Musculoskeletal complaints in the Netherlands in relation to age, gender and physically demanding work

Objectives: This cross-sectional study was performed in order to elucidate the relationship of musculoskeletal complaints with age, gender and physically demanding work in the Netherlands. Methods: Questionnaire data of male (n=36 756) and female (n=7730) employees, gathered as part of periodical occupational health surveys among active workers in the Netherlands, were stratified for age, gender, and type of work demands. For each stratified group prevalence rates (PR) were calculated for complaints of the back, neck, upper and lower extremities. Moreover, prevalence rate differences (PRD) were estimated as an absolute effect measure of exposure to various types of physical work demands, with active employees in mentally demanding work acting as a reference population. Results: Musculoskeletal complaints among workers in physically demanding occupations were found to increase with age for both sexes. For several complaints, substantially higher rates were reported for women than for men, with a relatively high number of complaints observed among the older female workers (around 40% for complaints of back, upper and lower extremities). Significant PRDs were present in particular for employees in heavy physically demanding occupations and in jobs with mixed mental and physical work demands. Conclusions: With the ageing of the workforce in mind, these findings stress the need for implementation of preventive measures. Special attention towards the susceptible group of female employees, the elderly age groups in particular, seems justified. In order to clarify the combined effects of age and physical work demands on musculoskeletal complaints, additional studies are required. Received: 11 November 1996 / Accepted: 7 March 1997     

Need adjustment of utilization of occupational health promotion for reducing back pain? Results of an employee survey of the metal industry

We analysed data of a cross-sectional survey of 974 employees in the German metal industry to determine the degree to which worksite health promotion matches the needs of employees. 27% of study participants have already taken part in individually oriented health promotion, and another 48% want to participate most readily in activities aiming at preventing and reducing musculo-skeletal complaints. Recent participation (within a fourteen-month period) in these classes was low among male blue collar workers (7%) compared to male and female white collar employees (18 and 26%). Among blue collar workers the percentage of subjects who suffered from chronic back pain and did not recently participate in the relevant classes of the company health insurance plan (unserved prevalence) was 30%, compared to 17 and 26% in male and female white collar employees. Participants were less exposed to work-related predictors of chronic back pain than non-participants. Participants were, however, more often afflicted with chronic back pain than non-participants. In addition, the intention to participate was strongly associated with this type of complaint. Shift work was the most important single explanation for the low participation rates of blue collar workers. Suggestions are advanced to neutralise the adverse effects of shift work on participation, to strengthen the primary preventive functions of individual worksite health promotion, and to integrate it with structural measures of health and safety at work.     

Selection related to musculoskeletal complaints among employees.

OBJECTIVES: To (a) describe differences in the outcome of cross sectional and longitudinal analysis on musculoskeletal complaints relative to age and work demands, and (b) to assess the entrance and drop out selection on musculoskeletal complaints among groups of employees relative to age and work demands. METHODS: A study population was selected on the basis of questionnaire data from periodical occupational health surveys of almost 45,000 employees collected between 1982 and 1993. From all companies within this data base that participated twice in company wide surveys four years apart, male employees were selected, and stratified for age and work demands. There were several populations: follow up (participation in both surveys); drop out (participation only in the first survey); entrance (participation only at the second survey); and two cross sectional populations (all participants at each survey). Prevalences of back complaints and turnover rates were analysed. RESULTS: Reported back complaints in the cross sectional analysis declined over the oldest age groups in heavy physical work versus a small increase in the longitudinal analysis. The age group 50-9 and back complaints were identified as predictors at the first survey for not participating at the second survey. Neither age nor work demands at the first survey indicated drop out among those employees with back complaints at the first survey. The effects of entrance selection on estimated prevalences were small. CONCLUSIONS: The results indicate that musculoskeletal disorders lead to selection out of work, affecting the validity of both cross sectional and longitudinal epidemiological studies. In future studies analyses of turnover figures on musculoskeletal complaints relative to work demands and age are recommended.     

Repeated survey on changes in musculoskeletal complaints relative to age and work demands.

OBJECTIVES: To examine changes in musculoskeletal complaints over four years in groups of employees relative to age and work demands. METHODS: Repeated questionnaire data of male employees in heavy physical work (exposed group, n = 7324) and mental work (control group, n = 4686), stratified for age (20-9, 30-9, 40-9, 50-9), were analysed. For each employee, data on the occurrence of musculoskeletal complaints from two surveys with a mean interval of around four years were available. Changes in prevalences over the follow up interval were analysed. Proportions of new, recovered, and chronic cases as well as those free of complaints at both surveys were studied. RESULTS: For most complaints, there were significantly greater increases in prevalences in the exposed group compared with the control group over the follow up interval particularly within the group aged 40-9 for back, neck, and several sites of the upper and lower limbs. The 20-9 year age group also had significantly greater changes for several musculoskeletal complaints. Within the oldest age group (50-9) exposure to heavy physical work demands only affected changes in prevalences of neck and upper arm complaints. After four years in the cohort free of complaints at the start of the follow up the group aged 40-9 had the highest prevalence of complaints of the back, neck, and the upper and lower limbs. CONCLUSIONS: Middle aged and younger employees develop musculoskeletal complaints as a result of exposure to heavy physical work. In the oldest age group health related selection seems to mask the occupational health risks under study. To prevent the expected increase in musculoskeletal disorders and related work disability in our aging workforce, preventive measures should be taken at all stages of a working life.     

An investigation into the effects of vacations on the health status in male white-collar workers

There are many stress factors in occupational settings, and the lack of vacations could be one of factors in the context of work stress. The authors have been studying the relationship between workload and employee health. This time, an investigation into the effects of leisure vacations on worker health status using male white-collar employees aged 20–60 years engaged in a manufacturing company was conducted. The subjects were questioned on work stress factors including vacations and modifiers in their occupational settings, and on psychological and physiological stress reactions; that is, how often they were able to take leisure vacations every year, their average working hours a day and work stress factors from the Demand-Control-Support model. The questions also examined other factors concerning the employees such as type-A behavior and lifestyles as modifiers, diseases of the employees, physical complaints, feelings about sleep, perceived stress, job and life satisfaction, and stress reactions as measured by physiological examination. Correlation and logistic regression analysis were conducted with the 551 eligible subjects. The results were as follows: Leisure vacation was decreasingly related to some of psychological stress reactions after adjustment was made for working hours and for modifiers. Less vacation was increasingly related to the workers’ diseases especially among the employees aged 20–34, though the association was not statistically significant. Vacations did not show obvious association with physiological measures. These findings demonstrate the effectiveness and possibility of leisure vacation in controlling fatigue and maintaining the health of workers. Vacation should always be taken into consideration as a stress factor in a survey of the health problems of white-collar workers.     

Joint effects of social class and community occupational structure on coronary mortality among black men and white men,upstate New York, 1988-92

STUDY OBJECTIVE: Occupational structure represents the unequal geographical distribution of more desirable jobs among communities (for example, white collar jobs). This study examines joint effects of social class, race, and county occupational structure on coronary mortality rates for men, ages 35-64 years, 1988-92, in upstate New York. DESIGN: Upstate New York's 57 counties were classified into three occupational structure categories; counties with the lowest percentages of the labour force in managerial, professional, and technical occupations were classified in category I, counties with the highest percentages were in category III. Age adjusted coronary heart disease (CHD) mortality rates, 35-64 years, (from vital statistics and census data) were calculated for each occupational structure category. MAIN RESULTS: An inverse association between CHD mortality and occupational structure was observed among blue collar and white collar workers, among black men and white men, with the lowest CHD mortality observed among white collar, white men in category III (135/100,00). About two times higher mortality was observed among blue collar than white collar workers. Among blue collar workers, mortality was 1.3-1.8 times higher among black compared with white workers, and the highest rates were observed among black, blue collar workers (689/100,00). Also, high residential race segregation was shown in all areas. CONCLUSIONS: Results suggest the importance of community conditions in coronary health of local populations; however, differential impact on subpopulations was shown. Blue collar and black workers may especially lack economic and other resources to use available community services and/or may experience worse working and living conditions compared with white collar and white workers in the same communities.     

Perceived job demands relate to self-reported health complaints

BACKGROUND: Illness and illness behaviour are important problems in the Dutch workforce. Illness has been associated with job demands, with high demands relating to poorer health. It has not been reported whether subjective health complaints relate to job demands. AIMS: To investigate whether perceived (physical and mental) workload and specific job demands are associated with self-reported health complaints. METHODS: Cross-sectional study of a random sample of 983 male employees working in manufacturing industry. Job demands and health complaints were investigated using the self-completed Basic Occupational Health Questionnaire. The relationship between demands and health complaints were studied using logistic regression analysis with health complaints as the outcome variable. RESULTS: The questionnaires of 867 workers (88%) were suitable for analysis. The prevalence of health complaints was high. Physical workload was related to musculoskeletal symptoms. Standing work predicted pain in the legs and thoracic as well as low back pain, while sedentary work predicted low back pain. Heavy lifting predicted low back pain and pain in the extremities. Regular bending predicted low back pain and pain in the legs. Repetitive movements predicted pain in the arms and thoracic as well as low back pain. Mental workload was associated with fatigue and chest pain. Working under time pressure and working behind schedule were not related to self-reported health complaints. CONCLUSIONS: Perceived physical job demands matched with self-reported musculoskeletal complaints, whereas perceived mental job demands were unrelated to specific complaints.     

Job insecurity and its association with health among employees in the Taiwanese general population

As employers respond to intensive global competition through the deregulation of labor, job insecurity has become a widespread problem. It has been shown to have significant health impacts in a growing number of workers, but less is known about its social distribution, the mechanisms through which it may act, and the moderating effects of gender, socioeconomic position, and company size. Utilizing data from a national survey of a representative sample of paid employees in Taiwan, we examined the prevalence of job insecurity and its associations with psychosocial work characteristics and health status. A total of 8705 men and 5986 women aged between 25 and 65 years old were studied. Information on perceived job insecurity, industrial and occupational types, psychosocial work characteristics as assessed by the Job Strain model, and various measures of health status were obtained by a self-administered questionnaire. The overall prevalence of job insecurity was high (50%). Job insecurity was more prevalent among employees with lower education attainment, in blue-collar and construction workers, those employed in smaller companies, and in older women. Insecure employees also reported lower job control, higher job demands, and poor workplace social support, as compared with those who held secure positions. Regression analyses showed that job insecurity was strongly associated with poor health, even with adjustment of age, job control, job demands, and work place social support. The deleterious effects of job insecurity appeared to be stronger in men than women, in women who held managerial or professional jobs than women in other employment grades, and in those working in larger companies than smaller ones. The findings of this study suggest that perceived job insecurity is an important source of stress, and it is accompanied with adverse psychosocial work conditions and poor health. High-risk groups were identified for further investigation.     

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.     

Occupational stress in health service employees.

Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed.     

Are musculoskeletal complaints,related work impairment and desirable adjustments in work age-specific?

Purpose

Musculoskeletal complaints from employees commonly occur and may lead to work impairments. Desirable adjustments in work may differ according to age and the type of complaint. We determined whether the prevalence of musculoskeletal complaints, resulting work impairment and desirable and feasible adjustments in work differs between employees of various age groups at a railway company.

Methods

Employees (n = 2,021) were asked to fill out a questionnaire about musculoskeletal complaints by body regions, the resulting work impairment and the desirable and feasible adjustments in their own work situation. Differences between employees of four age groups (22–35, 36–45, 46–55 and 56–66 years) were tested for significance using the chi-square test.

Results

Musculoskeletal complaints in the neck, arm and at least one other body region were most prevalent in the 46–55-year age group compared with the other age groups. Impairments in work due to the musculoskeletal complaints only differed significantly between age groups for lower back complaints, which occurred most often in the oldest age group. Regarding adjustments in work, proportionally more of the youngest employees with musculoskeletal complaints found it desirable and feasible to switch to another job in the company, whereas proportionally more employees within the oldest age group found it desirable and feasible to work fewer days per week.

Conclusions

Employee age groups differed significantly regarding musculoskeletal complaints, resulting work impairment and desirable adjustments in work. Age-specific preventive measures for musculoskeletal complaints could be useful to keep employees healthy to perform their job until retirement and may reduce the costs associated with absenteeism and health care.     

Survey on subjective symptoms in VDT workers: complaint rate and years of service

A questionnaire survey was conducted on 271 workers of microelectronics company. The questionnaire included such items as age, years of service, working conditions and subjective symptoms related to visual, musculoskeletal and general status. The following results were obtained: Of these workers, approximately 80% operated visual display terminals (VDT). The years of service for most were less than 4 to 5 years with the average being about 2 years (Fig. 1). The working hours per day on the VDT for most of them was less than 90 min, although some workers operated VDT for 3 or more hours per day (Fig. 2). A high incidence of complaints of visual function, i.e. eye strain and blurring of distant objects, was observed. Some also complained of musculoskeletal and general symptoms (Table 1). The rates of these subjective symptoms increased with years of service (Figs. 4 and 5), while the complaint rates decreased with age (Fig. 3). Significant positive correlations were found between most of these complaint rates and length of service (Table 2), although correlations between the complaint rates and age were generally non-significant but negative. The complaints tended to increase with working hours per day, although the operators who worked for longer period per day did not seem to complain as much as those who did not work so long (Fig. 6). In conclusion, the results of this questionnaire suggest that the effects of visual display terminals (VDT) work accumulate gradually over months and years.     

Smoking patterns and mortality attributable to smoking in a cohort of 3528 construction workers

This study describes the smoking patterns of 3528 construction workers as reported at occupational health examinations, in four occupational health centres located in the South of Germany, conducted between August 1986 and December 1988. Subjects were aged 20 to 59 years and were working as plumbers, carpenters, painters or varnishers, plasterers, bricklayers, unskilled workers or white collar employees. Overall smoking prevalence was 53.5%. It was considerably higher than in a representative population sample of the same age groups. Active follow up was carried out to ascertain vital status between October 1992 and July 1994. The effect of smoking on all cause mortality was assessed using the cox proportional hazard model. The relative risk of current smoking was 2.5 (95% CI 1.4–4.4) after adjustment for age, profession, self reported alcohol consumption, body mass index, nationality, and company size. 60% of the deaths among smokers and 34% of deaths in the whole cohort were attributable to smoking. These findings underline the need for comprehensive efforts to reduce smoking and its negative consequences in this occupational group.     

Job characteristics and the subjective oral health of Australian workers

Abstract : The way in which work is structured and organised is associated with the health and well-being of workers.
Objectives : To examine the associations between hours worked, job security, skill maintenance and work and home interference and subjective oral health; and to compare findings for different occupational groups.
Methods : Data were collected in 1999 from a random stratified sample of households in all Australian States and Territories using a telephone interview and a questionnaire survey. Subjective oral health was evaluated with the short form Oral Health Impact Profile (OHIP-14), which assesses the adverse impact of oral conditions on quality of life.
Results : Data were obtained for 2,347 dentate adults in the workforce. In the 12 months preceding the survey, 51.9% had experienced oral pain and 31.0% reported psychological discomfort from dental problems. Males, young adults, Australian-born workers, and those in upper-white collar occupations reported lower mean OHIP-14 scores (ANOVA p <0.001). Having controlled for the effects sex, age, country of birth and socio-economic factors in a linear multiple regression analysis, hours worked, skill maintenance and work and home interference were significantly associated with OHIP-14 scores for all workers. While part-time work was associated with higher OHIP-14 among upper white-collar workers, working >40 hours a week was associated with higher OHIP-14 scores for other workers.
Conclusions : Aspects of the work environment are associated with the subjective oral health of workers. Because these contexts are subject to only limited control by individual workers, their influence is a public health issue.     

Job characteristics and the subjective oral health of Australian workers

The way in which work is structured and organised is associated with the health and well-being of workers. OBJECTIVES: To examine the associations between hours worked, job security, skill maintenance and work and home interference and subjective oral health; and to compare findings for different occupational groups. METHODS: Data were collected in 1999 from a random stratified sample of households in all Australian States and Territories using a telephone interview and a questionnaire survey. Subjective oral health was evaluated with the short form Oral Health Impact Profile (OHIP-14), which assesses the adverse impact of oral conditions on quality of life. RESULTS: Data were obtained for 2,347 dentate adults in the workforce. In the 12 months preceding the survey, 51.9% had experienced oral pain and 31.0% reported psychological discomfort from dental problems. Males, young adults, Australian-born workers, and those in upper-white collar occupations reported lower mean OHIP-14 scores (ANOVA p < 0.001). Having controlled for the effects sex, age, country of birth and socioeconomic factors in a linear multiple regression analysis, hours worked, skill maintenance and work and home interference were significantly associated with OHIP-14 scores for all workers. While part-time work was associated with higher OHIP-14 among upper white-collar workers, working >40 hours a week was associated with higher OHIP-14 scores for other workers. CONCLUSIONS: Aspects of the work environment are associated with the subjective oral health of workers. Because these contexts are subject to only limited control by individual workers, their influence is a public health issue.     

The Atlas of health and working conditions by occupation

In this article, we describe methods which have been applied in the compilation of the Atlas of Health and Working Conditions by Occupation. First, we discuss the need for information systems to identify problems concerning working conditions and health. Such information systems have an exploratory purpose, being deployed to identify work risks in companies, groups of occupations and sectors of industry, and can also be a starting point for the generation of hypotheses on the causes of adverse health effects. In the Netherlands, occupational health services gather questionnaire data about work and health as part of periodical occupational health surveys. In the atlas, aggregated questionnaire data for 129 occupations with male employees and 19 occupations with female employees are presented. In this article, we explain the methodology used to compare occupations with regard to each item in the questionnaire. We then discuss applications of these occupational ranking lists. The cross-sectional nature of the data collection, various forms of selection and the limited size of some occupational populations have to be taken into account when interpreting the results. Occupational ranking lists can be applied in the allocation of resources and in the design of scientific research. The overviews for each occupation, presented in the second half of the atlas, provide an occupational profile of existing problems with respect to work and health. These profiles are used as basic information to develop a practical policy on working conditions and health.     

Home-care workers: work conditions and occupational exclusion: a comparison between carers on early-retirement and regular pensions

The aim of the study was to identify conditions associated with occupational exclusion from home-caring. In a group of 346 home-care workers who responded to a questionnaire, there were 18 newly-retired carers on early-retirement/disability pensions, and 28 carers who had just taken regular retirement. A discriminant analysis was conducted to identify work conditions that differentiated the two groups. The results show that a combination of variables--functional impairment (pain when doing physical work), psychosomatic complaints, and nature of relationship with/attitude to clients--significantly differentiated the two groups. When the discriminant coefficients were applied to other groups--older full-time and part-time employees (n = 224), carers who had undergone job transfers, and carers on long-term sick leave--the order of groups by discriminant-point score was largely as expected. The results are discussed in relation to dilemmas, psychological demands and organizational circumstances prevailing in home-care work.     

Gender differences in minor morbidity among full time employees of a British university

STUDY OBJECTIVE: To examine gender differences in minor morbidity among men and women working in similar circumstances, and to test whether the relation between reported working conditions and health is similar for men and women. DESIGN: Multivariate analysis of data collected from a postal questionnaire distributed to full time employees in white collar jobs within a single organisation. SETTING: A British university. PARTICIPANTS: 1641 employees (1009 men and 632 women) working full time in white collar occupations in the university. MAIN RESULTS: Overall, female university employees reported more "physical" symptoms (2.0 v 1.7, p < 0.001) and more "malaise" symptoms (1.4 v 1.1, p < 0.001) than male employees, but mean scores on a measure of minor psychiatric morbidity did not differ by gender. Poor perceived working conditions (and particularly lack of job stimulation, job drain and poor physical conditions) were consistently related to all three measures of minor morbidity, and these variables accounted for most of the variance in these health measures in this sample. When the analysis controlled for occupational grade, perceived working conditions and orientation to gender roles, there was no difference between men and women for any of the health measures. The relations for the predictor variables were generally the same for men and women (and there were no interactions with gender for any of the work related variables). CONCLUSIONS: Although small gender differences in recent experience of malaise and physical symptoms remain when examining men and women in as similar working circumstances as possible, these differences are cumulatively eroded by taking account of occupational grade, reported working conditions and orientation to gender. These results lend support to a differential exposure, rather than a differential vulnerability, model of gender differences in health.     

Occupational class, physical workload, and musculoskeletal morbidity in the engineering industry.

In 1973, 502 employees in three metal industry plants, stratified by age, sex, and occupational class, were examined for physical workload by interview and observation at the workplace and for musculoskeletal disorders by questionnaire, interview, and clinical examination. Five years later, 88% of the sample were re-examined for their musculoskeletal status. The work of the blue collar groups was heavier as measured by indices of physical work load based on the observation and interview (physical strain, physical load, static phases, and stereotypy). Rheumatic symptoms, clinical findings in the musculoskeletal system, and chronic musculoskeletal diseases were more frequent in both female and male blue collar workers than in the respective white collar groups on the first occasion and the increase in morbidity during follow up was higher in the blue collar groups. At an individual level within the blue collar class, however, associations between indices of physical workload and musculoskeletal morbidity were weak or non-existent. The associations were weakened by selective movement of people with musculoskeletal disorders from heavy jobs to premature retirement or to lighter jobs. Physical strain and physical load were negatively associated with the incidence of long term musculoskeletal disorders in the female blue collar group.