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In 2008, Sweden introduced a policy change to limit the number of days for sickness benefits (SB). This study aimed to elucidate the characteristics of those who reached the maximum entitlement period for receiving sickness benefits (MEPSB) and their future main source of income. Methods: All 5,309,759 individuals, aged 20–63 and residents of Sweden in 2009 were followed from July 2008 to July 2010 regarding SB-days and date of MEPSB and then categorised into three groups: I) no SB-days, II) ongoing SB-days, and III) MEPSB. Mean numbers of SB-days 2.5 years before and 2 years after the policy change and main source of income in 2011 were assessed. Associations between sociodemographic factors, occupation and paid work as main source of income were estimated by odds ratio (OR). Results: A total of 0.7% reached MEPSB in 2010. The mean numbers of SB-days before and after the policy change were higher in the MEPSB group than in the other two groups. In the MEPSB group, 14% had their main source of income from paid work in 2011; this was more common among women born in Sweden (OR = 1.29), people living with a partner and children (women OR = 1.29; men OR = 1.48), and those with occupations representing high educational levels. Conclusions: One out of seven individuals with MEPSB in 2010 had their main source of income from paid work in 2011, although they had a long-term SB before and after the policy change. Further research is warranted to address the long-term effects of this policy change.

Aim: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population. Methods: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25–75-year-olds living in Sweden in 2000 that received a postal questionnaire ( n = 6637, response rate = 53%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; ⩾ 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed. Results: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI. Conclusions: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.

Background Toinvestigate the effects of psychosocial work factors (PWF) and psychological distress (PD) on self-assessed work ability. Methods This follow-up study included 7,810 individuals (55%women) with good work ability at baseline. PWFandPD (measured by GHQ-12) were assessed at baseline and work ability at 7-year follow-up. Effects of PWF and PD on work ability were analyzed by logistic regression, odds ratios (OR) with 95% CI, and by mediation analysisusing 4-way decomposition. Results Low support was associated with poor work ability for both women and men (OR 1.78 and 1.89). For men, also low skill discretion was associated with poor work ability (OR 2.07). For both women and men, PD was associated with poor work ability (OR 3.41 and 1.84). PD did not act as an intermediate variablein the association between PWF and work ability. Conclusion Strategies for sustainable work ability should focus on both working conditions and health factors. Am. J. Ind. Med. © 2016 Wiley Periodicals, Inc.

Objectives This study presents an investigation of first-time decisions regarding work injury annuity due to occupational disease. Focus is a number of potential underlying factors behind the gender gap, where women are disadvantaged, in the granting of work injury annuity. Methods All 99 subjects (80 men and 19 women) who met the conditions of long-lasting reduction of work ability due to occupational disease (not occupational accident) in the Swedish Work Injury Insurance Act and were granted work injury annuity in 2010, together with a random sample of 118 subjects (55 men and 63 women) who were denied annuity in the same year, were selected for analysis. Each subject9s case file from the Social Insurance Agency was examined with regards to cause of disease, diagnosis and the Social Insurance Agency9s management and decision making of claims. The data were analysed by logistic regression analysis. Results Men had a higher probability of being granted work injury annuity than women for musculoskeletal disorders (OR 4.16), mental disorders (OR 7.93) and diseases in other diagnostic chapters (OR 3.65). After adjustment for age, country of birth, diagnosis, work exposure factors and decision support factors, the higher probability for men of being granted work injury annuity remained (full model: OR 2.67, 95% CI 1.20 to 5.94). Conclusions Actions are necessary in order to establish equitable and gender-neutral treatment of work injury insurance claims. There is a need for more detailed knowledge of exposures in female-dominated jobs and the relationship between these exposures and occupational disease.

BackgroundThe association between level of education and disability pension (DP) is well known. Earlier studies have investigated the importance of early life factors and work characteristics but not in combination. The aim of this study was to investigate the association between level of education and DP among Swedish middle-aged working men and to what extent such an association can be explained by factors measured in late adolescence and work characteristics in adulthood.MethodsInformation about IQ, health-related lifestyle factors, psychiatric and musculoskeletal diagnoses was obtained from the 1969 conscription cohort, consisting of 49 321 Swedish men. Data collected when subjects were 18–20 years of age were combined with national register-based information about level of education, job control and physical strain at work in adulthood, and information about DP between 1991 and 2002.ResultsThere was a strong graded association between level of education and DP. Those with the lowest level of education had a four times greater probability of having DP as compared with those with the highest level. In multivariable analyses, factors measured in late adolescence, IQ in particular, attenuated the association more than work-related characteristics in adulthood.ConclusionsThe authors found an association between level of education and DP among Swedish middle-aged working men. A large part of the association was explained by factors measured in late adolescence, IQ in particular, and somewhat less by work characteristics measured in adulthood. Level of education remained as a significant predictor of DP in middle age after full adjustment.

Purpose Work ability is commonly measured with self-assessments, in the form of indices or single items. The validity of these assessments lies in their predictive ability. Prospective studies have reported associations between work ability and sickness absence and disability pension, but few examined why these associations exist. Several correlates of work ability have been reported, but their mechanistic role is largely unknown. This study aims to investigate to what extent individual’s own prognosis of work ability predicts labor market participation and whether this was due to individual characteristics and/or working conditions. Methods Self-assessed prognosis of work ability, 2 years from “now,” in the Stockholm Public Health Questionnaire (2002–2003) was linked to national registers on sickness absence, disability pension and unemployment up to year 2010. Effects were studied with Cox regression models. Results Of a total of 12,064 individuals 1466 reported poor work ability. There were 299 cases of disability pension, 1466 long-term sickness absence cases and 765 long-term unemployed during follow-up. Poor work ability increased the risk of long-term sickness absence (HR 2.25, CI 95 % 1.97–2.56), disability pension (HR 5.19, CI 95 % 4.07–6.62), and long-term unemployment (HR 2.18, CI 95 % 1.83–2.60). These associations were partially explained by baseline health conditions, physical and (less strongly) psychosocial aspects of working conditions. Conclusions Self-assessed poor ability predicted future long-term sickness absence, disability pension and long-term unemployment. Self-assessed poor work ability seems to be an indicator of future labor market exclusion of different kinds, and can be used in public health monitoring.

Background: This register study aims to increase the knowledge on how common it is that sickness benefit recipients are sick-listed for as long as their physician prescribes in their medical sickness certificate, i.e. sick-listing adherence, or wholly/partly bring return-to-work (RTW) forward, i.e. early RTW. Methods: The unit for analysis was an episode of 100% sickness benefit, commenced between 1 January 2010 and 31 December 2013. Completed episodes of sickness benefit and full or partial early RTW was analysed by comparing the prescribed length of sick leave in medical sickness certificates and benefit days disbursed by the sickness insurance system. Probability for a full and partial early RTW was estimated with hazard ratio (HR) using the Cox proportional hazard model. Results: In total, about 1.4 million episodes of sickness benefit (60% women) were included in the study. The overall sick-listing adherence was 84% for women and 82% for men during the first year of sick leave. Adherence varied between 82 and 87% among women and between 79 and 86% among men with regard to ICD-10 diagnosis chapter. The probability of an early RTW varied between diagnosis chapters, where mental disorders was associated with a lower probability of a full early RTW among women and men (HR 0.52 and HR 0.47) as well as a partial early RTW (HR 0.51 and HR 0.46). Younger age (16-29 years), high educational level and high income was associated with a higher probability of an early RTW, while older age (>= 50 years), not native-born, low educational level, unemployment and parental leave were associated with a lower probability. Conclusion: The study demonstrates that sick-listing adherence is relatively high. Probability of an early RTW differs with regard to diagnosis chapter, demographic, socioeconomic and labour market characteristics of the sickness benefit recipients. Interventions intended to improve the sick-listing process, and to affect the length and degree of sick leave in certain target groups, should include measures targeted at physicians' sick-listing practices. Policies and economic incentives aimed at promoting RTW need to focus on individuals' residual capacity for work.

Objectives: To investigate whether different combinations of working and living conditions are associated with the risk for persistent neck/shoulder and/or low back disorders. The underlying purpose of this contextual approach was to identify target groups for primary/secondary prevention. Methods: In a baseline study, 11 groups with different working and living conditions were identified by cluster analysis. In this study, these 11 groups were followed up by a postal questionnaire 5 years after baseline (response rate 82%, n=1095). Results: Five of the groups-the onerous human services job, the free agent, the family burden, the mentally stretched and the physically strained groups-had an increased risk for persistent disorders (OR 2.38-2.70). Four of these groups had rather sex-specific working and living conditions. Conclusions: The results support the hypothesis that different combinations of working and living conditions may increase the risk for persistent neck/shoulder and/or low back disorders to different degrees. Sex-specific working and living conditions increased the risk for women as well as for men, irrespective of whether the conditions were specific to women or men.

Aim: The aims of this study were to investigate how common it is to change primary diagnosis between different diagnostic chapters during a sick-leave spell, and to explore patterns of diagnostic changes. Methods: The unit for analysis was episode of sickness benefit, that is, sick leave >14 days, which commenced between 2010 and 2012 in Sweden. For each case, the primary diagnosis was retrieved from the first and last/latest medical sickness certificate, respectively. The number of days of sickness benefit was linked to the cases. Any change of primary diagnosis was analysed by diagnostic chapter according to the ICD-10, and this was done separately for women and men. Results: In total, 803,041 cases of sickness benefit (63% women) were included in the study. During a sick-leave spell, 7.1% of female cases and 6.6% of male cases changed their primary diagnosis to a diagnosis from another diagnostic chapter. The change of primary diagnosis increased with the number of days with sickness benefit. For female cases, this increase was from 2.0% for cases that lasted 15–30 days to 20.2% for cases that lasted >365 days. For male cases, the corresponding increase was from 1.8% to 21.2%. A change of primary diagnosis was least common among those initially sick-listed for mental disorders and musculoskeletal disorders. The patterns of diagnostic changes were rather similar for women and men. Conclusions: A change of diagnosis during a sick-leave spell needs to be taken into consideration by the sickness insurance system and in the actions taken by its administration. Registry-based studies of sickness insurance need to consider diagnostic changes in both the study design and the interpretation of results.

Background Segregation of men and women into different jobs is often cited as one of the most plausible explanations for gender differences in exposure and musculoskeletal disorders. Methods Direct measurements of sitting, arm, and trunk postures were taken with two different technical instruments on 156 subjects (78 matched pairs of one female and one male worker) over one full workday in diverse labor markets. Results Exposure differences between workers were strongly associated with vertical occupational segregation (measured as level of status/authority). The results showed that this association was strongest for female-dominated jobs. Workers in female-dominated jobs with a low status/authority experienced longer duration in standing posture (P = 0.001), and higher frequency of arm elevation (P = 0.028 and 0.040 for the dominant and the non-dominant arm, respectively). They also had longer duration of work with bent trunk compared to corresponding workers with high status/authority (P = 0.035). The association was less pronounced for male-dominated jobs, and no such association was found for gender-integrated jobs. Conclusion The findings have implications for prevention as well as for future research. Am. J. Ind. Med. 47:381–393, 2005. © 2005 Wiley-Liss, Inc.

The aim was to investigate organizational impact on working conditions and to explore the associations between sector, different types of organizational change, and working conditions. A strategic selection was made of representative staff members from 72 work sites. Data pertaining to organizational factors were collected from managers, and to working conditions from employees. Multilevel analyses were performed, with 10 aspects of self-reported and expert assessed psychosocial and ergonomic/physical working conditions as the dependent variables, and patterns of organizational change and sector as the explanatory variables. The results showed that the variance in working conditions was significantly attributed to organizational level (16 – 65% of the variance), and that both the pattern of change and the sector were important. Organizations that had not undergone change provided the best work conditions. The “standardizing” and “market-adjusting” patterns of change had deleterious effects, while the “lea...

The aim of the study was to evaluate eight questions concerning physical loads, used in public health questionnaires. Working women and men (203) completed a self-administered questionnaire twice, following a test-retest method. The questions were also validated with a structured interview. Response agreement was calculated with Cohen's kappa statistics with quadratic weights (kappa w). Test-retest agreement varied from 0.74 to 0.92, and inter-method agreement from 0.38 to 0.81. The lowest coefficients were for the questions concerning bent/twisted work postures (kappa w 0.38) and repetitive movements (kappa w 0.39). The results did not indicate any substantial influence of gender, type of work or musculoskeletal complaint. The questions concerning general physical activity and sitting work postures, and physical exercise/sports during leisure times, had good validity. The questions concerning bent/twisted work posture and repetitive movements need to be re-designed.

Objectives: To investigate time trends of low back pain (LBP) and concurrent psychological distress in the general population. Methods: Every 4 years between 1990 and 2006, a self-administered questionnaire including the General Health Questionnaire (GHQ-12) and a question on LBP were sent to a random sample of the population in the county of Stockholm (response rate 61–69%). All individuals aged 21–64 years in the five samples (n = 1976–26 611) were included in the study. Results: Among women, the prevalence of self-reported LBP rose rather moderately during the 16-year period, from 12.5% to 16.4% (prevalence rate ratio (PRR) 1.31; 95% CI 1.11 to 1.55). The prevalence did not change at all among men (PRR 1.02; 95% CI 0.85 to 1.23). In contrast, the prevalence of LBP with concurrent psychological distress rose more substantially, from 2.6% to 5.9% among women (PRR 2.23; 95% CI 1.53 to 3.24) and from 1.9% to 3.5% among men (PRR 1.82; 95% CI 1.14 to 2.90). The prevalence of both LBP and LBP with concurrent psychological distress seemed to fluctuate somewhat over the period. Conclusions: Between 1990 and 2006, the focus of discussion of the high societal costs for sickness absence and disability pensions gradually shifted from musculoskeletal disorders to psychological well-being. As a result, the general population’s awareness and perception of pain and psychological distress may have changed and, in turn, affected individuals’ willingness to report these symptoms. Further research is necessary to investigate the impact of cultural changes on subjective symptom reporting.

Background There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. Methods This study included migrants to Sweden since 1960 who were 28–47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. Results Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. Conclusions Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

This study examines the effect of changing the floor from a 2-mm homogenous vinyl floor to a 4-mm heterogeneous vinyl floor (1.5-mm wear layer and 2.5-mm foam layer) on musculoskeletal symptoms in the lower extremities and low back among nursing assistants in a geriatric care centre. A pre-post design with a reference group consisting of nursing assistants from a similar geriatric care centre was used. Follow-up measurements were carried out 12 and 24 months after the intervention by means of questionnaires. At the 1-year follow-up, the pain intensity score in the feet of the intervention group had decreased compared with the baseline value and remained statistically significant at the 2-year follow-up. The decrease in pain intensity score of the feet in the intervention group was statistically significantly different from the reference group, both after 1 and 2 years.The results show the importance of flooring in the workplace with regard to reducing musculoskeletal symptoms. Appropriate flooring is especially important in the female-dominated health care sector, where workers must stand or walk for long periods.

Analysis of repeated cross-sectional surveys.To investigate the prevalence of neck-shoulder-arm pain and concurrent low back pain and psychological distress in a geographical area over a 16-year period.A large number of studies have shown that nonspecific neck, shoulder, and arm pain is a very common symptom in the general population. However, few studies have followed the prevalence of neck-shoulder-arm pain within a geographical area, in order to investigate time-trends.This study provides an analysis of questionnaire data collected every 4 years between 1990 and 2006 on the prevalence of neck-shoulder-arm pain and concurrent low back pain or psychological distress in the County of Stockholm, Sweden (response rate: 61%-69%). All individuals aged 21 to 64 years (n = 1976-26,611) were included in the study.Over the 16-year period, the prevalence of self-reported neck-shoulder-arm pain rose slightly, from 22.8% to 25.0% among females (prevalence rate ratio [PRR]: 1.10) and from 12.8% to 15.4% among males (PRR: 1.21). The prevalence of neck-shoulder-arm pain with concurrent low back pain also rose slightly, from 8.4% to 10.8% among females (PRR: 1.28) and from 5.3% to 6.6% among males (PRR: 1.24). In contrast, the prevalence of neck-shoulder-arm pain with concurrent psychological distress rose more substantially, from 4.4% to 8.5% among females (PRR: 1.91) and from 2.0% to 4.3% among males (PRR: 2.18). All prevalence rates rose between 1990 and 2002, and decreased in 2006 compared to 2002. The gender gap in prevalence did not change over time.Although the prevalence of neck-shoulder-arm pain and concurrent symptoms decreased in 2006 compared to 2002, it is still too early to conclude that we have reached and passed the peak of the "epidemic" of neck-shoulder-arm pain.

Musculoskeletal disorders (MSDs) have a multifactorial etiology. Therefore, a holistic approach to identifying target groups for primary/secondary prevention is essential. In this study, an exploratory person-oriented approach was applied, using cluster analysis of variables related to physical and psychosocial work conditions, and conditions in the private sphere, on a data set of 1,341 Swedish women and men who had not sought care for MSDs the 6 months preceding enrollment in the study. Three groups at risk and five "healthy" groups regarding MSDs were identified. Two of the risk groups had a strained situation regarding psychosocial work conditions or domestic/family conditions, respectively. The majority of individuals in these groups were women. The third risk group had a strained situation regarding both physical and psychosocial work conditions. This group consisted largely of men working in male-dominated jobs. The five healthy groups had low/moderate metabolic demands at work, and all of them having high proportions of subjects with moderate to high education, and fairly even distributions of men and women. In conclusion, the results indicate that gender-specific working and living conditions are associated with an increased risk for MSDs. The identification of these subgroups in the population may facilitate a selective prevention approach.

Segregation of men and women into different jobs is often cited as one of the most plausible explanations for gender differences in exposure and musculoskeletal disorders.Direct measurements of sitting, arm, and trunk postures were taken with two different technical instruments on 156 subjects (78 matched pairs of one female and one male worker) over one full workday in diverse labor markets.Exposure differences between workers were strongly associated with vertical occupational segregation (measured as level of status/authority). The results showed that this association was strongest for female-dominated jobs. Workers in female-dominated jobs with a low status/authority experienced longer duration in standing posture (P = 0.001), and higher frequency of arm elevation (P = 0.028 and 0.040 for the dominant and the non-dominant arm, respectively). They also had longer duration of work with bent trunk compared to corresponding workers with high status/authority (P = 0.035). The association was less pronounced for male-dominated jobs, and no such association was found for gender-integrated jobs.The findings have implications for prevention as well as for future research.

This study attempted to identify work and leisure-time conditions and life-style factors associated with excess metabolic levels (metabolic demands exceeding one-third of a person's aerobic capacity) at work among men and women.The study focused upon psychological, ergonomic, and physically loading factors and chemical and physical environmental conditions. Data were obtained through self-reports, interviews, workplace analyses, technical measurements, and observations. Gender-specific calculations were used in univariate analyses and in stepwise logistic regression models for excess metabolic level.Twenty-seven percent of the men and twenty-two percent of the women worked at an excess metabolic level during their workday. Awkward work postures, heavy manual materials handling, high circulatory strain, chemical exposures, noise levels, much routine work, and many obstacles to job performance characterized their work conditions. The women had low skill discretion and more often atypical workhours, while the men showed high circulatory strain during leisure-time activities. Important negative life-style factors were a high consumption of alcohol for the men and a high body mass index and no or little regular physical exercise for the women.Metabolic demands in worklife today remain high. The women who exceeded the recommended metabolic level at work in this study were characterized by low pay, poor health, and children at home, in addition to high physical load and psychosocial strain at work. These characteristics indicate a group with few possibilities to leave a hazardous job for a less physically demanding one. The men who worked at an excess metabolic level seemed to be characterized more by a life-style common in some male-dominated work cultures with monotonous work.

The purpose of this study was to investigate the prevalence of the excess of metabolic level (metabolic demands in work exceeding one-third of the individual's aerobic capacity) of working men and women today and to describe the population whose metabolic level is exceeded. A second aim was to explore how externally assessed metabolic demands match with the physical function and capacity of working men and women in jobs with the lowest and the highest demands. The aerobic power of each individual (94 men and 94 women) was estimated from heart rate and workload in sub-maximal tests from dynamic legwork on a cycle ergometer. Physical activity was assessed using a task-oriented interview technique. Physical function was measured by tests of muscle endurance in arms, abdomen and legs, handgrip pressure, balance and coordination. The calculation of individual metabolic demands during a "typical working day" showed that 27% of the men and 22% of the women exceeded their metabolic level. The results indicate that the physical fitness is low or somewhat low for two-thirds of the 94 men and for more than one-half of the 94 women. Women in the group with the highest job demands had significantly lower muscle endurance in the abdomen and legs and worse coordination than women in the group with the lowest job demands. Metabolic demands in working life today remain high. This is reflected in a mismatch between individual physical capacity and the physical demands of work for 25% of the population.

Work and health among native and foreign-born residents in Sweden 1990-2008 : a register-based study on hospitalization due to common potentially work-related disorders, disability pension and mortality

International audience; Aim: Low-back pain diseases (LBPD) belong to the most frequent diagnoses determined by general practitioners, and constitute one of the most common reasons for sick leave and permanent disability pension in the Czech Republic and other European countries. Epidemiological studies have shown a statistically significant association between LBPD and certain types of occupational burden. However, in the Czech Republic, LBPD caused by overload and/or whole-body vibrations have not yet been included in the list of occupational diseases. The aim of this study was to collect and compare the systems, criteria and diagnoses used to recognize LBPD as occupational diseases in other European countries.Methods: A questionnaire focused on LBPD was distributed and answered by specialists in occupational diseases in European countries. It included items concerning LBPD in the national list of occupational diseases, and work-related and diagnostic criteria that need to be fulfilled for recognizing LBPD as occupational diseases and possible awarding compensations to the patients.Results: In 13 countries out of the 23 countries studied, LBPD caused by overload can be recognized as occupational, providing that the diagnosis is sufficiently proven and exposure criteria and/or listed occupation are met and duration of exposure is confirmed (Belgium, Denmark, France, Germany, Hungary, Italy, Lithuania, Macedonia, Netherlands, Romania, Slovakia, Sweden, and Switzerland). LBPD due to vibrations can be also recognized as occupational in 14 countries. In 8 countries LBPD are not accepted as occupational unless they are caused by an injury at work. Specific criteria to evaluate occupational exposure of patients with LBPD were set in Belgium, Denmark, France, Germany, Lithuania, Macedonia, Netherlands, and Slovakia. In other countries, the evaluation is done at an individual basis.Conclusions: In practice, the assessment of occupational overload and its contribution to the development of LBPD as well as its inclusion in the compensation system are important for several reasons. Firstly, it may be considered essentially preventable. Secondly, cases with a significant contribution of occupational aetiology may be viewed as occupational diseases for which compensation may be claimed, as it is the case in many European countries. Importantly, inclusion of LBPD in the list of occupational diseases or another system of compensation may be viewed as a preventive measure as it increases the visibility of this problem not only for the workers, but especially for the employers.