General Working-age Population Research Articles

Musculoskeletal disorders and risk factors in the modern era: results from the Specchio cohort

Abstract Background Musculoskeletal disorders (MSDs) represent a major challenge for occupational and public health, but data are scarce in Switzerland or concentrated on a few sectors of activities. The aim of this study is to provide results on the prevalence and risk and protective factors of MSDs in the general working-age population of the Geneva canton, Switzerland. Methods A cross-sectional analysis was conducted as part of Specchio population-based cohort study. Prevalence and associations between MSDs and sociodemographic variables, individual behaviour (smoking, physical activity, sleep), health conditions (BMI, chronic diseases), physical and psychological risks at work were examined using regression models. The impact of teleworking was also evaluated. Results 2’733 participants took part in the survey, of which 38% were men, and mean age was 50. Overall prevalence of MSDs was 74% among men and 84% among women. 80% of the individuals experience back pain and 56% shoulder pain. Among individuals who experienced MSDs, 55.2% consulted a healthcare professional. The risk factors for MSDs were female sex (OR = 1.95; 95% IC = 1.55-2.28), body mass index (obese) (2.2; 1.51-3.32), lower education (1.77; 0.84-4.37), smoking (1.65; 1.19-2.35), exposure to physical risks (3.54; 2.78-4.51), stress at work (effort-reward imbalance) (3.23; 2.45-4.29) and a poor work-life balance (2.36; 1.88-2.97). The prevalence of MSDs remained high among workers who telework (78% versus 84% in working population). Conclusions This study, carried out in a large population-based cohort, confirmed several risk factors for MSDs. These results will contribute to the implementation of prevention strategies, especially as teleworking has gained in importance in recent years, which may have aggravated workers’ isolation and stress, sedentariness, and poor body posture. Main message: These data confirm the weight of musculoskeletal disorders and will help implementation of prevention health strategies. Key messages • The relationship between psychosocial risks at work and the occurrence of Musculoskeletal Disorders (MSDs) persists even following adjustment for exposure to physical risks and individual risk factors. • The prevalence of musculoskeletal (MSDs) disorders remained high among workers who telework.

Factors associated with carotid artery calcification in the general working-age population

Aim. To study factors associated with carotid artery calcification as an atherosclerotic marker in the general working-age population.Material and methods. The data of a representative ESSE-RF sample aged 25-64 years (n=1412) were studied. They underwent standard cardiology screening and assessment of carotid plaque (CP) characteristics using ultrasound. All respondents signed an informed consent to participate in the study. The association analysis included socio-demographic, anamnestic, laboratory, and ultrasound characteristics. Univariate and multivariate statistics were used.Results. The prevalence of detection of calcified CP (cCP) was 5,4% — 7,8% in men and 3,7% in women (odds ratio (OR)=2,2; p=0,001). The probability of cCP detection was associated with following factors: male sex (OR=3,9; p<0,001), age (OR=1,2; p<0,001), total cholesterol (women, OR=1,7; p=0,001), history of thyrotoxicosis (OR=2,1; p=0,034), osteoporosis (OR=2,6; p=0,009), and smoking (OR=1,8; p=0,046). The odds that the detected plaque would be calcified were higher in individuals in the 4th quartile of mean plaque size distribution (OR=3,8; p<0,001) and in the presence of the following factors: male sex (OR=1,9; p=0,031), age ≥55 years (OR=4,3; p<0,001), osteoporosis (OR=3,2; p=0,007), high-density lipoprotein cholesterol level ≥1,3 mmol/l (OR=2,0; p=0,025).Conclusion. The obtained data indicate an association of carotid calcification with both traditional cardiovascular risk factors and systemic diseases associated with impaired calcium and phosphorus metabolism (thyrotoxicosis, osteoporosis). The study results can be useful in practical healthcare, research, and developing preventive technologies.

Inclusive Faculty Hiring: Promising Practices for Increasing Higher Education Faculty Diversity

This paper reviews and synthesizes the extant work on promising practices in recruiting and hiring diverse college faculty in an equitable, inclusive process. First, I discuss the substantial demographic mismatch between faculty, the general working-age population, and undergraduate students. I then discuss the evidence that representational faculty diversity benefits students. I then integrate the literature on promising practices in inclusive faculty recruitment to recommend four strategies: better position advertisements, ongoing, proactive recruitment, thoughtful committee assignment and training, and a more deliberate, deliberative process. I offer multiple tactics within each strategy and urge institutions to adopt and prioritize whatever mix of these and other strategies/tactics makes the most sense for them.

Socioeconomic disparities in risk perceptions and precautionary actions against COVID-19 among the working age population aged 18–59 in Japan: a cross-sectional study

IntroductionRisk perceptions and precautionary actions against COVID-19 have been reported to be generally insufficient globally, and differences by subpopulation group have been concerning, as a key driver to widening health...

The prevalence and predictors of carotid plaques with irregular surface in the general working-age population

The prevalence and predictors of carotid plaques with irregular surface in the general working-age population

Electronic identification (e-ID) as a socio-technical system moderating migrants' access to essential public services – The case of Finland

Many welfare state services have rapidly become ‘digital by default’. Electronic identification (e-ID) technology is needed for secure identification authentication with regard to digital services. This study uses socio-technical systems theory to analyse the development and transfer of e-ID technology in the context of public-private partnerships (PPPs). Recent studies have shown that the ‘digital divide’ is prominent between ethnic minorities and the majority populations. Yet there is a scarcity of studies investigating inequalities related to obtaining an e-ID, which is required to access digital public services. Our empirical results show that transnational migrants had lower access to e-ID, which may hinder their ability to access public services. We used representative Finnish population-based survey data (FinMonik study) to analyse general socio-demographic and migration-specific factors associated with not having an e-ID. Our results showed that approximately 91% of the respondents had an e-ID. This is lower than the 98% among the general working-age population. There are significant differences in having an e-ID between different migrant groups. The lowest rate (84%) was observed for migrants who had moved to Finland from outside the EU and OECD countries. Regression analysis showed that lower socio-economic status and weak local language skills were associated with not having an e-ID. We argue that e-ID as a socio-technical system includes unintended contradictions stemming from PPP when the non-discrimination principle of the welfare state clashes with the private sector's operational logics and interests. We argue that the government should remain accountable for ensuring the safety, efficacy, quality, and adequate access to welfare state services developed in PPP.

SARS-CoV-2 Seroprevalence in Employees of Four Essential Non-Health Care Sectors at Moderate/High Risk of Exposure to Coronavirus Infection: Data From the "First Wave".

The aim of this study was to evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in Swiss non-health care employees at a moderate to high risk of exposure: bus drivers and supermarket, laundry service, and mail-sorting center employees. Data on 455 essential workers included demographics, SARS-CoV-2 exposure and use of protective measures. Anti-SARS-CoV-2 immunoglobulins G and A targeting the spike protein were measured between May and July 2020. The overall crude seroprevalence estimate (15.9%; 95% confidence interval [CI], 12.6% to 19.7%) among essential workers was not significantly higher than that of the general working-age population (11.2%; 95% CI, 7.1% to 15.2%). Seroprevalence ranged from 11.9% (95% CI, 6.3% to 19.8%) among bus drivers to 22.0% (95% CI, 12.6% to 19.7%) among food supermarket employees. We found no significant difference in seroprevalence between our sample of essential workers and local working-age population during the first lockdown phase of the COVID-19 pandemic. Having a seropositive housemate was the strongest predictor of SARS-CoV-2 seropositivity.

Factors, associated with effective control of arterial hypertension in the general working-age population

Objective. To analyze determinants and their contribution to efficiency of arterial hypertension (AH) control in the hypertensive population.Design and methods. In the cross-sectional study a total of 334 men and 436 women derived from a representative sample of the general population aged 25–64 years, meeting criteria for AH, were examined. All subjects signed voluntary informed consent to participate in the study. A standard questionnaire based on adapted international methods was used. The associative analysis included sets of socioeconomic, behavioral, psychosocial, medical and biological variables. We used univariable (χ2, Fisher exact test, Student’s t-test, Mann–Whitney test) and multivariable statistics (logistic regression). Effective AH control was considered in case of blood pressure (BP) < 140/90 mm Hg. Probabilities of error < 5% were considered statistically significant.Results. Irrespective of gender, use of hypotensive drugs was the most influential factor in ensuring effective control of AH in the population. A major barrier to reaching target BP levels in women was the number of current metabolic risk factors (RF). Age (more significant in men), general obesity (both sexes), history of kidney disease (men), elevated glucose and triglycerides (women) were also associated with ineffective AH control. Angiotensine receptor blockers, angiotensin converting enzyme inhibitors (ACEI), sympatholytics/ spasmolythics in men and ACEI, beta-blockers and diuretics (at moderate or higher affluence only) in women were associated with a higher probability of reaching BP targets. Knowledge of cholesterol level (both sexes), cardiovascular disease, use of statins, reduced quality of life (difficulty with daily activities), sedentary working activity and affluence in men were also associated with effective control of BP.Conclusions. The data obtained demonstrate that with an increase in the coverage of the hypertensive population with antihypertensive treatment, an increase in the proportion of people reaching the target BP levels may be significant, but still the most important issue is the treatment efficiency. The need to correct behavioral factors that lead to the development of metabolic disorders, especially obesity, but also other RF, remains the most challenging issue in this regard. The findings convince us that it is advisable to take measures to increase awareness of the main cardiovascular disease RF, to involve patients more in controlling their RF, to prescribe statins more frequently, to create conditions for taking antihypertensive drugs in the so-called “mobile” types of working activity, to keep developing infrastructure for mass participation of population in sport activities, and to improve economic conditions.

Analysis of factors associated with arterial stiffness in the general working-age population

Aim. To examine associations of cardio-ankle vascular index (CAVI) with classical, behavioral and social risk factors (RFs) of cardiovascular disease (CVD) in adult population.Material and methods. The study included 1365 people (women, 59%) from a representative sample aged 25-64 years (ESSE-RF), who underwent standard cardiology screening and volume sphygmography (VaSera-1500). All respondents signed an informed consent to participate in the study. The analysis included blocks of classical, social and behavioral risk factors for CVD. A linear model was used to identify associations. An error rate of <5% was considered significant.Results. Age, sex, systolic blood pressure (SBP), triglycerides were associated with higher CAVI values, and body mass index (BMI) was associated with lower values, respectively. After 45 years, a direct association with heart rate (HR) became increasingly important, while after 50 years — with diabetes and the intake of beta-blockers, while the association between diabetes and CAVI was observed only among individuals not taking angiotensin-converting enzyme (ACE) inhibitors. A direct association was found with high-sensitivity C-reactive protein (hsCRP) in men, and an inverse association with diuretics in women, respectively. A sedentary work in combination with a history of bronchitis or with positive family history for CVD showed a direct relationship, while a sufficient physical activity (PA) showed an inverse relationship with the studied indicator, but only among people with belowaverage income.Conclusion. According to the data obtained, in addition to age and sex, the following risk factors made a significant contribution to CAVI parameters in the examined population: BMI, SBP, triglycerides, diabetes, HR, intake of betablockers, diuretics, ACE inhibitors; hsCRP, PA. The unfavorable role of betablockers, high HR, diabetes, sedentary work, chronic lung pathology, hereditary burden, as well as the protective role of ACE inhibitors, diuretics and intense PA in relation to arterial stiffness in the working-age population has been shown. Additional studies are needed to determine the nature of a number of associations. The results obtained may contribute to the study of CAVI role in risk stratification and further development of methodological approaches to CVD prevention.

Can we distinguish the roles of demographic and temporal changes in the incidence and prevalence of musculoskeletal disorders? A systematic review.

ObjectivesMusculoskeletal disorders (MSD) represent a major public health issue, affecting more then 40 million European workers in 2017. The overall aging of the working population is expected to increase the burden of disease, but temporal changes in exposures or diagnosis may also drive the global trends in MSD. We therefore conducted a systematic review to summarize the evidence on the role of demographic and temporal changes in the occurrence of MSD.MethodsWe conducted a systematic review of articles reporting temporal trends in MSD in the general working-age population. Only articles controlling for age in the analysis were included. The risk of bias was assessed. The main indicators extracted were age-controlled time trends in MSD incidence or prevalence.ResultsAmong 966 articles, 16 fulfilled the inclusion criteria, representing 23 results according to the indicators extracted. No study was found with a high risk of bias. Results presenting time trends in prevalence were found in 12 studies and incidence in 11. After controlling for age, the reported temporal trends varied, mostly between non-monotonic changes (N=12/23) and increases (N=10/23). One article also highlighted an increase among women and non-monotonic changes among men (N=1/23). Several factors other than aging were suggested to explain temporal trends in MSD, mainly trends in obesity, changing occupational exposures, and cultural factors regarding pain tolerance.ConclusionThis review shows that different kind of factors in addition to aging may contribute to varying or increasing trends in MSD. This review also highlighted the scarcity of evidence regarding time trends in the burden of MSD and their underlying causes.

Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study.

A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, p = 0.001), symptom severity (60% vs. 27%, p < 0.001), and life impact subscales (53% vs. 20%, p < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.

Disentangling the roles of demographic and temporal trends in musculoskeletal disorders

Abstract Background Musculoskeletal disorders (MSDs) affect nearly 40 million European workers in 2017. Since age constitutes an important risk factor for MSDs, the overall aging of the working population is expected to influence the burden of disease. However, factors other than aging that may explain global trends in MSDs are unknown. We conducted a systematic review to summarise the evidence on the role of demographic and temporal changes in the occurrence of MSDs. Methods Following the PRISMA guidelines, we searched Pubmed, ScienceDirect and Web of Science over the 1990-2020 period for articles reporting temporal trends in MSDs incidence or prevalence in the general working-age population. We only included articles controlling for age in the analysis. To assure the quality of the articles, the bias risk was assessed using the RoB-SPEO tool. The main indicators we extracted were age-controlled time trends in MSDs incidence or prevalence. Results Among 966 articles, 16 fulfilled the inclusion criteria, representing 23 results according to the indicators extracted. No study was found with high risk of bias. Nine used a definition of MSDs based on pain and 14 based on repercussions on work or social life. Twelve results presented time trends in prevalence and 11 in incidence. After controlling for age, temporal trends in MSDs presented some heterogeneity. Indeed, 10 results documented increases and 12 reported non-monotonic changes. Only one result reported a decreasing trend in MSDs incidence. Several factors other than aging were suggested to explain temporal trends in MSDs, mainly trends in obesity, changing occupational exposures and cultural factors in tolerance to pain. Conclusions This review shows that factors additional to aging of the working population may contribute to varying or increasing trends in MSDs. Results also highlight the scarcity of available evidence on time trends in MSDs burden and their underlying causes. Key messages Despite a scarcity of evidence, our results suggest that factors additional to aging of the working population may contribute to varying or increasing trends in MSDs. Several factors other than aging were suggested to explain temporal trends in MSDs, mainly trends in obesity, changing occupational exposures and cultural factors in tolerance to pain.

Prevalence and predictors of statin therapy in the general working-age population

Aim. To study the prevalence and predictors of statin therapy in the general working-age population.Materials and methods. As a part of the ESSE-RF study, we examined 1,600 people aged 25-64 years (women — 59%) from the general population. All subjects signed informed consent. Association analysis included blocks of socio-economic, psychosocial, behavioral, and medical variables. We used methods of univariate and multivariate statistics. Error probability &lt; 5% was considered significant.Results. The prevalence of statin therapy in the general population was 3,3%: 5,5% in subjects ≥45 years, 8,1% in the group of 55-64 years old. We revealed that 2,5%, 2,9% and 10,9% of individuals with moderate, high and very high risk received statins, respectively. Among those receiving statins, 28,8% took it for primary prevention, 50% — due to cardiovascular diseases (CVD), and 21,2% — due to other disorders specifying risk. With priori indicators of very high risk, statins were taken more often than with SCORE ≥10 without risk indicators. According to multivariate model, older age, the presence of CVD + moderate and severe carotid atherosclerosis, antihypertensive therapy, stage 3 chronic kidney disease, and diabetes increased the likelihood of statin therapy, and SCORE ≥10 without risk indicators reduced it. The obtained data do not confirm the hypothesis about the significant role of sex, social gradient, and behavioral factors.Conclusion. Statins are one of the primary tools for primary and secondary prevention of CVD. Only a minor part of the population takes these drugs, in most cases due to CVD. Therefore, the prevention potential of statins at the population level has not yet been exhausted. More attention is required for individuals with SCORE ≥5 and without CVD who are less likely to receive therapy, but who may benefit more by taking statins. The decision to take statins for primary prevention of CVD should be based on the baseline risk, the value of absolute risk reduction, and how much this reduction justifies possible harm and long-term daily intake of the drug.

Social Security Disability Benefits: Characteristics of the Approved and Denied Populations

Using new data from the 2014 Survey of Income and Program Participation, I estimate that about 24 million individuals between the ages of 18 and 66 years have applied for Social Security disability benefits at some point in their lives. This population is about evenly divided among those who have ever received benefits from the program (beneficiaries) and those who have been denied. Those who have been denied benefits have only somewhat more favorable health circumstances than beneficiaries. Furthermore, relative to the general working age population, I find that the denied group has a high rate of poor health, high levels of poverty, and limited earnings. I also examine subpopulations of the denied group, finding that those who have been denied Social Security but who have received Supplemental Security Income disability face less favorable circumstances and those who have been denied Social Security but who have received Veterans Affairs, Workers Compensation, or private disability benefits have more favorable circumstances. Currently, no federal program or policy specifically targets work, health, or poverty outcomes of the denied Social Security population. Possible initiatives to improve outcomes, however, would need to take into account the underlying health conditions and work capacity of the population documented in this study.

Labor market outcomes before and after first episode of part-time sickness absence

Abstract Background Previous research suggests that part-time sickness absence (PTSA) results in better work participation compared to full-time sickness absence (FTSA), but few studies have examined trends in FTSA and unemployment before and after PTSA. Methods This Finnish population-based cohort study included 3406 individuals with first episode (&amp;gt;30 days) of PTSA in 2011 (=PTSA group), 42 510 individuals with FTSA (&amp;gt;30 days) in 2011 (=FTSA group), and 25 167 individuals with no sickness absence (&amp;gt;30 days) in 2011 from the general working-age population. Annual days of FTSA from 2007 to 2015 and unemployment from 2012 to 2015 were measured for the participants of each group. We modeled trends and relative risks for these labor market outcomes using negative binomial regression with generalized estimation equations. Results For the PTSA group, the adjusted mean annual number of FTSA days was 3 in the beginning of the follow-up, 15 a year before the index year, and 8-10 after the index year. The adjusted risk ratio (RR) of FTSA days after versus before PTSA was 1.95 (95% CI 1.75-2.17). For the FTSA group, mean of sickness absence days was 4 in the beginning, 13 a year before the index year and 9-19 after the index year. The mean of FTSA was 1-2 throughout the follow-up in the general population. An increasing slope in unemployment after the index year was observed in all groups, the absolute level of unemployment being highest among FTSA group and lowest among the general population group. Conclusions Long-term PTSA marks a decline in labour market participation. In absolute terms this decline is smaller than that in employees with long-term FTSA. Key messages Part-time sickness absence lasting &amp;gt;30 days marked an increase in full-time sickness absence although the absence levels did not reach those observed after full-time sickness absence of &amp;gt; 30 days. Our results show smaller impairment in labour market outcomes in employees granted a long-term part-time sickness absence than in those with long-term full-time sickness absence.

Suicide mortality follow-up of the Swiss National Cohort (1990-2014): sex-specific risk estimates by occupational socio-economic group in working-age population.

To identify occupations and socio-economic groups with detrimental or protective effect on suicide mortality. For every occupation and economic activity/industry, we computed directly age-standardized mortality rates (DSRs) using the age structure of the European population (2010) and standardized mortality ratios (SMRs) for suicide using national cause-specific mortality rates. We further stratified analyses by socio-economic variables, job-skill level, and by three calendar periods (1990-1998/1999-2006/2007-2014). The study sample comprised 5,834,618 participants (94,918,456 person-years). The highest DSRs were observed among unemployed/job-seeking group, in agricultural, fishery and related male workers, and in health and social activities female workers. The lowest DSRs were observed in real estate and renting, research and development, IT and other business activities in men and in agriculture, hunting and forestry industry in women. A consistent reduction in DSRs across three calendar periods was observed in men. In female corporate managers, DSRs increased over the 2007-2014 period compared with 1999-2006. Compared to general working-age population, unemployed/job-seeking people, manufacturing labourers, personal care and related workers, and motor vehicle drivers of both sexes were identified at risk of suicide. Moreover, an excess of suicide was observed among male material recording and transport clerks; nursing and midwife-associated professionals; and agricultural workers as well as among female writers and performing artists. The findings suggest the detrimental effect of low socioeconomic positions, including unemployment, with respect to suicide mortality and a relationship between suicide and poor psychosocial working conditions in elementary occupations. Sex-specific results need further investigation.

Vitamin D status in Thai dermatologists and working-age Thai population.

This study aimed to determine the prevalence of vitamin D insufficiency among Thai dermatologists compared with the general working-age population in Bangkok. A cross-sectional study was conducted in healthy Thai physicians who had at least 1years' experience in dermatology practise and a subsample of the general Thai population from the Fourth National Health Survey. Serum 25-hydroxyvitamin D (25[OH]D), a combination of 25(OH)D2 and 25(OH)D3, levels in both groups were measured using liquid chromatography coupled with mass spectrometry. The majority of dermatologists were of Fitzpatrick skin type III (n=61, 61.3%) or IV (n=32, 33.3%). The mean serum 25(OH)D and 25(OH)D3 levels were 18.9 and 18.2ng/mL, respectively, whereas the corresponding levels in the general population were 26.5 and 25.8ng/mL. None of the dermatologist had serum 25(OH)D sufficiency (>30ng/mL), 38 (38.78%) had vitamin D insufficiency (20-30ng/mL) and 60 (61.22%) had vitamin D deficiency (<20ng/mL). The frequency of vitamin D deficiency in dermatologists was significantly higher than in the general population (61.2% vs 19.2%, P<0.001). Ninety percent of dermatologists used sunscreen daily and spent time mostly indoors. Dermatologists used physical sun-protection more than half of the time when outdoors, for example, a book or paper as a sunshade (70.3%), an umbrella (48.4%), a long-sleeved shirt (20.4%) or a hat (9.7%). In conclusion, dermatologists showed a remarkably high prevalence of vitamin D deficiency which may be due to inadequate exposure to sunlight, regular use of sunscreen and practicing various sun-protection activities.

Association of Conventional Cardiovascular Risk Factors with Carotid Atherosclerosis Prevalence in General Population

Material and methods. In the cross-sectional population-based study of general unorganized population of Tomsk aged 25-64 years ultrasound screening examination of the carotid arteries was done for detection of atherosclerotic plaques (plaque). As potential plaque determinants the following factors were studied: age, gender, smoking, low and high density lipoproteins (LDL-C and HDL-C), triglycerides, arterial hypertension, body mass index (BMI), low educational status (LES), high-sensitive C-reactive protein, glucose, diabetes mellitus, antihypertensive and hypolipidemic therapy. Study of relationships was carried out with logistic regression analysis. The error probability of less than 5% was considered statistically significant.Results. In the crude analysis most of the determinants under study showed statistically significant relationship with plaque presence. After adjustment for age and sex, LDL-C, smoking and LES were associated with CAS prevalence. In multivariable regression analysis 9 risk factors appeared to be independently associated with plaque presence, wherein age, male sex, LDL-C, BMI and HDL-C were the most significant. In the participants of 50 years and older the smoking effect was the next in significance after LDL-C.Conclusion. The results obtained focus attention on the comparative value of the major atherogenic risk factors and suggest that currently effective and timely control of LDL-C is of primary importance for prevention of carotid atherosclerosis in the general working-age population. As well the findings of the study evidence that at the population level smoking is still one of the leading atherogenic risk factors.

Factors associated with participation on the competitive labour market of people with visual impairments in The Netherlands.

Worldwide, the employment rate of people with visual impairments (PVIs) is lower than that of the general working-age population. To improve the employment rate of this group, there is a need for knowledge about differences in modifiable factors between working and non-working PVIs. To identify modifiable factors associated with participation on the competitive labour market of PVIs. Based on the findings, we aim to develop an individual assessment instrument for determining the odds of labour market success of PVIs. Data were collected among 299 PVIs by means of a cross-sectional telephone survey based on existing (validated) and self-developed scales and items. Logistic regression analysis was used to find the strongest predictors of the dichotomous outcome of 'having paid work on the competitive labour market' (yes/no). We found three personal non-modifiable factors (level of education, comorbidity, level of visual impairment) and three modifiable factors (mobility, acceptance and optimism) to be significantly (p < 0.05) associated with having paid work. The factors of optimism, acceptance and mobility should be included in an individual assessment instrument which can provide PVIs and their job coaches with good starting points for improving the labour market situation of the PVIs.

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

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. 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 4years. We computed several sex-stratified logistic regression models with adjustments for various plausible confounders. 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. 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.