Description: Objective The aims of this systematic review were to determine the prevalence of reduced work productivity among people with chronic knee pain as well as specifically categorise determinants of work productivity losses into individual, disease and work-related factors, conduct an evaluation of study methodological quality and present a best-evidence synthesis. Methods We searched the literature using combinations of key words such as knee pain, knee osteoarthritis, absenteeism (days taken off work) and presenteeism (reduced productivity while at work) for observational studies published in English. Methodological quality appraisal and a best-evidence synthesis were used to pool the study findings. Results The studies were conducted exclusively in high income countries of North America, Western Europe and Hong Kong. 17 studies were included in the review, 10 measuring absenteeism and six measuring presenteeism. Of the 10 studies reporting absenteeism, seven found a 12-month absenteeism prevalence ranging from 5% to 22%. Only two studies evaluated presenteeism prevalence and reported a range from 66% to 71%. Using best-evidence synthesis: three high quality cohort studies and three cross-sectional studies provided strong evidence that knee pain or knee osteoarthritis was associated with absenteeism; two high quality cross-sectional studies and one cohort study provided limited evidence for an association with presenteeism; one cross-sectional study provided limited evidence for an association among age, high job demands and low coworker support and absenteeism among nurses with knee pain. No studies examined individual or work-related factors associated with presenteeism. Conclusions A number of high quality studies consistently demonstrated that chronic knee pain or knee osteoarthritis is associated with absenteeism. However, data are lacking regarding presenteeism and individual or work-related risk factors for reduced work productivity among older workers with chronic knee pain. Systematic review registration number PROSPERO registry number: CRD42013004137.

Description: Objective To describe the survey methodology and initial general findings of the first Central American Survey of Working Conditions and Health. Methods A representative sample of 12 024 workers was interviewed at home in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. Questionnaire items addressed worker demographics, employment conditions, occupational risk factors and self-perceived health. Results Overall, self-employment (37%) is the most frequent type of employment, 8% of employees lack a work contract and 74% of the workforce is not covered by social security. These percentages are higher in Guatemala, Honduras and El Salvador, and lower in Costa Rica, Panama and Nicaragua. A third of the workforce works more than 48 h per week, regardless of gender; this is similar across countries. Women and men report frequent or usual exposures to high ambient temperature (16% and 25%, respectively), dangerous tools and machinery (10%, 24%), work on slippery surfaces (10%, 23%), breathing chemicals (12.1%, 18%), handling toxic substances (5%, 12.1%), heavy loads (6%, 20%) and repetitive movements (43%, 49%). Two-thirds of the workforce perceive their health as being good or very good, and slightly more than half reports having good mental health. Conclusions The survey offers, for the first time, comparable data on the work and health status of workers in the formal and informal economy in the six Spanish-speaking Central American countries, based on representative national samples. This provides a benchmark for future monitoring of employment and working conditions across countries.

Description: Objectives Mental illness and psychotropic drugs have been linked with workplace injury, but few studies have measured exposures and outcomes independently or established their relative timings. To address this shortcoming, we conducted a case–control study nested within a database prospectively recording injury consultations, diagnoses and drug prescriptions. Methods The Clinical Practice Research Datalink logs primary care data for 6% of the British population, coding all consultations (by the Read system) and drug prescriptions. We identified 1348 patients aged 16–64 years from this database who had consulted a family doctor or hospital over a 20-year period for workplace injury (cases, 479 diagnostic codes) and 6652 age, sex and practice-matched controls with no such consultation. Groups were compared in terms of consultations for mental health problems (1328 codes) and prescription of psychotropic drugs prior to the case's injury consultation using conditional logistic regression. Results In total, 1846 (23%) subjects had at least one psychiatric consultation before the index date and 1682 (21%) had been prescribed a psychotropic drug. The OR for prior mental health consultation was 1.44 (p〈0.001) and that for psychotropic drug treatment was 1.57 (p〈0.001). Risks were significantly elevated for several subclasses of mental health diagnosis (eg, psychosis, neurosis) and for each of the drug classes analysed. Assuming causal relationships, about 9–10% of all workplace injuries leading to medical consultation were attributable to mental illness or psychotropic medication. Conclusions Mental health problems and psychotropic treatments may account for an important minority of workplace injuries.

Description: The objective was to provide a systematic literature review on associations between poor health and exit from paid employment through disability pension, unemployment and early retirement, and to estimate the magnitude of these associations using meta-analyses. Medline and Embase databases were searched for longitudinal studies on the relationship between health measures and exit from paid employment. Random-effects models were used to estimate the pooled effects. In total, 29 studies were included. Self-perceived poor health was a risk factor for transition into disability pension (relative risk (RR) 3.61; 95% CI 2.44 to 5.35), unemployment (RR 1.44; 95% CI 1.26 to 1.65) and early retirement (RR 1.27; 95% CI 1.17 to 1.38). Workers with mental health problems had an increased likelihood for transition into disability pension (RR 1.80; 95% CI 1.41 to 2.31) or unemployment (RR 1.61; 95% CI 1.29 to 2.01). Chronic disease was a risk factor for transition into disability pension (RR 2.11; 95% CI 1.90 to 2.33) or unemployment (RR 1.31; 95% CI 1.14 to 1.50), but not for early retirement. This meta-analysis showed that poor health, particularly self-perceived health, is a risk factor for exit from paid employment through disability pension, unemployment and, to a lesser extent, early retirement. To increase sustained employability it should be considered to implement workplace interventions that promote good health.

Description: Objectives An ‘information gap’ has been identified regarding the effects of chronic disease on occupational injury risk. We investigated the association of ischaemic heart disease, hypertension, diabetes, depression and asthma with acute occupational injury in a cohort of manufacturing workers from 1 January 1997 through 31 December 2007. Methods We used administrative data on real-time injury, medical claims, workplace characteristics and demographics to examine this association. We employed a piecewise exponential model within an Andersen–Gill framework with a frailty term at the employee level to account for inclusion of multiple injuries for each employee, random effects at the employee level due to correlation among jobs held by an employee, and experience on the job as a covariate. Results One-third of employees had at least one of the diseases during the study period. After adjusting for potential confounders, presence of these diseases was associated with increased hazard of injury: heart disease (HR 1.23, 95% CI 1.11 to 1.36), diabetes (HR 1.17, 95% CI 1.08 to 1.27), depression (HR 1.25, 95% CI 1.12 to 1.38) and asthma (HR 1.14, 95% CI 1.02 to 1.287). Hypertension was not significantly associated with hazard of injury. Associations of chronic disease with injury risk were less evident for more serious reportable injuries; only depression and a summary health metric derived from claims remained significantly positive in this subset. Conclusions Our results suggest that chronic heart disease, diabetes and depression confer an increased risk for acute occupational injury.

Description: Objectives Long-term night work has been suggested as a risk factor for breast cancer; however, additional studies with more comprehensive methods of exposure assessment to capture the diversity of shift patterns are needed. As well, few previous studies have considered the role of hormone receptor subtype. Methods Relationships between night shift work and breast cancer were examined among 1134 breast cancer cases and 1179 controls, frequency-matched by age in Vancouver, British Columbia, and Kingston, Ontario. Self-reported lifetime occupational histories were assessed for night shift work, and hormone receptor status obtained from tumour pathology records. Results With approximately one-third of cases and controls ever employed in night shift work, associations with duration demonstrated no relationship between either 0–14 or 15–29 years, while an association was apparent for ≥30 years (OR=2.21, 95% CI 1.14 to 4.31). This association with long-term night shift work is robust to alternative definitions of prolonged shift work, with similar results for both health and non-health care workers. Conclusions Long-term night shift work in a diverse mix of occupations is associated with increased breast cancer risk and not limited to nurses, as in most previous studies.

Description: Objectives To examine the association between occupational lifting during pregnancy and preterm birth. The risk of preterm birth was estimated for total burden lifted per day and number of medium and heavy loads lifted per day. Methods In a study population of 62 803 pregnant women enrolled to the Danish National Birth Cohort from 1996 to 2002, the association between self-reported occupational lifting in the first part of pregnancy and preterm birth was analysed using logistic regression models with adjustment for age, parity, cervical cone biopsy, assisted reproduction and smoking. Associations between lifting and extremely (before 28 weeks), very (28–32 weeks) and moderately (33–37 weeks) preterm birth were analysed using Cox regression models. Results We found a dose–response relation between total daily burden lifted and preterm birth with an OR of 1.50 (95% CI 1.03 to 2.19) with loads over 1000 kg/day. No threshold value was found. The associations were strongest for extremely and very preterm birth with HRs (95% CIs) of 4.3 (1.4 to 13.8) and 1.7 (0.7 to 4.0), respectively. Lifting heavy loads (〉20 kg) more than10 times/day was associated with preterm birth up to an OR of 2.03 (95% CI 1.14 to 3.62). Conclusion In a society with social welfare and a highly regulated working environment, occupational lifting was associated with an increased risk of preterm birth.

Description: Objectives At the end of the 1990s, as required by European Directive 92/57/EEC, two laws were enacted in Italy which laid down safety and health requirements for construction sites: Decree 494/96 and Decree 528/99. The aim is to evaluate the impact on injury rates due to actions performed by a group of eight regions that planned formalised programmes to enforce the laws around the year 2000. Methods Using the Work History Italian Panel-Salute integrated database, which extends from 1994 to 2005, total and serious injury rates were calculated for the construction sector. An interrupted time series analysis was applied to serious injury rates. Results During the 12 years under observation, at the national level the total and serious injury rates decreased while the number of employees increased. The results of the regression models indicate that in the period after the intervention the injury rates ( x 10 000 weeks worked) decreased by 0.21 per year more than in the period before the intervention (CI –0.41 to –0.01). The difference in pre-post trends is even larger after adjusting for external factors. Conclusions The intervention plans developed to enforce the two Italian decrees had an effect on the reduction in injury rates. The results showed that there was a decrease in injury rates that could not be explained by external factors. These findings highlight the importance of concrete initiatives to have employers and workers comply with regulatory safety standards.

Description: Objectives To quantify the variation in rates of absence due to musculoskeletal pain across 47 occupational groups (mostly nurses and office workers) from 18 countries, and to explore personal and group-level risk factors that might explain observed differences. Methods A standardised questionnaire was used to obtain information about musculoskeletal pain, sickness absence and possible risk factors in a cross-sectional survey of 12 416 workers (92–1017 per occupational group). Additionally, group-level data on socioeconomic variables, such as sick pay and unemployment rates, were assembled by members of the study team in each country. Associations of sickness absence with risk factors were examined by Poisson regression. Results Overall, there were more than 30-fold differences between occupational groups in the 12-month prevalence of prolonged musculoskeletal sickness absence, and even among office workers carrying out similar occupational tasks, the variation was more than tenfold. Personal risk factors included older age, lower educational level, tendency to somatise, physical loading at work and prolonged absence for non-musculoskeletal illness. However, these explained little of the variation between occupational groups. After adjustment for individual characteristics, prolonged musculoskeletal sickness absence was more frequent in groups with greater time pressure at work, lower job control and more adverse beliefs about the work-relatedness of musculoskeletal disorders. Conclusions Musculoskeletal sickness absence might be reduced by eliminating excessive time pressures in work, maximising employees’ responsibility and control and providing flexibility of duties for those with disabling symptoms. Care should be taken not to overstate work as a cause of musculoskeletal injury.

Description: Objective To investigate whether interventions implemented by the UK Health and Safety Executive addressing exposure to isocyanate-based spray paints in motor vehicle repair (MVR), flour dust in craft bakeries, rosin-based solder flux fume (RBSFF) in the electronics industry, metalworking fluids and wood dust coincided with a decline in incidence of work-related short latency respiratory disease (SLRD) or asthma in the target groups. Method Changes in the incidence of SLRD reported to a UK-based surveillance scheme were compared using a longitudinal, negative binomial regression model with β distributed random effects. An interrupted time series design was used and comparisons according to inclusion or exclusion in the target group were made by including a statistical interactions expressed as a ratio of incidence rate ratios (RIRRs) in the model. Results The incidence of SLRD attributed to flour dust significantly increased relative to all other agents (RIRR: 1.10; 95% CI 1.06 to 1.16) whereas SLRD attributed to RBSFF significantly declined relative to all other agents (0.94; 0.90 to 0.99). No significant changes in the incidence of SLRD attributed to wood dust (1.03; 0.91 to 1.16) or spray paints (1.03; 0.95 to 1.11) relative to all other agents were observed. A higher proportion of reports originated from the industries targeted by the intervention for RBSFF (65/107; 61%) than spray painting (27/93; 27%) or wood dust (16/42; 38%). Conclusions These data support a beneficial effect of interventions to reduce exposure to RBSFF but an increase in SLRD attributed to flour dust may indicate increased exposure or increased awareness of the problem.