Publications by authors named "Sannie Vester Thorsen"

23 Publications

  • Page 1 of 1

Expected Labor Market Affiliation: A New Method Illustrated by Estimating the Impact of Perceived Stress on Time in Work, Sickness Absence and Unemployment of 37,605 Danish Employees.

Int J Environ Res Public Health 2021 05 7;18(9). Epub 2021 May 7.

Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.

As detailed data on labor market affiliation become more accessible, new approaches are needed to address the complex patterns of labor market affiliation. We introduce the expected labor market affiliation (ELMA) method by estimating the time-restricted impact of perceived stress on labor market affiliation in a large sample of Danish employees. Data from two national surveys were linked with a national register. A multi-state proportional hazards model was used to calculate ELMA estimates, i.e., the number of days in work, sickness absence, and unemployment during a 4-year follow-up period, stratified by gender and age. Among employees reporting frequent work-related stress, the expected number of working days decreased with age, ranging from 103 days lost among older women to 37 days lost among younger and middle-aged men. Young and middle-aged women reporting frequent work- and personal life-related stress lost 62 and 81 working days, respectively, and had more days of sickness absence (34 days and 42 days). In conclusion, we showed that perceived stress affects the labor market affiliation. The ELMA estimates provide a detailed understanding of the impact of perceived stress on labor market affiliation over time, and may inform policy and practice towards a more healthy and sustainable working life.
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http://dx.doi.org/10.3390/ijerph18094980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124718PMC
May 2021

High physical work demands have worse consequences for older workers: prospective study of long-term sickness absence among 69 117 employees.

Occup Environ Med 2021 11 10;78(11):829-834. Epub 2021 May 10.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Objective: This study investigates the role of age for the prospective association between physical work demands and long-term sickness absence (LTSA).

Methods: We followed 69 117 employees of the general working population (Work Environment and Health in Denmark study 2012-2018), without LTSA during the past 52 weeks preceding initial interview, for up to 2 years in the Danish Register for Evaluation of Marginalisation. Self-reported physical work demands were based on a combined ergonomic index including seven different types of exposure during the working day. Using weighted Cox regression analyses controlling for years of age, gender, survey year, education, lifestyle, depressive symptoms and psychosocial work factors, we determined the interaction of age with physical work demands for the risk of LTSA.

Results: During follow-up, 8.4% of the participants developed LTSA. Age and physical work demands interacted (p<0.01). In the fully adjusted model, very high physical work demands were associated with LTSA with HRs of 1.18 (95% CI 0.93 to 1.50), 1.57 (95% CI 1.41 to 1.75) and 2.09 (95% CI 1.81 to 2.41) for 20, 40 and 60 years old (point estimates), respectively. Results remained robust in subgroup analyses including only skilled and unskilled workers and stratified for gender.

Conclusion: The health consequences of high physical work demands increase with age. Workplaces should consider adapting physical work demands to the capacity of workers in different age groups.
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http://dx.doi.org/10.1136/oemed-2020-107281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8526881PMC
November 2021

Associations between physical and psychosocial work environment factors and sickness absence incidence depend on the lengths of the sickness absence episodes: a prospective study of 27 678 Danish employees.

Occup Environ Med 2021 01 9;78(1):46-53. Epub 2020 Sep 9.

Analysis and Data, National Research Centre for the Working Environment, Copenhagen, Denmark.

Objectives: This study examined if the association between work environment factors and sickness absence (SA) depended on the inclusion or exclusion of short-term SA episodes.

Methods: We linked the 'Work Environment and Health in Denmark' survey with the 'Danish Register of Work Absences' (n=27 678). Using covariate adjusted Cox regression, we examined the associations between work environment factors and SA by changing the cut-off points for the length of the SA episodes, for example, episodes ≥1 day, ≥6 days and ≥21 days. We examined three physical work environment factors: 'Back bend or twisted', 'Lifting or carrying', 'Wet hands' and three psychosocial work environment factors: 'Poor influence', 'Role conflicts' and 'Bullying'.

Results: 'Back bend or twisted' and 'Lifting or carrying' had small significant HRs for SA episodes ≥1 day and large and highly significant HRs for SA episodes ≥6 days and ≥21 days. 'Wet hands' had small significant HRs for SA episodes ≥1 day for both sexes and large and highly significant HR for ≥6 days for women. HRs of all three psychosocial factors were highly significant for SA episodes ≥1 day and ≥6 days for both sexes, and 'Poor influence' and 'Role conflicts' were significant for SA episodes ≥21 days for women.

Conclusions: The physical work factors had higher associations with SA when SA episodes of 1-5 days were excluded and focus was on SA episodes ≥6 days. The psychosocial work factors were strongly associated with SA both with and without SA episodes of 1-5 days included in the analyses.
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http://dx.doi.org/10.1136/oemed-2020-106554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803903PMC
January 2021

The physical activity paradox revisited: a prospective study on compositional accelerometer data and long-term sickness absence.

Int J Behav Nutr Phys Act 2020 07 20;17(1):93. Epub 2020 Jul 20.

National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen Ø, Denmark.

Background: The 'physical activity paradox' advocates that leisure physical activity (PA) promotes health while high occupational PA impairs health. However, this paradox can be explained by methodological limitations of the previous studies-self-reported PA measures, insufficient adjustment for socioeconomic confounding or not addressing the compositional nature of PA. Therefore, this study investigated if we still observe the PA paradox in relation to long-term sick absence (LTSA) after adjusting for the abovementioned limitations.

Methods: Time spent on moderate-to-vigorous physical activity (MVPA) and remaining physical behaviors (sedentary behavior, standing, light PA and time in bed) at work and in leisure was measured for 929 workers using thigh accelerometry and expressed as isometric log-ratios (ilrs). LTSA was register-based first event of ≥6 consecutive weeks of sickness absence during 4-year follow-up. The association between ilrs and LTSA was analyzed using a Cox proportional hazards model adjusted for remaining physical behaviors and potential confounders, then separately adjusting for and stratifying by education and type of work.

Results: During the follow-up, 21% of the workers experienced LTSA. In leisure, more relative MVPA time was negatively associated with LTSA (20% lower risk with 20 min more MVPA, p = 0.02). At work, more relative MVPA time was positively associated with LTSA (15% higher risk with 20 min more MVPA, p = 0.02). Results remained unchanged when further adjusted for or stratified by education and type of work.

Conclusion: These findings provide further support to the 'PA paradox'.
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http://dx.doi.org/10.1186/s12966-020-00988-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370435PMC
July 2020

Impact of depressive symptoms on worklife expectancy: a longitudinal study on Danish employees.

Occup Environ Med 2019 11 3;76(11):838-844. Epub 2019 Oct 3.

Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Objective: Depressive symptoms are associated with sickness absence, work disability and unemployment, but little is known about worklife expectancy (WLE). This study investigates the impact of depressive symptoms on the WLE of a large sample of Danish employees.

Methods: We used occupational health survey data of 11 967 Danish employees from 2010 and linked them with register data on salary and transfer payments from 2010 to 2015. Depressive symptoms were self-reported using the Major Depression Inventory. We used multistate data and a life table approach with Cox proportional hazard modelling to estimate the WLE of employees, expressed by time in work, unemployment and sickness absence. Separate analyses were conducted for sex and employees with a voluntary early retirement pension scheme. Using age as time axis, we used inverse probability weights to account for differences in educational level, sector, body mass index, smoking habits and loss of employment during sickness absence.

Results: The WLE of employees reporting depressive symptoms was shorter compared with those not reporting depressive symptoms; that is, the expected time in unemployment and sickness absence was longer, while the expected time in work was shorter. The shorter WLE was most pronounced in women; for example, a 40-year-old woman with depressive symptoms can expect 3.3 years less in work, 0.8 years more in unemployment and 0.7 years more in sickness absence. Employees with a voluntary early retirement pension scheme showed an even lower WLE.

Conclusions: Our study showed a meaningful impact of depressive symptoms on the WLE of Danish employees using a multistate framework.
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http://dx.doi.org/10.1136/oemed-2019-105961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839798PMC
November 2019

Determinants of voluntary early retirement for older workers with and without chronic diseases: A Danish prospective study.

Scand J Public Health 2020 Mar 18;48(2):190-199. Epub 2019 Jul 18.

Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands.

This study explored differences in determinants (i.e. health-related, work-related and social factors) of voluntary early retirement between older workers with and without chronic diseases in Denmark. Workers aged 56-64 years who were members of a voluntary early retirement scheme were selected from the Danish National Working Environment Survey (2008-2009) and were followed in a public register for four years. Cox regression analyses were performed separately for older workers with and without chronic disease to identify the associations between determinants and voluntary early retirement. To explore the differences between groups, an interaction term between the determinant and having a chronic disease was included in the analyses for the total population. Among 1861 eligible older workers, determinants associated with a higher risk of voluntary early retirement included poorer self-rated health, more depressive symptoms, a higher physical workload, lower job satisfaction and lower influence at work. For older workers with a chronic disease (=1185), the presence of work-family conflict was also associated with a higher risk of voluntary early retirement, whereas for those with no chronic disease (=676), a poorer relationship with colleagues was an additional determinant. Higher emotional demands, a higher work pace and higher quantitative demands were not significantly associated with voluntary early retirement for either group. None of the interaction terms was found to be statistically significant (>0.05).
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http://dx.doi.org/10.1177/1403494819852787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042495PMC
March 2020

Comparison of exhaustion symptoms in patients with stress-related and other psychiatric and somatic diagnoses.

BMC Psychiatry 2019 03 4;19(1):84. Epub 2019 Mar 4.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Background: Several rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. However, more knowledge is needed about the performance of these rating scales in patients with stress-related disorders as well as in other patient groups. With the recently developed Karolinska Exhaustion Disorder Scale (KEDS), we compared symptoms of exhaustion in different patient groups that were sorted according to diagnosis.

Methods: Patients were sampled consecutively from departments of occupational medicine (DOM) at three Danish hospitals. The total study group comprised 698 care-seeking patients (487 women). Patients with stress-related diagnoses (n = 217; the International Classification of Diseases [ICD]-10 code F43: reaction to severe stress and adjustment disorder) were compared to a diverse group of patients with a range of somatic diagnoses (n = 338) and to patients with other psychiatric diagnoses (n = 143), including subgroups with major depression disorder (n = 34; F32 and F33) and problems related to employment and unemployment (n = 99; Z56). The data were analysed using linear mixed models with the SPSS statistical program.

Results: The mean KEDS sum score in patients with stress-related diagnoses (29.3; SD = 8.0) was significantly higher than in patients with other psychiatric diagnoses (25.9; SD = 9.5) and in patients with somatic diagnoses (17.6; SD = 10.8). The subgroup with a major depression disorder had high mean KEDS sum scores (31.4, SD = 8.1), similar to patients with stress-related diagnoses, while the mean KEDS sum score in patients with problems related to employment and unemployment (Z56) was 23.5 (SD = 9.0). Young and old patients scored similarly on KEDS, but in patients with somatic diagnoses, female patients scored significantly higher than male patients.

Conclusion: The symptoms of exhaustion measured with KEDS were higher in patients with stress-related diagnoses and major depression disorder than in patients with somatic diagnoses. The intermediate level of the symptoms of exhaustion that were associated with problems related to employment and unemployment, (Z56) compared to the lower level of the symptoms with somatic diagnoses, suggests that KEDS might be useful in detecting mild, prodromal states of exhaustion. This needs further investigation.
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http://dx.doi.org/10.1186/s12888-019-2066-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399825PMC
March 2019

Technically measured compositional physical work demands and prospective register-based sickness absence (PODESA): a study protocol.

BMC Public Health 2019 Mar 4;19(1):257. Epub 2019 Mar 4.

National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, Denmark.

Background: Various physical work demands are shown to be associated with sickness absence. However, these studies have: (a) predominantly used self-reported data on physical work demands that have been shown to be inaccurate compared with technical measurements, (b) principally focused on various physical work demands in 'isolation', i.e. ignoring their co-dependency - compositional nature -, and (c) mainly used register data on long-term sickness absence. The present article describes the protocol of a study with the objective of investigating the association between technically measured compositional data on physical work demands and prospective long- and short-term register-based data on sickness absence.

Methods: 'The technically measured compositional Physical wOrk DEmands and prospective association with register-based Sickness Absence study (PODESA)' comprises data from two Danish cohorts (NOMAD and DPhacto) primarily on blue-collar workers. In the PODESA cohort, data on 1108 workers were collected at baseline (between 2011 and 2014). The cohort data comprise, e.g., self-reported information on descriptives, lifestyle, workday, and health, as well as accelerometer-based measurements of physical work demands (physical activity, movements, and postures). These baseline measurements are linked with prospective register-based data on sickness absence for up to four years after baseline. The prospective association between physical work demands and sickness absence will be analysed using a Compositional Data Analysis approach.

Discussion: PODESA provides a unique possibility of unravelling which combinations of physical work demands are associated with prospective sickness absence. PODESA employs technically measured information on physical work demands (taking into account the compositionality of physical work demand data) and prospective sickness absence data. The findings from PODESA can be used to develop strengthened preventive interventions for sickness absence. Results are expected in 2019-2021.
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http://dx.doi.org/10.1186/s12889-019-6581-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398236PMC
March 2019

Perceived stress and sickness absence: a prospective study of 17,795 employees in Denmark.

Int Arch Occup Environ Health 2019 08 27;92(6):821-828. Epub 2019 Feb 27.

The National Research Centre for the Working Environment (NRCWE), Lersø Parkallé 105, 2100, Copenhagen, Denmark.

Objectives: The aims were to examine (1) the prospective association between perceived stress and sickness absence, and if this association (2) differed by sex, and (3) was stronger when only long-term sickness absence (≥ 31 days) instead of all-length sickness absence (≥ 1 day) was included. Moreover, different cut-points for the length of the sickness absence periods were applied.

Methods: We followed respondents (10,634 women and 7161 men) from the 'Work Environment and Health in Denmark' 2014-survey for up to 18 months in the 'Register of Work Absences' from Statistics Denmark. Perceived stress was measured by a single question: "In the last 2 weeks, how often have you felt stressed?" We used Cox-regression with repeated events, adjusted for age, sector, education, and previous sickness absence.

Results: The hazard ratio (HR) for all-length sickness absence (≥ 1 day) for "Often/Always" stress compared to "Seldom/Never" stress was statistically significant among both men (HR = 1.25 [1.13-1.38]) and women (HR = 1.43 [1.34-1.51]). The HR was statistically significant for women (HR = 2.26 [1.89-2.70]), but not for men (HR = 1.22 [0.86-1.73]), when the analyses were restricted to long-term sickness absence (≥ 31 days). The sex-difference was statistically significant. Additional analyses with cut-points at ≥ 2, ≥ 4, ≥ 6, ≥ 8, ≥ 11, ≥ 15, ≥ 20, and ≥ 25 sickness absence days showed that among women, the HR increased gradually with increasing lengths of the sickness absence periods.

Conclusions: The prospective association of perceived stress with risk of sickness absence was stronger among women than men. Among women, perceived stress was more strongly associated with long-term sickness absence than with all-length sickness absence.
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http://dx.doi.org/10.1007/s00420-019-01420-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609587PMC
August 2019

Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain.

Pain Res Treat 2018 2;2018:8347120. Epub 2018 Sep 2.

National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, Denmark.

Background And Objective: Musculoskeletal pain is common in the population. Negative beliefs about musculoskeletal pain and physical activity may lead to avoidance behavior resulting in absence from work. The present study investigates the influence of fear avoidance beliefs on long-term sickness absence.

Methods: Workers of the general working population with musculoskeletal pain (low back, neck/shoulder, and/or arm/hand pain; n = 8319) from the Danish Work Environment Cohort Study were included. Long-term sickness absence data were obtained from the Danish Register for Evaluation and Marginalization (DREAM). Time-to-event analyses (cox regression) controlled for various confounders estimated the association between fear avoidance beliefs (very low, low, moderate [reference category], high, and very high) at baseline and long-term sickness absence (LTSA; ≥6 consecutive weeks) during a 2-year follow-up.

Results: During the 2-year follow-up, 10.2% of the workers experienced long-term sickness absence. In the fully adjusted model, very high-level fear avoidance increased the risk of LTSA with hazard ratio (HR) of 1.48 (95% CI 1.15-1.90). Similar results were seen analyses stratified for occupational physical activity, i.e., sedentary workers (HR 1.72 (95% CI 1.04-2.83)) and physically active workers (HR 1.48 (95% CI 1.10-2.01)).

Conclusion: A very high level of fear avoidance is a risk factor for long-term sickness absence among workers with musculoskeletal pain regardless of the level of occupational physical activity. Future interventions should target fear avoidance beliefs through information and campaigns about the benefits of staying active when having musculoskeletal pain.
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http://dx.doi.org/10.1155/2018/8347120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139188PMC
September 2018

Self-reported or register-based? A comparison of sickness absence data among 8110 public and private employees in Denmark.

Scand J Work Environ Health 2018 11 20;44(6):631-638. Epub 2018 Jun 20.

The National Research Centre for the Working Environment (NRCWE), Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.

Objectives The study aim was to examine (i) non-response bias between responders and non-responders, and (ii) whether the association between self-reported sickness absence (SA) and register-based SA differed by gender, age, sector, or physically demanding work. Methods The responses of 8110 participants to a question on self-reported SA in past 12 months in the Work Environment and Health in Denmark Survey (2014) was linked to 12 months of SA data from the Danish Register of Work Absence. We used logistic regression for the non-response analysis and Poisson regression to examine associations. Results Responders had on average 0.5 days less SA per year than non-responders. Public employees had a higher response rate than private employees (approximately five percentage points), women had a higher rate than men (approximately nine percentage points), and older employees a higher rate than younger employees (approximately nine percentage points in ten years). Self-reported SA correlated highly with register-based SA (Spearman's rank correlation=0.76). In general, responders with few SA days (<10) under-reported their SA while responders with many SA days (>30) over-reported their SA. Women under-reported significantly more than men (average difference one day); older employees under-reported significantly more than younger employees (difference between age groups 18-29 and 60-64 was 1.7 days). Differences between sectors or levels of physically demanding work were non-significant. Conclusions Self-reported SA data may be influenced by non-response bias, and different accuracy in different demographic groups. When available, the use of register-based SA data is recommended.
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http://dx.doi.org/10.5271/sjweh.3747DOI Listing
November 2018

Re: Sainani K. Interpreting "null" results.

PM R 2018 05;10(5):562-563

National Research Centre for the Working Environment, Copenhagen, Denmark.

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http://dx.doi.org/10.1016/j.pmrj.2017.12.012DOI Listing
May 2018

Does workplace social capital protect against long-term sickness absence? Linking workplace aggregated social capital to sickness absence registry data.

Scand J Public Health 2018 May 7;46(3):290-296. Epub 2017 Aug 7.

1 National Research Centre for the Working Environment, Copenhagen, Denmark.

Aims: Most previous prospective studies have examined workplace social capital as a resource of the individual. However, literature suggests that social capital is a collective good. In the present study we examined whether a high level of workplace aggregated social capital (WASC) predicts a decreased risk of individual-level long-term sickness absence (LTSA) in Danish private sector employees.

Methods: A sample of 2043 employees (aged 18-64 years, 38.5% women) from 260 Danish private-sector companies filled in a questionnaire on workplace social capital and covariates. WASC was calculated by assigning the company-averaged social capital score to all employees of each company. We derived LTSA, defined as sickness absence of more than three weeks, from a national register. We examined if WASC predicted employee LTSA using multilevel survival analyses, while excluding participants with LTSA in the three months preceding baseline.

Results: We found no statistically significant association in any of the analyses. The hazard ratio for LTSA in the fully adjusted model was 0.93 (95% CI 0.77-1.13) per one standard deviation increase in WASC. When using WASC as a categorical exposure we found a statistically non-significant tendency towards a decreased risk of LTSA in employees with medium WASC (fully adjusted model: HR 0.78 (95% CI 0.48-1.27)). Post hoc analyses with workplace social capital as a resource of the individual showed similar results.

Conclusions: WASC did not predict LTSA in this sample of Danish private-sector employees.
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http://dx.doi.org/10.1177/1403494817721672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946659PMC
May 2018

Physical working conditions as covered in European monitoring questionnaires.

BMC Public Health 2017 06 5;17(1):544. Epub 2017 Jun 5.

Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (Federal Institute for Occupational Safety & Health), Department "Work & Health", Nöldnerstraße 40-42, 10317, Berlin, Germany.

Background: The prevalence of workers with demanding physical working conditions in the European work force remains high, and occupational physical exposures are considered important risk factors for musculoskeletal disorders (MSD), a major burden for both workers and society. Exposures to physical workloads are therefore part of the European nationwide surveys to monitor working conditions and health. An interesting question is to what extent the same domains, dimensions and items referring to the physical workloads are covered in the surveys. The purpose of this paper is to determine 1) which domains and dimensions of the physical workloads are monitored in surveys at the national level and the EU level and 2) the degree of European consensus among these surveys regarding coverage of individual domains and dimensions.

Method: Items on physical workloads used in one European wide/Spanish and five other European nationwide work environment surveys were classified into the domains and dimensions they cover, using a taxonomy agreed upon among all participating partners.

Results: The taxonomy reveals that there is a modest overlap between the domains covered in the surveys, but when considering dimensions, the results indicate a lower agreement. The phrasing of items and answering categories differs between the surveys. Among the domains, the three domains covered by all surveys are "lifting, holding & carrying of loads/pushing & pulling of loads", "awkward body postures" and "vibrations". The three domains covered less well, that is only by three surveys or less, are "physical work effort", "working sitting", and "mixed exposure".

Conclusions: This is the fırst thorough overview to evaluate the coverage of domains and dimensions of self-reported physical workloads in a selection of European nationwide surveys. We hope the overview will provide input to the revisions and updates of the individual countries' surveys in order to enhance coverage of relevant domains and dimensions in all surveys and to increase the informational value of the surveys.
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http://dx.doi.org/10.1186/s12889-017-4465-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460526PMC
June 2017

Associations between the workplace-effort in psychosocial risk management and the employee-rating of the psychosocial work environment - a multilevel study of 7565 employees in 1013 workplaces.

Scand J Public Health 2017 Jul 8;45(5):463-467. Epub 2017 Apr 8.

2 Center for Industrial Production, Aalborg University Copenhagen, Denmark.

Aims: This study examined the association between the workplace-effort in psychosocial risk management and later employee-rating of the psychosocial work environment.

Method: The study is based on data from two questionnaire surveys - one including 1013 workplaces and one including 7565 employees from these workplaces. The association was analyzed using multi-level linear regression. The association for five different trade-groups and for five different psychosocial work environment domains was examined.

Results: Limited but statistically significant better employee-ratings of the psychosocial work environment in the respective domains were observed among Danish workplaces that prioritized "development possibilities for employees," "recognition of employees," "employees influence on own work tasks," good "communication at the workplace," and "help to prevent work overload."

Conclusion: Danish workplaces with a high effort in psychosocial risk management in the preceding year had a small but significantly more positive rating of the psychosocial work environment by the employees. However, future studies are needed to establish the causality of the associations.
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http://dx.doi.org/10.1177/1403494817696377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495429PMC
July 2017

Psychosocial work environment and retirement age: a prospective study of 1876 senior employees.

Int Arch Occup Environ Health 2016 Aug 7;89(6):891-900. Epub 2016 Apr 7.

The Danish National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, DK-2100, Denmark.

Purpose: Retention of senior employees is a challenge for most developed countries. We aimed to identify psychosocial work environment factors of importance for the retention of older employees by evaluating the association between the psychosocial work environment and voluntary early retirement in a longitudinal study.

Methods: Data about work environment, health, and background factors came from the DANES 2008 questionnaire survey. We followed members of the Danish early retirement scheme for up to 4 years in national registers-focusing on the age range, 60-64 years, where early retirement was possible. We used Cox proportional hazard regression to analyze the rate of early retirement.

Results: The study included 16 psychosocial work environment factors. The following 10 psychosocial factors were significant predictors of early retirement in covariate adjusted analyses: Low job satisfaction, low influence in job, low possibilities for development, low role clarity, perceived age discrimination, low recognition from management, low workplace justice, poor trust in management, poor leadership quality, and poor predictability. No significant association with early retirement was found for work pace, quantitative demands, emotional demands, role conflicts, social community between colleagues, and trust between colleagues.

Conclusion: Older employees with high job satisfaction, influence, possibilities for development, positive management relations, and jobs with no age discrimination remained longer at the labor market. However, we found no evidence that low demands or good relations between colleagues could influence older employees' decision on early retirement.
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http://dx.doi.org/10.1007/s00420-016-1125-7DOI Listing
August 2016

Physical workload and risk of long-term sickness absence in the general working population and among blue-collar workers: prospective cohort study with register follow-up.

Occup Environ Med 2016 Apr 6;73(4):246-53. Epub 2016 Jan 6.

National Research Centre for the Working Environment, Copenhagen, Denmark Department of Sports Science and Clinical Biomechanics, Institute of Sports Science and Clinical Biomechanics, Physical Activity and Health in Work Life, University of Southern Denmark, Odense, Denmark.

Objective: To determine the prospective association between physical workload--in terms of specific physical exposures and the number of exposures--and long-term sickness absence (LTSA).

Methods: Using cox-regression analyses, we estimated the risk of register-based incident LTSA (at least 3 consecutive weeks) from self-reported exposure to different physical workloads among 11,908 wage earners from the general working population (Danish Work Environment Cohort Study year 2000 and 2005).

Results: The incidence of LTSA was 8.9% during two-year follow-up. Spending 25% or more of the total work time with a bent or twisted back (HR 1.59 (95% CI 1.39 to 1.83)), arms above shoulder height (HR 1.35 (95% CI 1.14 to 1.59)), squatting or kneeling (HR 1.30 (95% CI 1.09 to 1.54)), pushing/pulling or lifting/carrying (HR 1.40 (95% CI 1.22 to 1.62)) and standing in the same place for 50% or more of total work time (HR 1.19 (95% CI 1.00 to 1.42), were risk factors for LTSA when adjusted for baseline age, gender, psychosocial work environment, lifestyle, musculoskeletal and mental disorders, and socioeconomic status. HR increased from 1.25 (95% CI 1.04 to 1.51) for one to 1.94 (95% CI 1.56 to 2.41) for four combined physical workloads. Results largely remained stable in subgroup analyses including only blue-collar workers (n=5055). Population attributable risks for LTSA from one or more physical workloads were 26% and 40% in the general working population and among blue-collar workers, respectively.

Conclusions: Several of the investigated types of physical workload were risk factors for LTSA when exceeding 25% of the work time. A higher number of combined physical workloads was associated with progressively increased risk. Our study underscores the importance of physical workload as risk factors for LTSA in the general working population as well as among blue-collar workers.
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http://dx.doi.org/10.1136/oemed-2015-103314DOI Listing
April 2016

Dimensional comparability of psychosocial working conditions as covered in European monitoring questionnaires.

BMC Public Health 2014 Dec 9;14:1251. Epub 2014 Dec 9.

Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (Federal Institute for Occupational Safety & Health), Department "Work & Health", Nöldnerstraße 40-42, 10317 Berlin, Germany.

Background: In most countries in the EU, national surveys are used to monitor working conditions and health. Since the development processes behind the various surveys are not necessarily theoretical, but certainly practical and political, the extent of similarity among the dimensions covered in these surveys has been unclear. Another interesting question is whether prominent models from scientific research on work and health are present in the surveys--bearing in mind that the primary focus of these surveys is on monitoring status and trends, not on mapping scientific models. Moreover, it is relevant to know which other scales and concepts not stemming from these models have been included in the surveys. The purpose of this paper is to determine (1) the similarity of dimensions covered in the surveys included and (2) the congruence of dimensions of scientific research and of dimensions present in the monitoring systems.

Method: Items from surveys representing six European countries and one European wide survey were classified into the dimensions they cover, using a taxonomy agreed upon among all involved partners from the six countries.

Results: The classification reveals that there is a large overlap of dimensions, albeit not in the formulation of items, covered in the seven surveys. Among the available items, the two prominent work-stress-models--job-demand-control-support-model (DCS) and effort-reward-imbalance-model (ERI)--are covered in most surveys even though this has not been the primary aim in the compilation of these surveys. In addition, a large variety of items included in the surveillance systems are not part of these models and are--at least partly--used in nearly all surveys. These additional items reflect concepts such as "restructuring", "meaning of work", "emotional demands" and "offensive behaviour/violence & harassment".

Conclusions: The overlap of the dimensions being covered in the various questionnaires indicates that the interests of the parties deciding on the questionnaires in the different countries overlap. The large number of dimensions measured in the questionnaires and not being part of the DCS and ERI models is striking. These "new" dimensions could inspire the research community to further investigate their possible health and labour market effects.
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http://dx.doi.org/10.1186/1471-2458-14-1251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295265PMC
December 2014

Demand-specific work ability, poor health and working conditions in middle-aged full-time employees.

Appl Ergon 2014 Jul 12;45(4):1174-80. Epub 2014 Mar 12.

Dept. of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark. Electronic address:

We investigated the prevalence of reduced demand-specific work ability, its association with age, gender, education, poor health, and working conditions, and the interaction between poor health and working conditions regarding reduced demand-specific work ability. We used cross-sectional questionnaire data from 3381 full-time employees responding to questions about vocational education, job demands and social support (working conditions), musculoskeletal pain (MSP) and major depression (MD) (poor health) and seven questions about difficulty managing different job demands (reduced demand-specific work ability). Reduced demand-specific work ability varied from 9% to 19% among the 46-year old and from 11% to 21% among the 56-year old. Age was associated with two, gender with four, and education with all measures of reduced demand-specific work ability. MSP was associated with four and MD was associated with six measures of reduced demand-specific work ability. We found no interaction between working conditions and poor health regarding reduced demand-specific work ability.
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http://dx.doi.org/10.1016/j.apergo.2014.02.007DOI Listing
July 2014

The predictive value of mental health for long-term sickness absence: the Major Depression Inventory (MDI) and the Mental Health Inventory (MHI-5) compared.

BMC Med Res Methodol 2013 Sep 17;13:115. Epub 2013 Sep 17.

The Danish National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.

Background: Questionnaires are valuable for population surveys of mental health. Different survey instruments may however give different results. The present study compares two mental health instruments, the Major Depression Inventory (MDI) and the Mental Health Inventory (MHI-5), in regard to their prediction of long-term sickness absence.

Method: Questionnaire data was collected from N = 4153 Danish employees. The questionnaire included the MDI and the MHI-5. The information of long-term sickness absence was obtained from a register. We used Cox regression to calculate covariance adjusted hazard ratios for long-term sickness absence for both measures.

Results: Both the MDI and the MHI-5 had a highly significant prediction of long-term sickness absence. A one standard deviation change in score was associated with an increased risk of long-term sickness absence of 27% for the MDI and 37% for the MHI-5. When both measures were included in the same analysis, the MHI-5 performed best.

Conclusion: In general population surveys, the MHI-5 is a better predictor of long-term sickness absence than the MDI.
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http://dx.doi.org/10.1186/1471-2288-13-115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848657PMC
September 2013

A one-item workability measure mediates work demands, individual resources and health in the prediction of sickness absence.

Int Arch Occup Environ Health 2013 Oct 28;86(7):755-66. Epub 2012 Aug 28.

National Research Centre for the Working Environment, Copenhagen, Denmark,

Objectives: The study tested the hypothesis that a one-item workability measure represented an assessment of the fit between resources (the individuals' physical and mental health and functioning) and workplace demands and that this resource/demand fit was a mediator in the prediction of sickness absence. We also estimated the relative importance of health and work environment for workability and sickness absence.

Methods: Baseline data were collected within a Danish work and health survey (3,214 men and 3,529 women) and followed up in a register of sickness absence. Probit regression analysis with workability as mediator was performed for a binary outcome of sickness absence. The predictors in the analysis were as follows: age, social class, physical health, mental health, number of diagnoses, ergonomic exposures, occupational noise, exposure to risks, social support from supervisor, job control and quantitative demands.

Results: High age, poor health and ergonomic exposures were associated with low workability and mediated by workability to sickness absence for both genders. Low social class and low quantitative demands were associated with low workability and mediated to sickness absence among men. The mediated part was from 11 to 63 % of the total effect for the significant predictors.

Conclusion: Workability mediated health, age, social class and ergonomic exposures in the prediction of sickness absence. The health predictors had the highest association with both workability and sickness absence; physical work environment was higher associated with the outcomes than psychosocial work environment. However, the explanatory value of the predictors for the variance in the model was low.
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http://dx.doi.org/10.1007/s00420-012-0807-zDOI Listing
October 2013

Reliability of the Copenhagen Psychosocial Questionnaire.

Scand J Public Health 2010 Feb;38(3 Suppl):25-32

National Research Centre for the Working Environment, Copenhagen, Denmark.

Aims: Reliabilities of the work environment questionnaire Copenhagen Psychosocial Questionnaire (COPSOQ) have previously been estimated by Cronbach's alpha, but since the internal consistency assumption may not apply to all COPSOQ scales, Cronbach's alpha may underestimate true reliability. This study aims to evaluate reliability in a test-retest design.

Methods: We analyzed postal questionnaire data from 349 persons (of whom 283 were employees) who completed two forms with a median interval of 22 (range 6-65) days between baseline and follow-up. Test-retest reliabilities were estimated by the intraclass correlation (ICC). For scales where the internal consistency assumption was theoretically plausible, reliabilities were also estimated by Cronbach's alpha and by Green's test-retest alpha.

Results: With one exception, the ICC estimated reliabilities of the COPSOQ scales were adequate or good (range 0.70-0.89). A scale concerning mutual trust between employees had a low reliability of 0.64. Among the scales where the internal consistency assumption was plausible, Cronbach's alpha was adequate or good (0.75-0.85) for seven out of eight scales. Green's retest alpha was adequate or good for six out of eight scales (0.72-0.81).

Conclusions: Standard criteria for acceptable intraclass correlation reliability were achieved for all COPSOQ scales but one. The test-retest design and intraclass correlation appears to be more appropriate than Cronbach's alpha for assessing the reliability of psychosocial work environment scales.
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http://dx.doi.org/10.1177/1403494809349859DOI Listing
February 2010

Childhood asthma after bacterial colonization of the airway in neonates.

N Engl J Med 2007 Oct;357(15):1487-95

Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Copenhagen.

Background: Pathological features of the airway in young children with severe recurrent wheeze suggest an association between bacterial colonization and the initiating events of early asthma. We conducted a study to investigate a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma, and allergy during the first 5 years of life.

Methods: The subjects were children from the Copenhagen Prospective Study on Asthma in Childhood birth cohort who were born to mothers with asthma. Aspirates from the hypopharyngeal region of asymptomatic 1-month-old infants were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Wheeze was monitored prospectively on diary cards during the first 5 years of life. Blood eosinophil count and total IgE and specific IgE were measured at 4 years of age. Lung function was measured and asthma was diagnosed at 5 years of age.

Results: Hypopharyngeal samples were cultured from 321 neonates at 1 month of age. Twenty-one percent of the infants were colonized with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms; colonization with one or more of these organisms, but not colonization with S. aureus, was significantly associated with persistent wheeze (hazard ratio, 2.40; 95% confidence interval [CI], 1.45 to 3.99), acute severe exacerbation of wheeze (hazard ratio, 2.99; 95% CI, 1.66 to 5.39), and hospitalization for wheeze (hazard ratio, 3.85; 95% CI, 1.90 to 7.79). Blood eosinophil counts and total IgE at 4 years of age were significantly increased in children colonized neonatally with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms, but specific IgE was not significantly affected. The prevalence of asthma and the reversibility of airway resistance after beta2-agonist administration at 5 years of age were significantly increased in the children colonized neonatally with these organisms as compared with the children without such colonization (33% vs. 10% and 23% vs. 18%, respectively).

Conclusions: Neonates colonized in the hypopharyngeal region with S. pneumoniae, H. influenzae, or M. catarrhalis, or with a combination of these organisms, are at increased risk for recurrent wheeze and asthma early in life.
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http://dx.doi.org/10.1056/NEJMoa052632DOI Listing
October 2007
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