographically assessed carotid intima media thickness (IMT) used repeated measures of occupational physical activity during baseline, 4-year, and 11-year examinations of 612 Finnish men 42-60 years of age at baseline. The association between five measures of energy expenditure and the 11-year change in maximum IMT was evaluated in regression models adjusting for 21 potential confounders, including biological factors, leisure-time physical activity, smoking, socioeconomic status, psychosocial job factors, and baseline health status. Results At baseline, 31% of all the men and 51% of those with ischemic heart disease (IHD) exceeded the recommended maximum levels of relative aerobic strain. All five measures of energy expenditure were significantly associated with adjusted 11-year IMT change. Significant interactions were found between IHD and several measures of energy expenditure. Maximum relative aerobic strain resulted in a 90% increase in IMT among the men with IHD compared with a 46% increase among those without IHD. The men with preexisting carotid stenosis also had higher rates of IMT progression than the men without this condition. Conclusions This study shows that high energy expenditures at work are associated with an accelerated progression of atherosclerosis even after control for virtually all known cardiovascular risk factors, especially among older workers and workers with preexisting IHD or carotid artery stenosis. The findings support the hemodynamic theory of atherosclerosis and have important implications for workplace surveillance and disease prevention.