Publications by authors named "Tom Sterud"

30 Publications

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Changes in effort-reward imbalance at work and risk of onset of sleep disturbances in a population-based cohort of workers in Denmark.

Sleep Med X 2020 Dec 8;2:100021. Epub 2020 Aug 8.

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

Objective/background: Associations between exposure to effort-reward imbalance at work (eg, high time pressure/low appreciation) and risk of sleep disturbances have been reported, but the direction of the effect is unclear. The present study investigated changes in effort-reward imbalance and risk of concomitant and subsequent onset of sleep disturbances.

Methods: Participants with sleep disturbances at baseline were excluded. We included participants from a population-based cohort in Denmark (n = 8,464, 53.6% women, mean age = 46.6 years), with three repeated measurements (2012 (T); 2014 (T); 2016 (T)). Changes in effort-reward imbalance (T-T) were categorized into 'increase', 'decrease' and 'no change'. Self-reported sleep disturbances (difficulties initiating or maintaining sleep, non-restorative sleep, daytime tiredness) were dichotomized (presence versus absence). We regressed concomitant (T) and subsequent (T) sleep disturbances on changes in effort-reward imbalance (T-T) and calculated odds ratios (OR) and 95% confidence intervals, adjusted for sex, age, education and cohabitation.

Results: At follow-up, 8.4% (T) and 12.5% (T) reported onset of sleep disturbances. Increased effort-reward imbalance was associated with concomitant sleep disturbances (T) (OR = 3.16, 2.56-3.81), whereas decreased effort-reward imbalance was not (OR = 1.22, 0.91-1.63). There was no association between increased effort-reward imbalance and subsequent sleep disturbances (T) (OR = 1.00, 0.74-1.37). Results were similar for men and women.

Conclusions: Increased effort-reward imbalance was associated with a three-fold higher risk of concomitant onset of sleep disturbances at two-year follow-up, but not subsequent onset of sleep disturbances at four-year follow-up, indicating that changes in effort-reward imbalance have immediate rather than delayed effects on sleep impairment. It is possible that the results from the two-year follow-up were to some extent affected by reverse causality.
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http://dx.doi.org/10.1016/j.sleepx.2020.100021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041122PMC
December 2020

Safety incidents associated with extended working hours. A systematic review and meta-analysis.

Scand J Work Environ Health 2021 Sep 9;47(6):415-424. Epub 2021 Apr 9.

National Institute of Occupational Health, PB 5330 Majorstuen, 0304 Oslo, Norway.

Objective: We performed a systematic review to assess potential consequences of extended working hours on accidents, near-accidents, safety incidents and injuries (incidents) by considering the overall certainty of evidence.

Methods: We searched five databases systematically (Medline, Embase, PsycINFO, Web of Science, and Proquest Health and safety Science Abstract) and identified 10072 studies published until December 2020. Twenty-two studies met the inclusion criteria. We followed a systematic approach to evaluate risk of bias and synthesize results in a meta-analysis. The certainty of evidence was determined by a modified version of The Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Our analyses indicated an association between working >12 hours/day (RR: 1.24, 95%CI: 1.11, 1.40), or working >55 hours/week (RR: 1.24, 95%CI: 0.98, 1.57), and elevated risk of incidents. The certainty of evidence evaluated as low. Weak or no associations were observed for other exposure contrasts: working >8 hours/day (RR: 0.93, 95%CI: 0.72, 1.19), or working overtime (RR: 1.08, 95%CI: 0.75, 1.55), working 41-48 hours/week (RR: 1.02, 95%CI: 0.92, 1.13) or 49-54 hours/week (RR: 1.02, 95%CI: 0.97, 1.07). The certainty of evidence was evaluated as low (very low for 41-48 hours/week).

Conclusions: Daily working hours >12 hours and weekly working hours exceeding 55 hours was associated and increased risk of incidents. The level of evidence was low. Hence, further high-quality research is warranted to elucidate these associations.
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http://dx.doi.org/10.5271/sjweh.3958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504541PMC
September 2021

Adverse social behaviour at the workplace and subsequent physician certified sick leave: a three-wave prospective study of the general working population in Norway.

Occup Environ Med 2021 Jan 29. Epub 2021 Jan 29.

National Institute of Occupational Health (STAMI), Oslo, Norway.

Objectives: We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at the workplace and sick leave.

Methods: Data from a randomly drawn prospective cohort of the general working population. Eligible respondents were interviewed in 2009, 2013 or 2016, and were registered with an employee relationship of at least 50 working days in the national register the year following the survey interviews (n=21 674 observations/13 470 respondents). We investigated the prospective associations of self-reported exposure to ASB, including threats/acts of violence, bullying and sexual harassment, with physician-certified sick leave of 1-16 days (ie, low level of sick leave (LLSL)) and >16 days (ie, high level of sick leave (HLSL)) by means of mixed effects logistic regression.

Results: The prevalence of sick leave was 18.4% (n=3986 observations) for LLSL and 16.1% (n=3492 observations) for HLSL. The different facets of ASB were independently associated with higher odds of sick leave, with stronger associations for HLSL than for LLSL. Adjusted for sex, age, education level, occupation, previous sickness absence level, OR (95% CI) for HLSL was 1.97 (1.61 to 2.35) for threats/acts of violence, 1.97 (1.53 to 2.54) for bullying and 1.41 (1.10 to 1.79) for sexual harassment. The population risks of LLSL and HLSL attributable to ASB were 5.27 (95% CI 1.85 to 8.81) and 8.27% (95% CI 4.01 to 12.48), respectively.

Conclusions: Threats/acts of violence, bullying and sexual harassment were all independent predictors of sick leave, with threats/acts of violence appearing as the single most important factor.
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http://dx.doi.org/10.1136/oemed-2020-106973DOI Listing
January 2021

Effects of adverse social behaviour at the workplace on subsequent mental distress: a 3-year prospective study of the general working population in Norway.

Int Arch Occup Environ Health 2021 Feb 1;94(2):325-334. Epub 2020 Nov 1.

National Institute of Occupational Health (STAMI), PO Box 5330 Majorstuen, N-0033, Oslo, Norway.

Objective: We aimed to provide an integrated picture of the relationship between different facets of adverse social behaviour (ASB) at work and mental health problem.

Methods: Data were provided from a longitudinal nationwide study of the general population in Norway. Eligible respondents were in paid work during a reference week in 2013, or temporarily absent from such work, and was interviewed at 3-year follow-up (n = 3654, response at baseline/follow-up = 53.1%/71.8%). We investigated the prospective associations of self-reported exposure to ASBs, including threats/acts of violence, bullying, sexual harassment and workplace conflicts, with mental distress (the Hopkins Symptoms Checklist) at follow-up, by means of multiple logistic regression.

Results: In total, 6.6% (242 individuals) were classified with mental distress at follow-up. Work-related predictors were sexual harassment (OR = 1.64 07, 95% CI 1.03 - 2.61), bullying (OR = 2.07, 95% CI 1.19 - 3.60) and workplace conflicts (OR = 1.51, 95% CI 1.07 - 2.13). An elevated, but non-statistically significant association was observed for threats/acts of violence. No significant interactions were found between ASB and mental distress score at baseline. Overall there were few indications of substantial confounding related to age, sex, education level or occupation. After adjusting for these factors, the overall population attributable risk of mental distress attributable to any exposure to ASB was 11.3% (95%CI 0.6-22.3).

Conclusions: We observed robust associations between exposure to three out of four types of ASB and risk of mental distress. Taken together, the results underscore that adverse social behaviour at the workplace may have a substantial impact on the level of mental distress in the general working population.
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http://dx.doi.org/10.1007/s00420-020-01581-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873096PMC
February 2021

Effort-reward imbalance at work and weight changes in a nationwide cohort of workers in Denmark.

Am J Ind Med 2020 07 14;63(7):634-643. Epub 2020 Apr 14.

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

Objective: To investigate the relation between effort-reward imbalance (ERI) at work and subsequent weight changes.

Methods: We included participants from a population-based cohort of workers in Denmark (mean age = 47 years, 54% women) with two (n = 9005) or three repeated measurements (n = 5710). We investigated the association between (a) ERI (ie, the mismatch between high efforts spent and low rewards received at work) at baseline and weight changes after a 2-year follow-up (defined as ≥5% increase or decrease in body mass index (BMI) vs stable), and (b) onset and remission of ERI and subsequent changes in BMI. Using multinomial logistic regression we calculated risk ratios (RR) and 95% confidence intervals (CI), adjusted for sex, age, education, cohabitation, migration background, and follow-up time.

Results: After 2 years, 15% had an increase and 13% a decrease in BMI. Exposure to ERI at baseline yielded RRs of 1.09 (95% CI: 0.95-1.25) and 1.04 (95% CI: 0.90-1.20) for the increase and decrease in BMI, respectively. There were no differences between sex and baseline BMI in stratified analyses. The onset of ERI yielded RRs of 1.04 (95% CI: 0.82-1.31) and 1.15 (95% CI: 0.84-1.57) for subsequent increase and decrease in BMI. The RRs for the remission of ERI and subsequent increase and decrease in BMI were 0.92 (95% CI: 0.71-1.20) and 0.78 (95% CI: 0.53-1.13), respectively. Of the ERI components, high rewards were associated with a lower risk of BMI increase.

Conclusion: ERI was not a risk factor for weight changes. Future studies may investigate whether this result is generalizable to other occupational cohorts and settings.
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http://dx.doi.org/10.1002/ajim.23110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317465PMC
July 2020

Effort-reward imbalance at work and risk of type 2 diabetes in a national sample of 50,552 workers in Denmark: A prospective study linking survey and register data.

J Psychosom Res 2020 01 1;128:109867. Epub 2019 Nov 1.

National Research Centre for the Working Environment, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark.

Objective: To examine the prospective relation between effort-reward imbalance at work and risk of type 2 diabetes.

Methods: We included 50,552 individuals from a national survey of the working population in Denmark, aged 30-64 years and diabetes-free at baseline. Effort-reward imbalance was defined, in accordance with the literature, as a mismatch between high efforts at work (e.g. high work pace, time pressure), and low rewards received in return (e.g. low recognition, job insecurity) and assessed as a continuous and a categorical variable. Incident type 2 diabetes was identified in national health registers. Using Cox regression we calculated hazard ratios (HR) and 95% confidence intervals (95% CI) for estimating the association between effort-reward imbalance at baseline and risk of onset of type 2 diabetes during follow-up, adjusted for sex, age, socioeconomic status, cohabitation, children at home, migration background, survey year and sample method.

Results: During 136,239 person-years of follow-up (mean = 2.7 years) we identified 347 type 2 diabetes cases (25.5 cases per 10,000 person-years). For each one standard deviation increase of the effort-reward imbalance score at baseline, the fully adjusted risk of type 2 diabetes during follow-up increased by 9% (HR: 1.09, 95% CI: 0.98-1.21). When we used effort-reward imbalance as a dichotomous variable, exposure to effort-reward imbalance was associated with an increased risk of type 2 diabetes with a HR of 1.27 (95% CI: 1.02-1.58).

Conclusion: The results of this nationwide study of the Danish workforce suggest that effort-reward imbalance at work may be a risk factor for type 2 diabetes.
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http://dx.doi.org/10.1016/j.jpsychores.2019.109867DOI Listing
January 2020

Mechanical and psychosocial work exposures: the construction and evaluation of a gender-specific job exposure matrix (JEM).

Scand J Work Environ Health 2019 05 13;45(3):239-247. Epub 2018 Nov 13.

National Institute of Occupational Health, PO Box 8149 Dep., 0033 Oslo, Norway.

Objectives The aim of this study was to (i) construct and evaluate a gender-specific job exposure matrix (JEM) for mechanical and psychosocial work exposures and (ii) test its predictive validity for low-back pain. Methods We utilized data from the Norwegian nationwide Survey of Living Conditions on work environment in 2006 and 2009. We classified occupations on a 4-digit level based on the Norwegian version of the International Standard Classification of Occupations (ISCO-88). The mechanical and psychosocial exposure information was collected by personal telephone interviews and included exposures that were known risk factors for low-back pain. We evaluated the agreement between the individual- and JEM-based exposure estimates, with kappa, sensitivity and specificity measures. We assessed the JEM`s predictive validity by testing the associations between low-back pain and the individual- and JEM-based exposure. Results The results showed an overall fair-to-moderate agreement between the constructed JEM and individual work exposures. The JEM performed considerably better for mechanical work exposures compared with psychosocial work exposures. The predictive validity of the mechanical and psychosocial JEM showed a consistently lower but predominantly reproducible association with low-back pain for both genders. Conclusions The mechanical estimates and psychosocial stressors, such as psychological demands, monotonous work and decision latitude in the constructed JEM, may be useful in large epidemiological register studies. The predictive validity of the matrix was evaluated as being overall acceptable, it can thus be an effective and versatile approach to estimate the relationship between work exposures and low-back pain.
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http://dx.doi.org/10.5271/sjweh.3774DOI Listing
May 2019

Interaction of smoking with respiratory effects of occupational dust exposure: a prospective population study among Norwegian men.

ERJ Open Res 2018 Apr 26;4(2). Epub 2018 Jun 26.

National Institute of Occupational Health, Dept of Occupational Medicine and Epidemiology, Oslo, Norway.

http://ow.ly/w0RF30jUL2Z.
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http://dx.doi.org/10.1183/23120541.00021-2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018214PMC
April 2018

Influence of occupational factors on regional differences in sick leave: A prospective population study.

Scand J Public Health 2018 May 19;46(3):314-320. Epub 2017 Dec 19.

Department of Occupational Health Surveillance, National Institute of Occupational Health, Norway.

Aims: Number of sick leave days vary by county, but little is known about the extent to which this gradient may be explained by differences pertaining to occupational composition and occupational exposure.

Methods: A randomly drawn cohort from the general population in Norway, aged 18-69 years, was interviewed by telephone in the second half of 2009 ( n=12,255; response at baseline=60.9%) and followed up in national registries to the end of 2010. Eligible respondents were registered with an active employee relationship in 2009 and 2010 ( n=8275). Information on counties ( n=19) was based on the administrative register. The outcome of interest was the number of physician-certified sick-leave days divided by scheduled man-days during 2010 (i.e. sick-leave percentage (SLP)).

Results: The average SLP during 2010 was 5.2%. The between-county variation in SLP ranged from 4.0% to 7.2%. Compared to the age- and gender-adjusted model, adjustment for occupation, economic sector and self-reported occupational exposure reduced the median difference in SLP between the county with the lowest SLP (reference county) and the SLP in the other counties by 1.08 percentage points (i.e. a 58% reduction). The impact of occupational composition and occupational exposure on the total between-county variance in SLP was a 16% reduction.

Conclusions: Occupational composition and self-reported occupational exposure help to explain a significant part of the difference in SLP between counties, and appear to be more important explanatory factors than demographic variables, self-reported health and smoking.
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http://dx.doi.org/10.1177/1403494817748263DOI Listing
May 2018

Psychosocial factors at work and sleep problems: a longitudinal study of the general working population in Norway.

Int Arch Occup Environ Health 2017 10 20;90(7):597-608. Epub 2017 Apr 20.

National Institute of Occupational Health, PO Box 8149 Dep, 0033, Oslo, Norway.

Purpose: A growing number of longitudinal studies report associations between adverse psychosocial factors at work and sleep problems. However, the evidence regarding the direction of these associations and the effects of changes in exposure across time is limited. This study examined the plausibility of normal, reverse, and reciprocal associations between ten psychosocial factors at work and sleep problems. In addition, we analyzed if reduced exposure across time had the anticipated result of reducing the risk of sleep problems.

Methods: Randomly drawn from the general working-age population, the cohort comprised respondents with an active employee relationship in 2009 and 2013 (N = 5760). Exposures and outcome were measured on two occasions separated by 4 years. We computed several sex-stratified logistic regression models with adjustments for various plausible confounders.

Results: We found support for the commonly hypothesized unidirectional forward associations between psychosocial factors at work and sleep problems among women only. Among men, psychosocial stressors at work and sleep problems were reciprocally and reversely related. Nevertheless, reduced exposure levels across time pertaining to effort-reward imbalance (OR = 0.36; 95% CI = 0.19-0.69) and lack of social support (OR = 0.55; 95% CI = 0.32-0.93) among men, and work-family imbalance (OR = 0.26; 95% CI = 0.15-0.46) among women were associated with a robust significant lower risk of sleep problems compared to those in the stable high exposure groups.

Conclusions: The study results suggest that preventive measures targeting effort-reward imbalance and lack of social support among men, and work-family imbalance among women, might contribute to reduce the risk of troubled sleep among employees.
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http://dx.doi.org/10.1007/s00420-017-1222-2DOI Listing
October 2017

The contribution from psychological, social, and organizational work factors to risk of disability retirement: a systematic review with meta-analyses.

BMC Public Health 2017 02 8;17(1):176. Epub 2017 Feb 8.

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

Background: Previous studies indicate that psychological, social, and organizational factors at work contribute to health, motivation, absence from work, and functional ability. The objective of the study was to assess the current state of knowledge of the contribution of psychological, social, and organizational factors to disability retirement by a systematic review and meta-analyses.

Methods: Data sources: A systematic literature search for studies of retirement due to disability in Medline, Embase, and PsychINFO was performed. Reference lists of relevant articles were hand-searched for additional studies.

Data Extraction: Internal validity was assessed independently by two referees with a detailed checklist for sources of bias. Conclusions were drawn based on studies with acceptable quality.

Data Synthesis: We calculated combined effect estimates by means of averaged associations (Risk ratios) across samples, weighting observed associations by the study's sample size. Thirty-nine studies of accepted quality were found, 37 of which from the Nordic countries.

Results: There was moderate evidence for the role of low control (supported by weighted average RR = 1.40; 95% CI = 1.21-1.61) and moderate evidence for the combination of high demands and low control (although weighted average was RR = 1.45; 95% CI = 0.96-2.19) as predictors of disability retirement. There were no major systematic differences in findings between the highest rated and the lowest rated studies that passed the criterion for adequate quality. There was limited evidence for downsizing, organizational change, lack of employee development and supplementary training, repetitive work tasks, effort-reward imbalance to increase risk of disability pension. Very limited evidence was found for job demands, evening or night work, and low social support from ones superior.

Conclusions: Psychological and organizational factors at work contribute to disability retirement with the most robust evidence for the role of work control. We recommend the measurement of specific exposure factors in future studies.
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http://dx.doi.org/10.1186/s12889-017-4059-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299735PMC
February 2017

Do Work-Related Mechanical and Psychosocial Factors Contribute to the Social Gradient in Low Back Pain?: A 3-Year Follow-Up Study of the General Working Population in Norway.

Spine (Phila Pa 1976) 2016 Jul;41(13):1089-1095

Department of Occupational Health Surveillance, National Institute of Occupational Health, Oslo, Norway.

Study Design: A prospective cohort study.

Objective: The aim of the study was to investigate the extent to which work-related factors contribute to the social gradient in low back pain (LBP).

Summary Of Background Data: A social gradient in LBP is well established, but only a few studies have examined the extent to which exposure to mechanical and psychosocial work environment factors is a pathway for this gradient.

Methods: A randomly drawn cohort from the general population in Norway aged 18 to 66 years was followed up for 3 years (n = 12,550, response rate at baseline = 67%). Eligible respondents were in paid work during 2006 and 2009 (n = 6819). Based on administrative register data respondents were coded into five educational levels (university/college ≥4 years was set as the reference group). Outcome of interest was self-reported moderate or severe LBP at follow-up adjusted for baseline LBP.

Results: In total, 11.2% (397 individuals) men and 14.5% (461 individual) women reported LBP at follow-up. There was a strong social gradient ranging from 16.4% (elementary) to 6.4% (university/college ≥4 years). The corresponding figures among women were 22.4% and 7.5%. Corrected for age, LBP at baseline and working hours, educational level was a significant predictor of LBP at follow-up (odds ratios 1.8-2.3 in men and 1.7-3.1 in women). Adjusting for mechanical factors reduced the gradient by 39% to 43% in men and 28% to 34% in women. Adjusting for psychosocial factors reduced the gradient by 5% to 12% in men and increased the gradient by 7% to 11% in women.

Conclusion: Work-related mechanical factors contributed substantially to the social gradient in LBP among both men and women. The impact of psychosocial factors was modest among men and contributed to an increased gradient among women.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000001451DOI Listing
July 2016

Do work-related factors contribute to differences in doctor-certified sick leave? A prospective study comparing women in health and social occupations with women in the general working population.

BMC Public Health 2016 Mar 8;16:235. Epub 2016 Mar 8.

Department of Occupational Health Surveillance, National Institute of Occupational Health, PO Box 8149 Dep, N-0033, Oslo, Norway.

Background: Doctor -certified sick leave is prevalent in the health and social sector. We examined whether the higher risk of doctor-certified sick leave in women in health and social occupations compared to women in other occupations was explained by particular work-related psychosocial and mechanical risk factors.

Methods: A randomly drawn cohort aged 18-69 years from the general population in Norway was surveyed in 2009 (n = 12,255, response at baseline = 60.9 %), and was followed up in the national registry of social transfer payments in 2010. Eligible respondents were women registered with an active employee relationship for ≥100 actual working days in 2009 and 2010 (n = 3032). Using this sample, we compared health and social workers (n = 661) with the general working population (n = 2371). The outcome of interest was long-term sick leave (LTSL) ≥21 working days during 2010. Eight psychosocial and eight mechanical factors were evaluated.

Results: After adjusting for age, previous LTSL, education and working hours/week, women in health and social occupations had a higher risk for LTSL compared with women in the general working population (OR = 1.42, 95 % CI = 1.13-1.79; p = 0.003). After adjusting for psychosocial and mechanical factors, 70 % of the excess risk for LTSL was explained compared with the initial model. The main contributory factors to the increased risk were threats of violence and violence, emotional demands and awkward lifting.

Conclusions: Psychosocial and mechanical factors explained much of the excess risk for LTSL in women in health and social occupations compared with working women in general. Psychosocial risk factors were the most important contributors.
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http://dx.doi.org/10.1186/s12889-016-2908-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782354PMC
March 2016

Psychosocial factors at work and occupational injuries: A prospective study of the general working population in Norway.

Am J Ind Med 2015 May 2;58(5):561-7. Epub 2015 Mar 2.

National Institute of Occupational Health, Oslo, Norway.

Background: We examined the effects of psychosocial stressors at work on subsequent injuries, taking into account organizational and mechanical working conditions.

Methods: Randomly drawn from the general population, the cohort comprised respondents with an active employee relationship in 2006 and 2009 (n = 6,745).

Outcome Measure: "Have you, over the past 12 months, afflicted injuries that were caused by an accident at work, and resulting in time off work after the day of the accident?".

Results: High job strain (Odds ratio [OR] 2.31; 95% confidence interval [CI] 1.16-4.57), high role conflict (OR 3.01; 95% CI 1.70-5.31), and high emotional demands (OR 1.96; 95% CI 1.15-3.35) predicted injury at follow up (P < 0.01). The population risk attributable to each of these factors ranged from 11% to 14%.

Conclusions: Excess risk of occupational injuries was attributable to job strain, role conflict, and emotional demands. These factors are potentially amenable to preventive measures.
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http://dx.doi.org/10.1002/ajim.22431DOI Listing
May 2015

Psychosocial and organizational risk factors for doctor-certified sick leave: a prospective study of female health and social workers in Norway.

BMC Public Health 2014 Sep 29;14:1016. Epub 2014 Sep 29.

Department of Occupational Health Surveillance, National Institute of Occupational Health, PO BOX 8149 Dep, NO-0033 Oslo, Norway.

Background: Doctor-certified sick leave differs substantially across sectors, and among health and social workers, in particular, there is an increased risk. Previous studies have shown that work environmental factors contribute to sick leave. Hence, the identification of specific organizational and psychosocial risk factors for long- term sick leave, taking into account potential confounding related to mechanical risk factors such as lifting and awkward body postures, will be of importance in the work of prevention.

Methods: A randomly drawn population sample of Norwegian residents was interviewed about working conditions in 2009 (n = 12,255; response rate 60.9%). Female health and social care workers (n = 925) were followed in a national registry for subsequent sickness absence during 2010. The outcome of interest was doctor-certified sick leave of 21 days or more (long-term sick leave). Eleven work-related psychosocial and organizational factors were evaluated.

Results: In total, 186 persons (20.1%) were classified with subsequent long-term sick leave. After thoroughly adjusting for competing explanatory variables, the most consistent predictors for long-term sick leave were violence and threats of violence (OR = 1.67; 95% CI 1.14-2.45). The estimated population attributable risk for violence and threats of violence was 13%.

Conclusions: The present study among female health and social care workers revealed a substantial relationship between self-reported violence and threats of violence and subsequent long- term sick leave.
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http://dx.doi.org/10.1186/1471-2458-14-1016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190425PMC
September 2014

Work-related psychosocial risk factors for long-term sick leave: a prospective study of the general working population in Norway.

J Occup Environ Med 2014 Aug;56(8):787-93

From the Department of Occupational Health Surveillance (Ms Aagestad and Drs Johannessen, Tynes, Gravseth, and Sterud), National Institute of Occupational Health, Oslo; and Department of Behavioral Sciences (Ms Aagestad), Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.

Objective: To examine the effect of work-related psychosocial exposures on long-term sick leave (LTSL) in the general working population.

Methods: A prospective study of the general working population in Norway. Eligible respondents were interviewed in 2009 and registered with at least 100 working days in 2009 and 2010 (n = 6758). The outcome was medically confirmed LTSL of 40 days or more during 2010.

Results: In the fully adjusted model, high exposure to role conflict (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.20 to 2.09), emotional demands (OR, 1.32; 95% CI, 1.03 to 1.69), and low supportive leadership (OR = 1.50; 95% CI, 1.15 to 1.96) predicted LTSL. A test for trend was statistically significant for all factors (P ≤ 0.05). We estimated that 15% of LTSL cases were attributable to these factors.

Conclusions: This study underlines the importance of taking into account psychosocial exposures as risk factors for LTSL.
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http://dx.doi.org/10.1097/JOM.0000000000000212DOI Listing
August 2014

Work-related gender differences in physician-certified sick leave: a prospective study of the general working population in Norway.

Authors:
Tom Sterud

Scand J Work Environ Health 2014 Jul 1;40(4):361-9. Epub 2014 Apr 1.

National Institute of Occupational Health, PO Box 8149 Dep, NO-0033 Oslo, Norway.

Objectives: This study aimed to examine gender differences in physician-certified sick leave and the extent to which these differences can be explained by work-related psychosocial and mechanical risk factors.

Methods: Randomly drawn from the general population in Norway, the cohort comprised working men and women aged 18-69 years (N=12 255, response rate at baseline = 60.9%). Eligible respondents were interviewed in 2009 and registered with an active employee relationship of ≥ 100 actual working days in 2009 and 2010 (N=3688 men and 3070 women). The study measured 11 work-related psychosocial factors and 11 mechanical exposures, and outcomes of interest were physician-certified general sick leave (GSL) >0 days and long-term sick leave (LTSL) ≥ 40 working days during 2010.

Results: Women reported a significantly higher level of exposure to 9 of the 11 psychosocial factors evaluated. For mechanical factors, the reporting was mixed. After controlling for age, educational level, sick leave during 2009, housework, working hours and family status, a 1.7-fold risk for GSL and LTSL were found among women. In comparison with the initial model, adjusting for psychosocial factors reduced the excess risk by 21% and 27% for GSL and LTSL, respectively. The total effect of mechanical factors was negligible. Differences between occupations held by women and men explained an additional one-tenth of the excess risk for LTSL among women.

Conclusions: Work-related psychosocial factors contributed significantly to a higher level of GSL and LTSL among women. The most important factors were demands for hiding emotions, emotional demands, and effort-payment imbalance.
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http://dx.doi.org/10.5271/sjweh.3427DOI Listing
July 2014

Do work-related mechanical and psychosocial factors contribute to the social gradient in long-term sick leave: a prospective study of the general working population in Norway.

Scand J Public Health 2014 May 30;42(3):329-34. Epub 2014 Jan 30.

Department of Occupational Health Surveillance, National Institute of Occupational Health, Oslo, Norway.

Aims: A social gradient in long-term sick leave (LTSL) rates is well established, but only a few studies have examined to what extent this gradient may be explained by mechanical and psychosocial work environment factors.

Methods: A randomly drawn cohort from the general population in Norway, aged 18-69 years, was interviewed in the second half of 2009 (n=12,255, response at baseline 60.9%) and followed up in national registries to the end of 2010. Eligible respondents were registered with an active employee relationship of at least 100 actual working days in 2009 and 2010 (n=6758). Based on administrative register data, respondents were coded into five educational levels (university/college ≥4 years was set as the reference group). Eight work-related psychosocial factors and 10 mechanical exposures were measured. The outcome of interest was medically confirmed LTSL ≥40 working days during 2010.

Results: In total, 9.4% (635 individuals) were classified with LTSL during 2010. There was a strong social gradient ranging from 12.4% (elementary) to 3.3% (university/college ≥4 years) among men. The corresponding figures among women were 15.4 and 4.6%. Adjusting for work-related mechanical and psychosocial factors explained between 41 and 44% of the social gradient in men. Among women, the corresponding figures were 31 and 54%.

Conclusions: Work-related mechanical and psychosocial factors contribute to the social gradient in LTSL. The work-related factors that accounted for this gradient were rather similar for men and women.
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http://dx.doi.org/10.1177/1403494814521506DOI Listing
May 2014

Work-related psychosocial and organizational risk factors for headache: a 3-year follow-up study of the general working population in Norway.

J Occup Environ Med 2013 Dec;55(12):1436-42

From the Department of Occupational Health Surveillance, National Institute of Occupational Health, Oslo, Norway.

Objectives: To determine the effects of work-related psychosocial and organizational factors on headache.

Methods: A random cohort from the Norwegian general population (aged 18 to 66 years) had been observed for 3 years. Eligible respondents answered a question about headache, and were engaged in paid employment during the reference weeks in 2006 and 2009, or were temporarily absent from such work (N = 3325).

Results: In the fully adjusted model, the main risk factors were high role conflict (highest odds ratio [OR] = 2.86; 95% confidence interval [CI] = 1.49 to 5.48), low social climate (highest OR = 2.21; 95% CI = 1.09 to 4.49), bullying/harassment (OR = 3.94; 95% CI = 1.36 to 11.42), and downsizing (OR = 2.38; 95% = 1.20 to 4.71).

Conclusions: Role conflict, low social climate, and bullying/harassment were the main predictors of headaches. These factors should be considered to prevent headaches at work.
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http://dx.doi.org/10.1097/JOM.0b013e3182a7e678DOI Listing
December 2013

Work-related mechanical risk factors for long-term sick leave: a prospective study of the general working population in Norway.

Authors:
Tom Sterud

Eur J Public Health 2014 Feb 8;24(1):111-6. Epub 2013 Jun 8.

Department of Occupational Health Surveillance, National Institute of Occupational Health, Oslo, Norway.

Background: The overall evidence for work-related mechanical exposures as risk factors for long-term sick leave (LTSL) in the general working population is limited.

Methods: The study cohort was randomly drawn from the general population in Norway, aged 18-69 years (n = 12 255, response at baseline = 60.9%). Eligible respondents were interviewed in 2009 and were registered with an active employee relationship of at least 100 actual working days in 2009 and 2010 (n = 6758). The outcome of interest was medically confirmed LTSL ≥40 working days during 2010.

Results: In total, 9.4% (635 individuals) were classified with LTSL during 2010. The risk of LTSL was higher in women, employees with fewer years of education, regular smokers, employees with chronic health complaints and employees with LTSL during 2009. After adjusting for these factors, we estimated that 24.6% of LTSL cases were attributable to work-related mechanical exposure. Mechanical risk factors were neck flexion, hand/arm repetition, standing, working with upper body bent forward and awkward lifting. The odds ratio for highest exposure levels ranged from 1.32 (95% confidence interval 1.04-1.69) for standing to 2.15 (95% confidence interval 1.24-3.73) for awkward lifting. A test for trend was statistically significant for all contributing factors (P ≤ 0.05), except standing. No psychosocial factors acted as major confounders related to any of the mechanical risk factors.

Conclusion: This study underlines the importance of work-related mechanical exposures as risk factors for LTSL in the general working population. An exposure-response relationship was indicated for 5 of the 10 factors evaluated.
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http://dx.doi.org/10.1093/eurpub/ckt072DOI Listing
February 2014

Effects of occupational role conflict and emotional demands on subsequent psychological distress: a 3-year follow-up study of the general working population in Norway.

J Occup Environ Med 2013 Jun;55(6):605-13

National Institute of Occupational Health, Oslo, Norway.

Objective: To examine the impact of occupational role conflict and emotional demands on subsequent psychological distress.

Methods: A randomly drawn cohort from the general Norwegian working-age population was followed up for 3 years (n = 12,550; response rate = 67%). Eligible respondents were in paid work during the reference week in 2006 and 2009 or temporarily absent from such work (n = 6,745; response rate = 68%).

Results: In the fully adjusted model, both high role conflict (odds ratios = 1.53; 95% CI = 1.15 to 2.03) and high emotional demands (odds ratios = 1.38; 95% CI = 1.13 to 1.69) were significant predictors of psychological distress. Additional significant predictors were low job control, bullying/harassment, and job insecurity (P < 0.05).

Conclusions: Considering all of the evaluated work-related factors, role conflict and emotional demands contributed the most to the population risk of developing psychological distress.
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http://dx.doi.org/10.1097/JOM.0b013e3182917899DOI Listing
June 2013

Work-related psychosocial and mechanical risk factors for neck/shoulder pain: a 3-year follow-up study of the general working population in Norway.

Int Arch Occup Environ Health 2014 Jul 26;87(5):471-81. Epub 2013 May 26.

Department of Occupational Health Surveillance, National Institute of Occupational Health, PO Box 8149 Dep, 0033, Oslo, Norway,

Purpose: This study examines the impact of work-related psychosocial and mechanical exposure on the development of neck/shoulder pain in the general working population.

Methods: A randomly drawn cohort from the general population in Norway aged 18-66 was followed up for 3 years (n = 12,550, response rate = 67 %). Eligible respondents were in paid work during the reference week in 2006 and 2009, or temporarily absent from such work (n = 6,745). Four work-related psychosocial factors and six mechanical exposures were measured. Outcomes of interest were moderate or severe neck/shoulder pain at follow-up adjusted for baseline neck/shoulder pain.

Results: In total, 16.9 % (1,138 individuals) reported neck/shoulder pain during the last month at follow-up. Work related psychosocial predictors of neck/shoulder pain were high job demands (highest OR 1.41, 95 % CI 1.11-1.78) and low levels of supportive leadership (highest OR 1.66, 95 % CI 1.08-2.54). Mechanical factors were neck flexion (highest OR 1.77, 95 % CI 1.31-2.39) and lifting in awkward postures (highest OR 1.81, 95 % CI 1.21-2.71). The estimated population risk attributable to these factors was about 23 %. The relative risk for neck/shoulder pain associated with psychosocial exposure was slightly influenced by adjustment for physical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress.

Conclusions: Highly demanding jobs, neck flexion and awkward lifting appear as the most important predictors of neck/shoulder pain.
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http://dx.doi.org/10.1007/s00420-013-0886-5DOI Listing
July 2014

Work-related psychosocial and mechanical risk factors for work disability: a 3-year follow-up study of the general working population in Norway.

Authors:
Tom Sterud

Scand J Work Environ Health 2013 Sep 25;39(5):468-76. Epub 2013 Mar 25.

National Institute of Occupational Health, PO Box 8149 Dep, NO-0033 Oslo, Norway.

Objectives: This study examines the impact of work-related psychosocial and mechanical risk factors for work disability in the general working population.

Methods: A randomly drawn cohort from the general population in Norway aged 18-66 years was followed for 3 years (N = 12 550, 67% response rate at baseline). Eligible respondents were in paid work for ≥ 10 hours per week in 2006 and were still in paid work or had quit working because of health problems (work disability) in 2009 (N = 6745). Five work-related psychosocial factors and eight mechanical exposures were measured. The outcome of interest was self-reported work disability at 3-year follow-up.

Results: In total, 2.6% (176 individuals) reported work disability at the 3-year follow-up. Disability rates were higher among women, older workers, and those with fewer years of education and higher levels of psychological distress and musculoskeletal complaints. After adjusting for these factors, work-related psychosocial predictors of disability were low levels of supportive leadership [odds ratio (OR) 1.61, 95% confidence interval (95% CI) 1.02-2.56] and monotonous work (OR 1.53, 95% CI 1.09-2.16). Mechanical factors were neck flexion (OR 2.49, 95% CI 1.36-4.56), prolonged standing (OR 1.79, 95% CI 1.21-2.46), whole-body vibration (OR 4.15, 95% CI 1.77-9.71), and heavy physical work (OR 2.23. 95% CI 1.08-4.57). The estimated population risk attributable to these factors was about 45%.

Conclusion: Monotonous work, prolonged standing, neck flexion, and whole-body vibration appear to be the most consistent and important predictors of work disability.
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http://dx.doi.org/10.5271/sjweh.3359DOI Listing
September 2013

Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway.

Occup Environ Med 2013 May 15;70(5):296-302. Epub 2013 Jan 15.

National Institute of Occupational Health, Oslo, Norway.

Aims: This study examines the impact of work-related psychosocial and mechanical exposure on the development of low back pain (LBP) in the general working population.

Methods: A randomly drawn cohort from the general population in Norway aged 18-66 years was followed up for 3 years (n=12 550, response rate at baseline=67%). Eligible respondents were in paid work during a reference week in 2006 and 2009, or temporarily absent from such work (n=6745). Five work-related psychosocial factors and seven mechanical exposures were measured. Outcomes of interest were moderate or severe LBP at follow-up adjusted for baseline LBP.

Results: In total, 12.8% (861 individuals) reported LBP during the last month at follow-up. Work-related psychosocial predictors of LBP were high job demands (OR 1.41, 95% CI 1.16 to 1.72) and low job control (OR 1.26, 95% CI 1.01 to 1.57). Mechanical factors were prolonged standing (OR 1.48, 95% CI 1.20 to 1.83), awkward lifting (OR 1.55, 95% CI 1.28 to 1.88) and squatting/kneeling (OR 1.29, 95% CI 1.04 to 1.61). The estimated population risk attributable to these factors was approximately 42%. The risk for LBP associated with psychosocial exposure was not influenced by adjustment for mechanical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress.

Conclusions: Highly demanding jobs, prolonged standing and awkward lifting appear as the most consistent and important predictors of LBP.
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http://dx.doi.org/10.1136/oemed-2012-101116DOI Listing
May 2013

A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel.

J Occup Med Toxicol 2011 Mar 31;6(1):10. Epub 2011 Mar 31.

Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111 Blindern, NO-0317 Oslo, Norway.

Objectives: To address the relative importance of general job-related stressors, ambulance specific stressors and individual characteristics in relation to job satisfaction and health complaints (emotional exhaustion, psychological distress and musculoskeletal pain) among ambulance personnel.

Materials And Methods: A nationwide prospective questionnaire survey of ambulance personnel in operational duty at two time points (n = 1180 at baseline, T1 and n = 298 at one-year follow up, T2). The questionnaires included the Maslach Burnout Inventory, The Job Satisfaction Scale, Hopkins Symptom Checklist (SCL-10), Job Stress Survey, the Norwegian Ambulance Stress Survey and the Basic Character Inventory.

Results: Overall, 42 out of the possible 56 correlations between job stressors at T1 and job satisfaction and health complaints at T2 were statistically significant. Lower job satisfaction at T2 was predicted by frequency of lack of leader support and severity of challenging job tasks. Emotional exhaustion at T2 was predicted by neuroticism, frequency of lack of support from leader, time pressure, and physical demands. Adjusted for T1 levels, emotional exhaustion was predicted by neuroticism (beta = 0.15, p < .05) and time pressure (beta = 0.14, p < 0.01). Psychological distress at T2 was predicted by neuroticism and lack of co-worker support. Adjusted for T1 levels, psychological distress was predicted by neuroticism (beta = 0.12, p < .05). Musculoskeletal pain at T2 was predicted by, higher age, neuroticism, lack of co-worker support and severity of physical demands. Adjusted for T1 levels, musculoskeletal pain was predicted neuroticism, and severity of physical demands (beta = 0.12, p < .05).

Conclusions: Low job satisfaction at T2 was predicted by general work-related stressors, whereas health complaints at T2 were predicted by both general work-related stressors and ambulance specific stressors. The personality variable neuroticism predicted increased complaints across all health outcomes.
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http://dx.doi.org/10.1186/1745-6673-6-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074526PMC
March 2011

Occupational stressors and its organizational and individual correlates: a nationwide study of Norwegian ambulance personnel.

BMC Emerg Med 2008 Dec 2;8:16. Epub 2008 Dec 2.

Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.

Background: High levels of stress among ambulance personnel have been attributed to the conditions of ambulance work. However, there is little research to support this notion, and it has been questioned whether ambulance work is inherently stressful. We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences

Methods: A comprehensive nationwide questionnaire survey of ambulance personnel (n = 1180) in operational duty. The questionnaire included the Job Stress Survey, the Norwegian Ambulance Stress Survey, the Basic Character Inventory, General Self-Efficacy Scale, and questions addressing organizational conditions.

Results: Serious operational tasks and physical demands were identified as the two most severe stressors. Lack of support from co-workers was the most severe and frequent organizational stressor. Higher frequency of stressors was most strongly associated with size of service districts (beta ranging between .18 and .30, p < .01) and working overtime (beta ranging from .13 to .27, p < .05). Stressor severity was related to lack of support after exposure to critical event (beta ranging from .11 to .24, p < .01) and working overtime. Neuroticism (beta ranging from .09 to .17, p < .01) and low general self-efficacy (beta ranging from -.12 to -.16, p < .001) were equally strongly related to severity of stressors, as were organizational conditions.

Conclusion: Ambulance-specific stressors were reported as both more severe and more frequently occurring stressors than were organizational stressors. Organizational working conditions were more strongly related to frequency of job stressors than were individual differences. In general, the relationship between occupational stressors and individual differences was weak.
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http://dx.doi.org/10.1186/1471-227X-8-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2612695PMC
December 2008

Occupational stressors and its organizational and individual correlates: a nationwide study of Norwegian ambulance personnel.

BMC Emerg Med 2008 Dec 2;8:16. Epub 2008 Dec 2.

Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.

Background: High levels of stress among ambulance personnel have been attributed to the conditions of ambulance work. However, there is little research to support this notion, and it has been questioned whether ambulance work is inherently stressful. We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences

Methods: A comprehensive nationwide questionnaire survey of ambulance personnel (n = 1180) in operational duty. The questionnaire included the Job Stress Survey, the Norwegian Ambulance Stress Survey, the Basic Character Inventory, General Self-Efficacy Scale, and questions addressing organizational conditions.

Results: Serious operational tasks and physical demands were identified as the two most severe stressors. Lack of support from co-workers was the most severe and frequent organizational stressor. Higher frequency of stressors was most strongly associated with size of service districts (beta ranging between .18 and .30, p < .01) and working overtime (beta ranging from .13 to .27, p < .05). Stressor severity was related to lack of support after exposure to critical event (beta ranging from .11 to .24, p < .01) and working overtime. Neuroticism (beta ranging from .09 to .17, p < .01) and low general self-efficacy (beta ranging from -.12 to -.16, p < .001) were equally strongly related to severity of stressors, as were organizational conditions.

Conclusion: Ambulance-specific stressors were reported as both more severe and more frequently occurring stressors than were organizational stressors. Organizational working conditions were more strongly related to frequency of job stressors than were individual differences. In general, the relationship between occupational stressors and individual differences was weak.
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http://dx.doi.org/10.1186/1471-227X-8-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2612695PMC
December 2008

Health problems and help-seeking in a nationwide sample of operational Norwegian ambulance personnel.

BMC Public Health 2008 Jan 4;8. Epub 2008 Jan 4.

Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111 Blindern, NO-0317 Oslo, Norway.

Background: To estimate the prevalence of anxiety and depression symptoms, and their association with professional help-seeking, among operational ambulance personnel and a general working population, and to study the symptoms of musculoskeletal pain and disturbed sleep among ambulance personnel.

Methods: The results of a comprehensive nationwide questionnaire survey of operational ambulance personnel (n = 1180) were compared with the findings of a population-based Norwegian health study of working people (n = 31,987). The questionnaire included measures of help-seeking, the Hospital Anxiety and Depression Scale, the Subjective Health Complaints Questionnaire, the Karolinska Sleep Questionnaire and the Need for Recovery after Work Scale.

Results: Compared with those in the reference population, the mean of level anxiety symptoms in the ambulance sample was lower for men (3.5 vs. 3.9, P <0.001) and women (4.0 vs. 4.4, P <0.05), and the mean level of depression symptoms in ambulance workers was lower for men (2.3 vs. 2.8, P <0.05) but not for women (2.9 vs. 3.1, P = 0.22). A model adjusted for anxiety and depression symptoms indicated that ambulance personnel had lower levels of help-seeking except for seeing a chiropractor (12% vs. 5%, P <0.01). In the ambulance sample, symptoms of musculoskeletal pain were most consistently associated with help-seeking. In the adjusted model, only symptoms of disturbed sleep were associated with help-seeking from a psychologist/psychiatrist (total sample = 2.3%). Help-seeking was more often reported by women but was largely unaffected by age.

Conclusion: The assumption that ambulance personnel have more anxiety and depression symptoms than the general working population was not supported. The level of musculoskeletal pain and, accordingly, the level of help-seeking from a chiropractor were higher for ambulance workers. More research should address the physical strains among ambulance personnel.
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http://dx.doi.org/10.1186/1471-2458-8-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254402PMC
January 2008

Occupational stress and alcohol use: a study of two nationwide samples of operational police and ambulance, personnel in Norway.

J Stud Alcohol Drugs 2007 Nov;68(6):896-904

Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O. Box 1111, Blindern, NO-0317 Oslo, Norway.

Objective: Police and ambulance personnel are widely believed to have a high prevalence of excessive alcohol consumption. However, the empirical basis for this assumption is scant or nonexistent. We assessed the association of alcohol use with burnout and job stressors, with drinking to cope and neuroticism as two possible moderating factors in two occupations, the police and ambulance services.

Method: We undertook a comprehensive nationwide questionnaire survey of police (n = 2,372) and ambulance (n = 1,096) personnel in operational duty. The questionnaire encompassed the Alcohol Use Disorders Identification Test (AUDIT), the Maslach Burnout Inventory, the Job Stress Survey, and the Basic Character Inventory.

Results: With a modified AUDIT score of 6 or more, the prevalence for men was 17.7% (police personnel) versus 16.6% (ambulance personnel). The prevalence for women was 9.1% versus 7.4%, respectively. Personnel who were male, were younger, and had higher levels of neuroticism reported higher levels of alcohol-related problems. Drinking to cope was most strongly associated with higher levels of alcohol-related problems (standardized beta = .29, p < .001) and was found to moderate the effect of depersonalization (e.g., cynical and distant attitude toward one's work and the people with whom one works) and gender.

Conclusions: In general, the present study does not support the notion of a strong relationship between occupational stress and alcohol use in these emergency service occupations. However, drinking to cope may be a risk factor for alcohol-related problems, particularly among male personnel and those experiencing higher levels of depersonalization.
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http://dx.doi.org/10.15288/jsad.2007.68.896DOI Listing
November 2007

Health status in the ambulance services: a systematic review.

BMC Health Serv Res 2006 Jul 3;6:82. Epub 2006 Jul 3.

Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111 Blindern, NO-0317 Oslo, Norway.

Background: Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services.

Methods: We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group.

Results: Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population.

Conclusion: Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for future research.
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http://dx.doi.org/10.1186/1472-6963-6-82DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1559607PMC
July 2006
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