Work-related life events, psychological well-being and cardiovascular risk factors in male Swedish automotive workers

AIMS: To analyse the relationship between life events, social support, psychological well-being and cardiovascular risk factors in blue- and white-collar Swedish automotive workers. METHODS: Baseline questionnaire regarding life events, social support, depressed mood and mental strain and smoking habits. Follow-up questionnaire after 5 years included the Psychological General Well-being Inventory to assess various health variables. At baseline and follow-up, anthropometric data were obtained. Blood pressure, blood glucose and serum lipids were measured and smoking habits were surveyed. RESULTS: The blue-collar workers showed a profile indicating increased cardiovascular risk with a higher proportion of smokers, a higher waist to hip ratio and higher triglycerides. They also reported themselves to have worse general health and less emotional self-control, but were less anxious than the white-collar workers. Negative life events, especially those related to work seemed to affect the well-being of the blue-collar workers more adversely than the white-collar workers. Being nervous and depressed at baseline increased the risk of poor psychological well-being at the follow-up. Social support within this 5-year perspective was a factor which predicted psychological well-being in both worker categories. Increase in cholesterol/high-density lipoprotein-cholesterol (HDL-C) ratio was the only cardiovascular risk factor associated with the strain of life events but not with work-related events. CONCLUSION: Over a 5-year period, men who experienced negative, strongly stressful and work-related life events displayed poorer psychological well-being at follow-up regardless of worker category. Social support was protective.     

Life events, mood, mental strain and cardiovascular risk factors in Swedish middle-aged men. Data from the Swedish part of the Renault/Volvo Coeur Study

The associations between life events, mood, mental strain andcardiovascular risk factors were investigated in the Renault/VolvoCoeur Study. About 1,000 men, blue-collar and white-collar workers,were asked by means of interview-administered questionnairesabout life events experienced during the year preceding thescreening, about mood and mental strain and about smoking, alcoholconsumption and exercise habits. Blood pressure, concentrationof serum lipids and blood glucose, and anthropometric measureswere determined in a screening procedure. Negative life events,especially work-related, were associated with depressed moodand mental strain but not with elevation of biological riskfactors such as elevated blood pressure and serum lipids. Depressedmood and mental strain were related to increased tobacco consumptionin blue-collar workers and increased alcohol consumption inwhite-collar workers.     

Risk factors for first-ever low back pain among workers in their first employment

BACKGROUND: Low back pain has been estimated to be the most costly ailment of people of working age. Both work characteristics and individual factors have been identified as risk factors. The first interaction between work characteristics and individual factors occurs when workers start in their first job. AIMS: To investigate work-related risk factors for first-ever low back pain in young workers in their first employment. METHODS: A cross-sectional analysis was performed on 278 young workers in their first employment and without a history of low back pain prior to working. Work-related physical factors, psychosocial work characteristics, individual variables and first-ever low back pain were queried by means of a questionnaire. RESULTS: About half of the workers who developed low back pain after job start did so in the first year of employment. An increased risk was observed for (i) long periods of seated work [relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.6-6.4]; (ii) more than 12 flexion or rotation movements of the trunk per hour (RR = 3.0, 95%CI = 1.4-6.4); and (iii) more than 3 years seniority in a job involving lifting more than 25 kg at least once an hour (RR = 3.7, 95%CI = 1.4-9.4). As to psychosocial work characteristics, first-ever low back pain was associated with a combination of low psychological job demands and low supervisor support. CONCLUSION: Work-related physical factors and psychosocial work characteristics should be considered as risk factors for first-ever low back pain. First-ever episodes of low back pain are common in the first year of employment. This may reflect a lack of work experience or training.     

Indicators of cardiovascular risk among workers exposed to high intermittent levels of carbon disulphide

The effects of exposure to carbon disulphide have been studied mostly among workers in the viscous rayon industry, where the usual exposure profile has been relatively steady exposure over work shifts. We investigated 13 workers in a small chemical company who were exposed to low levels, peaking intermittently to relatively high levels in the range of 100-200 ppm at the end of the work shift, a pattern that may change the risk profile. Our investigation was part of a compliance order that was fought by the company and our access and follow-up was limited. Two workers had burns on their bodies associated with exposure to caustic. Four had elevations in total serum cholesterol, one had elevated serum triglycerides and three had elevations in fasting blood glucose--two of them were known to be diabetics before employment and one had a history of unexplained peripheral neuropathy. No consistent pattern suggestive of a defined lipoprotein abnormality was obvious but several atherogenic profiles were observed. Five had abnormalities on electrocardiogram, four of whom appeared to be among the most heavily exposed. The presence of these changes taken together in this context may suggest accelerated atherosclerotic changes. Tests of liver and kidney function were within the normal range for all workers, as was a complete blood count. Four of the workers had evidence of a bilateral reduction in hearing threshold at 4,000 Hz. A complete set of recommendations was forwarded to the employer, emphasizing further control of exposure to carbon disulphide, personal protection requirements and a cardiovascular risk reduction programme. Conditions improved in the plant following modifications introduced in response to a stop work order from the provincial government's occupational health and safety agency. However, a fire in 1998 put the company out of business and ended further follow-up or interventions. We conclude that these findings, while difficult to interpret because of the circumstances of the investigation, are compatible with an atherogenic effect of exposure to peaking levels of carbon disulphide. The observation should be tested in a larger population with fewer confounding factors and greater control over the investigation.     

Hydrogen Sulphide

Hydrogen sulphide (H₂S is the primary chemical hazard in naturalgas production in ‘sour’ gas fields. It is alsoa hazard in sewage treatment and manure-containment operations,construction in wetlands, pelt processing, certain types ofpulp and paper production, and any situation in which organicmaterial decays or inorganic sulphides exist under reducingconditions. H₂S dissociates into free sulphide in the circulation.Sulphide binds to many macromolecules, among them cytochromeoxidase. Although this is undoubtedly an important mechanismof toxicity due to H₂S, there may be others. H₂S provides littleopportunity for escape at high concentrations because of theolfactory paralysis it causes, the steep exposure-response relationships,and the characteristically sudden loss of consciousness it cancause which is colloquially termed ‘knockdown.’Other effects may include mucosal irritation, which is associatedat lower concentrations with a keratoconjunctivitis called ‘gaseye’ and at higher concentrations with risk of pulmonaryoedema. Chronic central nervous system sequelae may possiblyfollow repeated knockdowns: this is controversial and the primaryeffects of H₂S may be confounded by anoxia or head trauma. Treatmentis currently empirical, with a combination of nitrite and hyperbaricoxygen preferred. The treatment regimen is not ideal and carriessome risk.     

Musculoskeletal disorders and visual strain in intensive data processing workers

BACKGROUND: This study was conducted for a UK Trade Union in response to increasing numbers of health complaints among intensive computer workers in a data processing environment. AIM: To estimate prevalence of musculoskeletal pain/discomfort and visual strain symptoms among data processing workers and to explore associations with work factors. METHODS: A self-report questionnaire was distributed to data processors (n = 175) and a control group (n = 129) in the same organization. RESULTS: Eighty-six per cent of data processors reported musculoskeletal pain/discomfort in the previous year, with the highest prevalence rate found for the neck (58%). The 12 month reported prevalence for visual strain symptoms was 47%, tired eyes (41%) was the most commonly reported symptom. In the last week, 56% reported pain/discomfort and 25% visual strain symptoms. Data processors reporting pain in the previous year were more likely to be dissatisfied with their jobs (P < 0.01), to report a lack of choice in deciding what they did at work (P < 0.02), to have insufficient time to complete work (P < 0.05) or to receive help from others when time was limited (P < 0.03). CONCLUSION: The prevalence of self-reported musculoskeletal pain/discomfort and visual strain symptoms was high among data processors. A systematic approach to risk reduction addressing organizational, psychosocial and physical work factors is required. This study has implications for reorganization of this and other intensive computer work, given the increasing requirement for intensive computing work in many industrial sectors. More research is needed to investigate interactions between job demands and support systems for these workers.     

The association between cheese consumption and cardiovascular risk factors among adults

Background Although current dietary guidelines recommend limiting foods high in fat and saturated fat, such as high‐fat dairy, the effect of cheese consumption on body composition and cardiovascular risk factors is largely unknown. Methods Participants from a US population‐based survey, NHANES III, aged 25–75 years who completed a food frequency questionnaire and had measures of body composition and cardiovascular risk factors were included (n = 10 872). Linear regression was used to compare anthropometrics, blood lipids, blood pressure and blood glucose across categories of cheese consumption (combined full and low‐fat). Results In women, more frequent cheese consumption was associated with higher HDL‐C and lower LDL‐C (p for trend, < 0.05). However, in men, more frequent cheese consumption was associated with a higher body mass index (BMI), waist circumference, HDL‐C and LDL‐C, and diastolic blood pressure (p for trend, < 0.05). Men consuming 30 + servings/month had significantly higher BMI, waist circumference, and diastolic blood pressure compared to nonconsumers (P < 0.05). Conclusions More frequent cheese consumption was associated with less favourable body composition and cardiovascular risk profile in men, but with a more favourable cardiovascular risk profile in women. However, the type of cheese consumed by men and women may have differed resulting in opposing trends on body composition and cardiovascular risk factors.     

The relationship between occupational psychological stress and female fertility

OBJECTIVE: To investigate the association between occupational psychological stress and female fertility. METHODS: This was a case-control study including consecutive working female patients attending fertility and in vitro fertilization clinics in the Soroka University Medical Center. We compared occupational stress between 64 working patients who had attended the clinics due to female infertility (case group) and 106 working patients who had attended the clinics due to their partner's reproductive impairment (control group). RESULTS: Patients from the female infertility group were older (31.9 +/- 6.2 versus 30.2 +/- 4.6, P = 0.047) and tended to participate more in sporting activity [23.4 versus 10.4%, odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.05-6.73, P = 0.022] as compared with patients from the male infertility group. Patients from the case group tended to work more weekly hours as compared with the controls (33.6 +/- 16.8 versus 26.9 +/- 17.4, P = 0.028). High reliability was found, as demonstrated by Cronbach's alpha of 0.81-0.90 for the four burnout parameters. Patients from the female infertility group had significantly lower listlessness scores as compared with the control group, using the Mann-Whitney test (2.6 +/- 1.1 versus 3.1 +/- 1.2, P = 0.013). CONCLUSIONS: Patients admitted due to female infertility tended to have lower listlessness scores as compared with patients admitted due to their partner's infertility problem. No significant association was found between other burnout, job strain and job satisfaction scores and women's fertility status.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.     

Job stress and dissatisfaction in association with non-fatal injuries on the job in a cross-sectional sample of petrochemical workers

This cross-sectional study analysed the frequency and severity of work stressors and job satisfaction at workplaces in relation to work-related non-fatal injuries amongst a sample of petrochemical workers in Taiwan. The study participants consisted of 568 cases injured on the job between 1991 and 1997, and 954 injury-free controls matched to cases on frequencies of age, sex and work site. After adjusting for potential confounders, we found that cases were more likely than controls to report stressors with a higher frequency [odds ratio (OR) = 1.4, 95% confidence interval (CI) = 0.9-2.0] and a more severe reaction (OR = 1.3, 95% CI = 0.9-1.8). The dose-response analyses further indicated that the OR of injury was monotonically associated with stress reaction only (P for test for trend of ORs = 0.02). Job satisfaction, though, was unrelated to non-fatal injury. Although the cross-sectional nature of our study precludes a causal inference between stress reaction to stressors and risk of developing non-fatal injuries, our results tend to suggest that the severity of stress reaction is more associated with occupational non-fatal injury than is the frequency of stress or job dissatisfaction.     

Occupational Coronary Heart Disease among Bridge and Tunnel Officers

Traffic-control officers employed in New York City tunnels prior to 1981 have been at increased risk of mortality from coronary heart disease. In this study, the authors assessed current coronary heart disease prevalence and evaluated associations between coronary heart disease and occupational factors among New York City bridge and tunnel officers. A clinical cardiovascular disease surveillance and cross-sectional occupational epidemiologic study was conducted. The authors used comprehensive evaluations to identify current and prior incidences of coronary heart disease. Occupational risk factors evaluated included job strain, current and historic exposure to carbon monoxide, and occupational physical inactivity. Current carbon monoxide exposure was assessed via workshift changes in carboxyhemoglobin. Coronary heart disease occurred in 29 (5.5%) of the 526 bridge and tunnel officers examined. Risk of coronary heart disease was associated positively with total years each bridge and tunnel officer work had worked in that capacity (odds ratio = 1.64 for each decade of employment, adjusted for nonoccupational coronary heart disease risk factors). Carboxyhemoglobin levels were low in the subjects, and job strain and physical inactivity were very prevalent. Occupational factors contributed to the risk of coronary heart disease in New York City bridge and tunnel officers. The authors were unable to identify the specific factors that led to the increase in risk described.     

Toothless tests: associations between the results of routine screening medical examinations and ill-health retirement of firefighters in west central Scotland

The final routine medical examinations (RME) of 526 full-time firefighters, all male, retiring from Strathclyde Fire Brigade in the decade beginning 1 January 1985 were studied to determine differences between the results of the 328 taking ill-health retirement (IHR) and the 198 completing maximum service (MS). Mean ages at IHR and MS were 48 and 54 years/respectively. This was statistically significant (P = 0.0000), so the results of the third RMEs, performed after the subjects' 46th birthdays, were also analysed. The findings were also reduced into quinquennia. Since the RMEs were weighted towards cardiovascular disorders, the outcomes of the 37 IHRs from arterial disease were sought and compared to the final results of those with MS. In both final and third RMEs, those completing MS were more likely to be non-smokers (60.9 vs 41.4%; 51.6 vs 42.6%; P = 0.01 and 0.015). In the final RME, subjects with MS generally had normal lung function (abnormal results 4.8 vs 10.4%; P = 0.002), abnormal chest X-rays and near vision (22.4 vs 7.6%; 91.1 vs 51.6%; P = 0.000 for both). In the third RME, firefighters with IHR were more likely to have hypertriglyceridaemia (39.6 vs 22.4%; P = 0.004), and reduced distance vision (32.2 vs 21.2%; P = 0.03). Where IHR resulted from arterial disease, sufferers had raised mean cholesterol (6.76 vs 6.20 mmol/l; P = 0.049), raised median triglycerides (2.1 vs 1.55 mmol/l; P = 0.0236), hypertriglyceridaemia (44.4 vs 21.2%; P = 0.008) and less likely to be non-smokers (32.4 vs 60.9%; P = 0.001). Differences between body mass index, systolic and diastolic blood pressure, fasting and HDL cholesterol, electrocardiogram abnormalities, urinary abnormalities and total numbers of risk factors did not reach statistical significance, apart from isolated quinquennial episodes. These results suggest that, except for highlighting known health hazards, current RMEs are ineffective in identifying those at risk of ill-health retirement in this group.     

Occupational coronary heart disease among bridge and tunnel officers

Traffic-control officers employed in New York City tunnels prior to 1981 have been at increased risk of mortality from coronary heart disease. In this study, the authors assessed current coronary heart disease prevalence and evaluated associations between coronary heart disease and occupational factors among New York City bridge and tunnel officers. A clinical cardiovascular disease surveillance and cross-sectional occupational epidemiologic study was conducted. The authors used comprehensive evaluations to identify current and prior incidences of coronary heart disease. Occupational risk factors evaluated included job strain, current and historic exposure to carbon monoxide, and occupational physical inactivity. Current carbon monoxide exposure was assessed via workshift changes in carboxyhemoglobin. Coronary heart disease occurred in 29 (5.5%) of the 526 bridge and tunnel officers examined. Risk of coronary heart disease was associated positively with total years each bridge and tunnel officer work had worked in that capacity (odds ratio = 1.64 for each decade of employment, adjusted for nonoccupational coronary heart disease risk factors). Carboxyhemoglobin levels were low in the subjects, and job strain and physical inactivity were very prevalent. Occupational factors contributed to the risk of coronary heart disease in New York City bridge and tunnel officers. The authors were unable to identify the specific factors that led to the increase in risk described.     

Predicting job loss in those off sick

BACKGROUND: Evidence shows incapacity benefit claimants (those off sick >26 weeks) are at greatest risk of long-term job loss. AIM: To develop a screening tool to select those at risk of job loss, defined as failure to return to work among those off sick. The screening tool was for use in the Job Retention and Rehabilitation Pilot of the Department for Work and Pensions. METHODS: A literature review identified risks for long-term incapacity and job loss as multifactorial. Potential predictors for return to work were then assembled into a set of questions and tested by a prospective study in general practice surgeries and a retrospective study of occupational health records of local authority employees referred for sickness absence management, using univariate and multivariate logistic regression analysis. RESULTS: Univariate logistic regression analysis of the retrospective study produced odds ratios with 95% confidence intervals for each question (where P 相似文献   

Identifying workers at risk of sickness absence by questionnaire

BACKGROUND: Sickness absence is an important economic problem, because of high costs and lost productivity. Determining factors associated with increased risk of sickness absence may lead to the development of preventive measures. AIMS: To determine whether self-report questionnaires can identify those employees at risk of sickness absence METHODS: Prospective study of 238 healthy administrative workers. Participants completed a questionnaire proven to be valid and consistent. The questionnaire consisted of 116 items about health, work and working conditions. Sickness absence was followed-up for a period of 1 year. RESULTS: The questionnaires of 191 workers (80%) were suitable for analysis. The number of reported health complaints was significantly (P < 0.01) associated with sickness absence (OR 2.18; 95% CI 1.32-3.61). Concentration problems were correlated with more frequent absences, and both nervous complaints and coping problems with longer duration. Age (OR 0.96; 95% CI 0.93-0.99; P = 0.02) and job insecurity (OR 0.68; 95% CI 0.47-0.98; P = 0.04) were negatively associated with sickness absence. Psychosocial and physical work factors were not associated with sickness absence. CONCLUSIONS: Questionnaires on health and work can identify employees at future risk of sickness absence. Workers who report multiple health complaints, especially concentration problems, nervous complaints or coping problems, may be at increased risk of sickness absence.     

Burnout as a clinical entity--its importance in health care workers

Burnout, viewed as the exhaustion of physical or emotional strengthas a result of prolonged stress or frustration, was added tothe mental health lexicon in the 1970s, and has been detectedin a wide variety of health care providers. A study of 600 Americanworkers indicated that burnout resulted in lowered production,and increases in absenteeism, health care costs, and personnelturnover. Many employees are vulnerable, particularly as theAmerican job scene changes through industrial downsizing, corporatebuyouts and mergers, and lengthened work time, Burnout producesboth physical and behavioural changes, in some instances leadingto chemical abuse. The health professionals at risk includephysicians, nurses, social workers, dentists, care providersin oncology and AIDS-patient care personnel, emergency servicestaff members, mental health workers, and speech and languagepathologists, among others. Early identification of this emotionalslippage is needed to prevent the depersonalization of the provider-patientrelationship. Prevention and treatment are essentially parallelefforts, including greater job control by the individual worker,group meetings, better up-and-down communication, more recognitionof individual worth, job redesign, flexible work hours, fullorientation to job requirements, available employee assistanceprogrammes, and adjuvant activity. Burnout is a health careprofessional's occupational disease which must be recognizedearly and treated.     

Relationship between job stress and plasma fibrinolytic activity in male Japanese workers

 Psychosocial job stress has been shown to be associated with the development of cardiovascular disease. However, the pathophysiological mechanisms underlying this relationship remain unclear. The aim of the present study was to elucidate whether marked job stress affects the parameters of blood coagulation and fibrinolysis, such as plasma fibrinogen concentration, tissue plasminogen activator (t-PA), and plasminogen activator inhibitor 1 (PAI-1) activities, in 213 middle-aged male workers in a computer-producing factory. Job stress was measured using a Japanese version of the Job Content Questionnaire (JCQ) developed by Karasek. The mean t-PA activity in workers with lower and higher job demands was 0.23 and 0.18 IU/ml respectively, and this difference was significant (P<0.05). The mean plasma fibrinogen in workers with lower and higher job decision latitude was 224.8 and 236.3 mg/dl respectively, and the mean PAI-1 activity in workers with lower and higher job strain was 14.9 and 17.7 U/ml respectively, though these differences remained at a borderline level of significance (0.05<P<0.10). Multiple regression analyses showed that the parameters of blood coagulation and fibrinolysis were closely associated with the cardiovascular risk factors of age, obesity, blood pressure, elevated serum lipids, and smoking, but that high job demands were significantly related to decreases in t-PA activity, independently of the traditional risk factors. These results suggest that psychosocial job stress may be related, at least partly, to the development of cardiovascular disease via changes in plasma fibrinolytic activity. Received: 26 October 1995/Accepted: 24 November 1995     

Ventilatory function in brass workers of Gadaladeniya, Sri Lanka

A cross sectional study was conducted to determine the respiratoryhazards of brass workers. The study group was selected randomly.The control group was selected from the general population matchedfor age by cluster sampling. There was a total of 154 pairsfor the final analysis. A questionnaire was administered todetermine the prevalence of respiratory symptoms. Forced vitalcapacity (FVC), forced expiratory volume in the first second(FEV_1.0), forced expiratory flow rate in the mid 50% of theFVC(FEF_25%–75%) and peak expiratory flow rate(PEFR) weremeasured. Chest radiography was performed on those with 5 ormore years of service. Cough, phlegm, chronic bronchitis anddyspnoea were significantly higher among brass workers. Theventilatory capacity was significantly lower in all the indicatorsexcept FVC. Smoking had no significant effect and a dose responserelationship could not be demonstrated after inclusion of agein the regression model. Five point five per cent had evidenceof septal lines while 6.4% had emphysema.     

Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982-1992

STUDY OBJECTIVE: The decline in cardiovascular mortality in Denmark during the 1980s has been greatest in the highest socioeconomic groups of the population. This study examines whether the increased social inequality in cardiovascular mortality has been accompanied by a different trend in cardiovascular risk factors in different educational groups. DESIGN: Data from three cross sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92, were analysed to estimate trends in biological (weight, height, body mass index, blood pressure, and serum lipids) and behavioural (smoking, physical activity during leisure, and eating habits) risk factors in relation to educational status. SETTING: County of Copenhagen, Denmark. PARTICIPANTS: 6695 Danish men and women of ages 30, 40, 50, and 60 years. MAIN RESULTS: The prevalence of smoking and heavy smoking decreased during the study but only in the most educated groups. In fact, the prevalence of heavy smoking increased in the least educated women. There was no significant interaction for the remaining biological and behavioural risk factors between time of examination and educational level, indicating that the trend was the same in the different educational groups. However, a summary index based on seven cardiovascular risk factors improved, and this development was only seen in the most educated men and women. CONCLUSION: The difference between educational groups in prevalence of smoking increased during the 1980s, and this accounted for widening of an existing social difference in the total cardiovascular risk.     

Long-term sickness absence - risk indicators among occupationally active residents of a Danish county

This study aims to identify risk factors and their prevalence in long-term sickness absence. The study is designed as a case-referent study which comprises 481 participants who have experienced a sickness absence lasting >10 weeks and a reference group of 1326 individuals in active employment. Multivariate analysis identified the following significant risk factors for men: (i) age >50 years [odds ratio (OR) = 2.4]; (ii) short period of education (OR = 2.3); (iii) unemployment within the last 3 years (OR = 1.7); (iv) heavy-duty work (OR = 2.1); (v) monotonous, repetitive work (OR = 1.7); (vi) lack of job satisfaction (OR = 2.1); and (vii) much back pain during the last 3 years (OR = 2.1). The following risk factors were identified for women: (i) leaving school without graduation (OR = 2.6); (ii) unemployment within the last 3 years (OR = 1.5); (iii) heavy-duty work (OR = 2.8); (iv) lack of influence on own job situation (OR = 2.1); and (v) much back pain within the last 3 years (OR = 1.8). It is concluded that the identification of working environment risk factors constitutes a case for improvement of the working environment which may be instrumental in reducing long-term sickness absence.