Strenuous Occupations Research Articles

Associations between body mass index and all-cause and CVD mortality in agriculture, forestry, and fishing occupations: A prospective cohort study using NHANES data (1999-2014).

Obesity, as indicated by elevated Body Mass Index (BMI), is a well-established global health concern associated with increased morbidity and mortality across diverse populations. However, the influence of BMI on individuals in Agriculture, Forestry, and Fishing (AFF) occupations, characterized by unique challenges and environmental factors, has received limited research attention. Our study, a prospective cohort analysis, utilized National Health and Nutrition Examination Survey (NHANES) data from 1999-2014, targeting adults above 18 in AFF occupations with comprehensive BMI data, omitting individuals with a history of cancer. Mortality outcomes were extracted from the NHANES mortality file, and BMI was segmented into eight categories. Essential covariates such as age, sex, race, and various health factors were incorporated. The statistical analysis encompassed Cox regression, generalized additive models, smooth curve fitting, and stratified analyses. During 1,005 person-years with 201 all-cause and 57 CVD deaths, we observed L-shaped and U-shaped correlations of BMI with all-cause and CVD mortality, featuring a pivotal inflection at 26.69 and 27.40 kg/m2. Above this BMI threshold of 26.69 and 27.4 kg/m2, all-cause mortality association was not significant while CVD mortality was positive. This study highlights a unique BMI-mortality association in AFF occupations, diverging from standard patterns. The rigorous labor and environmental conditions in AFF jobs suggest that a certain range of higher BMI could reduce mortality risk. This highlights the necessity for tailored health guidelines in different occupations. Future research should concentrate on diverse health indicators and enhanced risk assessment for physically strenuous occupations.

Elevations in serum brain-derived neurotrophic factor following occupational heat stress are not influenced by age or common chronic disease

ABSTRACT With global warming, workers are increasingly exposed to strenuous occupations in hot environments. Given age- and disease-associated declines in thermoregulatory function, older workers are at an elevated risk of developing heat-related injuries. Brain-derived neurotrophic factor (BDNF) is thought to confer neuroprotection during acute exercise, however, the influence of environmental heat on BDNF responses during prolonged work remains unclear. Therefore, we evaluated serum BDNF concentrations before and after 180 min of moderate-intensity treadmill walking (200 W/m2) and after 60 min of post-exercise recovery in temperate (wet-bulb globe temperature (WBGT) 16°C) and hot (WBGT 32°C) environments in 13 healthy young men (mean [SD; 22 [3] years), 12 healthy older men (59 [4] years), 10 men with hypertension (HTN) (60 [4] years), and 9 men with type 2 diabetes (T2D) (60 [5] years). In the temperate condition, all but one participant (1 HTN) completed the 180 min of exercise. While exercise tolerance in the heat was lower in older men with HTN (117 min [45]) and T2D (123 min [42]) compared to healthy older men (159 min [31]) (both p ≤ 0.049), similar end-exercise rectal temperatures (38.9°C [0.4]) were observed across groups, paralleled by similar elevations in serum BDNF across groups at end-exercise (+1106 pg/mL [203]) and end-recovery (+938 pg/mL [146]; all p ≤ 0.01) in the heat. No changes in serum BDNF were observed in the temperate condition. Our findings indicate similar BDNF responses in individuals with HTN or T2D compared to their healthy counterparts, despite exhibiting reduced tolerance to heat.

Occupational Variation in Quantity–Quality Trade-off in a Brawn-Based Economy

The paper revisits the theory of the quantity–quality trade-off and demonstrates that the relationship between quantity and health of children is subject to occupational variation in physical energy requirements. It embeds, in a simple household optimisation model, a minimum consumption requirement that rises with physical work intensity of occupation. Occupational differences in minimum consumption requirement generates variation in child nutritional status – the shadow price of quantity, which in turn generates varying quantity–quality relationships. The model yields an equilibrium relationship between the number and nutritional status of children that is positive for households in strenuous occupations and ambiguous for other households. A numerical example using a calibrated model illustrates that these trade-offs are consistent with the phenomenon of intergenerational persistence of nutritional status. These new insights into the nature of the quantity-quality trade-off help reconcile some inconsistent empirical findings on such trade-offs.

Adherence to healthy dietary patterns and its association with physical fitness in military personnel

IntroductionPoor nutritional status might impact in unintentional weight loss and decreased muscle mass and strength. The levels of physical fitness (PF) is a predictor of chronic diseases in future years....

The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum

There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12months postpartum. This study used a prospective cohort design. At 6weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30min/wk) were compared with 120 nonexercisers (mean age=29 years, SD=4.3). Manometry was used to measure vaginal resting pressure, PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). No differences were found between exercisers (n=57) and non-exercisers (n=120) at 6weeks postpartum on vaginal resting pressure (B=-0.04 [95% CI=-3.4 to 2.1]), PFM strength (B=0.03 [95% CI=-4.7 to 7.4]), PFM endurance (B=-0.02 [95% CI=-59 to 46]), or symptoms of SUI (OR=0.51 [95% CI=0.25 to 1.1]) or POP (OR=0.62 [95% CI=0.26 to 1.5]) measured at 12months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and>30 were more likely to report SUI 12months postpartum (OR=2.2 [95% CI=1.0 to 4.7] and OR=3.3 [95% CI=1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12months postpartum (OR=3.0 [95% CI = 1.2 to 7.3]). This study suggests that regular exercise 6weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery. First-time mothers are encouraged to talk with a physical therapist about starting regular general exercise in the early postpartum weeks. Health care providers should advise patients on possible preventive measures for women at risk for PFD.

Lifestyle balance, restful and strenuous occupations, and physiological activation

ABSTRACT A balance between stressful and restful occupations is an important component of lifestyle balance (LB). We argue that excessive physiological activation from the stress of everyday engagement in occupation, and/or inadequate engagement in restful occupations, can lead to negative health outcomes through accumulation of allostatic load (AL), or physiological wear and tear on the body. This physiological activation manifests as increased heart rate, blood pressure, and activation of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in elevations in serum levels of hormones such as cortisol and catecholamines. “Stress,” as the term is used colloquially, is just one possible source of physiological activation. Other possible sources include cognitive challenges and high motivation tasks. The purpose of this paper is twofold: 1) to present an explanatory model for how the LB component of a “pattern of occupations with a balance between stressful and restful engagements” can affect health and 2) to discuss metrics to measure physiological activation from stress/rest and explore how these metrics relate to existing measures of lifestyle and occupational balance. We speculate that these metrics may relate to existing measures of lifestyle and occupational balance in ways that help explain the mechanisms underlying them, with the amount of physiological activation that individuals experience on a daily basis determining their long-term health outcomes. There remains a need to develop innovative lifestyle interventions that support management of stress related physiological activation to promote health and well-being.

Occupational variation in the relationship between child health and family size.

Empirical evidence for quantity-quality trade-off is hardly ubiquitous, especially when quality is measured by child health outcomes. The paper offers a new explanation to this puzzle. It shows that the quantity-quality relationships are subject to occupational variation when quality is given by nutritional status, and occupations differ in their physical labor intensity. It embeds, in a simple household optimization model, a minimum consumption requirement that rises with physical work intensity of occupation. The occupational differences in subsistence consumption requirement generate variation in child nutritional status, and hence, in the shadow price of children. The nature of the quantity-quality relationship, therefore, varies with work intensity of occupations. The model yields an equilibrium relationship between the number and nutritional status of children that is positive for households in strenuous occupations and ambiguous for other households. These results help reconcile some inconsistent findings on quantity-quality trade-off, which may partly be explained by the omission of occupational variation in nutritional status.

Reliability and Validity of a Maximal Treadmill Test for Predicting Aerobic Fitness in Norwegian Prospective Soldiers.

The Norwegian armed forces reintroduced physical fitness testing of prospective conscript soldiers in 2011. Since then, a customized maximal treadmill test (MILMAX) has been used to screen aerobic fitness in 15-20,000 young Norwegian men and women annually. The aim of the current study was to investigate reliability and validity of the MILMAX test. Sixty-seven young Army recruits (including 11 women) participated in this method comparison study. The subjects completed the MILMAX test twice (test-retest), consisting of walking and running at increasing speed and inclination until voluntarily exhaustion. Performance was registered as exercise tolerance time (ETT). Later, the subjects performed a treadmill test of direct maximal oxygen uptake (V̇O2max). All tests were conducted within 15 days. The study protocol was submitted to the Regional Committee for Medical and Health Research Ethics for review, prior to study initiation. The Committee considered the study to be exempted from notification. The study was carried out according to the guidelines in the Declaration of Helsinki. There was no significant mean difference in MILMAX ETT between test and retest. Test-retest intraclass correlation coefficient was 0.95 (0.91, 0.97), while 95% limits of agreement was ± 60 seconds. Regression analyses showed that MILMAX ETT and gender explained 78% of the variance in directly measured V̇O2max, and a prediction equation with these two independent variables was generated. The Pearson correlation coefficient between predicted and directly measured V̇O2max was 0.89 (0.83, 0.93), while limits of agreement was ± 5.6 mL·kg-1·min-1. The MILMAX is equally reliable and valid compared with well-known maximal indirect tests like the 2-mile run and the 20-m shuttle run test, and may serve as an alternative indoor test of aerobic fitness in the military, in other potentially physically strenuous occupations, or in healthy civilians.

Acute Kidney Injury in Sugarcane Workers at Risk for Mesoamerican Nephropathy

Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of acute kidney injury (AKI) in workers at risk for MeN. Cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI. 326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and prospective follow-up of workers with AKI. AKI during the harvest, as defined by Scr level increase≥ 0.3mg/dL over baseline to a level≥ 1.3mg/dL. Kidney function trajectory and development of CKD over 12 months. Linear regression models were used to analyze the association between job category and kidney function. For workers with AKI, the effect of time on Scr level was evaluated using linear mixed effects. 34 of 326 participants were found to have AKI, with a median late-harvest Scr level of 1.64mg/dL in the AKI group. Workers without AKI had a median Scr level of 0.88mg/dL. AKI was more common among cane cutters compared with other field workers. Participants with AKI had variable degrees of kidney function recovery, with median 6- and 12-month Scr values of 1.25 and 1.27mg/dL, respectively (P< 0.001 for each follow-up value compared to late-harvest Scr). When we compared workers' kidney function before the AKI episode to their kidney function at last follow-up, 10 participants with AKI developed de novo estimated glomerular filtration rate< 60mL/min/1.73m2 and 11 had a >30% decrease in estimated glomerular filtration rate. Follow-up limited to 1 year and some loss to follow-up in the prospective component of the study. Broad definition of AKI that includes both acute and subacute kidney injury. In a group of sugarcane workers with normal preharvest kidney function, newly decreased kidney function developing during the harvest season was common. Of those with kidneyinjury, nearly half had established CKD 12 months later.

Racial/Ethnic identity reduces effects of adolescent racial discrimination on adult cortisol

This paper studies the effects of immigration on health. Specifically, we merge information on individual characteristics from the German Socio-Economic Panel (1984–2009) with detailed local labour market characteristics, and we then exploit the longitudinal component of the data to determine how immigration affects the health of both immigrants and natives over time. We find that immigrants to Germany are healthier than natives upon their arrival (the healthy immigrant effect) but that immigrants’ health deteriorates over time. We show that the convergence in health is heterogeneous across immigrants and occurs more rapidly among those working in more physically demanding jobs. Because immigrants are significantly more likely to work in strenuous occupations, we investigate whether changes in the spatial concentration of immigrants affect the health of the native population. Our results suggest that immigration reduces the likelihood that residents will report negative health outcomes. We show that these effects are concentrated in blue-collar occupations and are stronger among low-educated natives. Improvements in natives’ average working conditions and workloads help explain the positive effects of immigration on the health of the native population.

Do immigrants improve the health of natives?

This paper studies the effects of immigration on health. Specifically, we merge information on individual characteristics from the German Socio-Economic Panel (1984–2009) with detailed local labour market characteristics, and we then exploit the longitudinal component of the data to determine how immigration affects the health of both immigrants and natives over time. We find that immigrants to Germany are healthier than natives upon their arrival (the healthy immigrant effect) but that immigrants’ health deteriorates over time. We show that the convergence in health is heterogeneous across immigrants and occurs more rapidly among those working in more physically demanding jobs. Because immigrants are significantly more likely to work in strenuous occupations, we investigate whether changes in the spatial concentration of immigrants affect the health of the native population. Our results suggest that immigration reduces the likelihood that residents will report negative health outcomes. We show that these effects are concentrated in blue-collar occupations and are stronger among low-educated natives. Improvements in natives’ average working conditions and workloads help explain the positive effects of immigration on the health of the native population.

Use of the Bootstrap Method to Develop a Physical Fitness Test for Public Safety Officers Who Serve as Both Police Officers and Firefighters

Physical fitness testing is a common tool for motivating employees with strenuous occupations to reach and maintain a minimum level of fitness. Nevertheless, the use of such tests can be hampered by several factors, including required compliance with US antidiscrimination laws. The Highland Park (Texas) Department of Public Safety implemented testing in 1991, but no single test adequately evaluated its sworn employees, who are cross-trained and serve as police officers and firefighters. In 2010, the department's fitness experts worked with exercise physiologists from Baylor Heart and Vascular Hospital to develop and evaluate a single test that would be equitable regardless of race/ethnicity, disability, sex, or age >50 years. The new test comprised a series of exercises to assess overall fitness, followed by two sequences of job-specific tasks related to firefighting and police work, respectively. The study group of 50 public safety officers took the test; raw data (e.g., the number of repetitions performed or the time required to complete a task) were collected during three quarterly testing sessions. The statistical bootstrap method was then used to determine the levels of performance that would correlate with 0, 1, 2, or 3 points for each task. A sensitivity analysis was done to determine the overall minimum passing score of 17 points. The new physical fitness test and scoring system have been incorporated into the department's policies and procedures as part of the town's overall employee fitness program.

Do Immigrants Bring Good Health?

This paper studies the effects of immigration on health. We merge information on individual characteristics from the German Socio-Economic Panel with detailed local labor market characteristics for the period 1984 to 2009. We exploit the longitudinal component of the data to analyze how immigration affects the health of both immigrants and natives over time. Immigrants are shown to be healthier than natives upon their arrival (healthy immigrant effect), but their health deteriorates over time spent in Germany. We show that the convergence in health is heterogeneous across immigrants and faster among those working in more physically demanding jobs. Immigrants are significantly more likely to work in strenuous occupations. In light of these facts, we investigate whether changes in the spatial concentration of immigrants affect natives' health. Our results suggest that immigration reduces residents' likelihood to report negative health outcomes by improving their working conditions and reducing the average workload. We show that these effects are concentrated in blue-collar occupations and are larger among low educated natives and previous cohorts of immigrants.

Performance requirements of physically strenuous occupations: validating minimum standards for muscular strength and endurance

Employment rights legislative mandates passed in the USA over the last three decades emphasize the importance of validating performance standards for physically strenuous occupations. This study validated minimally acceptable standards for the muscular strength and endurance necessary to perform fire suppression activities. Incumbent firefighters (n = 153) selected for key demographic characteristics completed a simulated set of firefighting tasks (Fire Suppression Evolution) and then a Predictor Test Battery of physical abilities tests. Regression analysis revealed that three predictor test items (hose drag/high rise pack carry; arm lift; arm endurance) combined to significantly predict performance time of the Fire Suppression Evolution (p ⩽ 0.01). Firefighters (n = 41) rating videotaped performance times of the Fire Suppression Evolution determined that more than one-half a standard deviation slower than the mean time established by the incumbents reflected unacceptable performance. Approximately 80% of incumbent firefighters passed the minimally acceptable performance standard. Use of the 3-predictor test battery would correctly identify 89% of successful performers and 72% of unsuccessful performers. This study demonstrates that validation of minimal physical performance standards will identify a cohort of individuals with a high probability of not being able to perform critical fire suppression activities. This finding has important implications for examining the relationship between physical performance standards and medical and economic outcomes.

Functional and economic outcome following microdiscectomy for lumbar disc herniation in 672 patients.

A retrospective assessment of 809 patients operated on in 1990-1998 was performed. A patient-based outcome questionnaire also was incorporated into the study. The outcome was graded according to the Functional Economic Rating scale. A total of 64% of the patients were relieved of their complaints 3.2-10.2 years (median 6.3 years) after lumbar disc surgery. An excellent outcome, defined as Prolo scale of 9 or 10, was achieved in 55.8%, a good outcome (Prolo scale 7 or 8) in 20.7%, a fair outcome (Prolo scale 5 or 6) in 11.4%, and a poor outcome (Prolo scale of </=4) in 12.1% of the patients. Patients with strenuous occupations had a significantly (P = 0.004) less favorable outcome than patients with less strenuous or sedentary occupations. Criteria for evaluating the results of treating lumbar spinal disorders vary widely. A more universal acceptance of common criteria for judging the outcome of spinal operations should facilitate comparisons among various methods of treatment.

Inpatient hospital care for back disorders in relation to industry and occupation in Finland.

The variation in hospital admission rates was studied for back disorders by industry and occupational title among gainfully employed Finns. Admissions to Finnish hospitals in 1996 among 25- to 64-year-olds, based on the Hospital Discharge Register, were linked with sociodemographic data from the 1995 population census for the following primary diagnoses [International Classification of Diseases, 10th revision (ICD-10)]: all back disorders (M40.0-54.9; N (individual patients) 7,253), lumbar intevertebral disc disorders (M51.0-M51.9, N = 3,863), and other common back disorders (ICD-10: M47.1-47.2, M47.8-47.9, M48.0, M54.1, M54.3-54.5, M54.8-54.9; N = 2,433), with the total occupationally active workforce (same age range and gender) as reference. Age-standardized hospitalization rate ratios (SRR) were calculated. The highest SRR values for hospitalization for any back disorder were found for fishing (SRR 195), "other" mining and carrying (SRR 168), and sewage and refuse disposal (SRR 152) among the men and water transport (SRR 158), wood product (SRR 149) and pulp, paper and paper product (SRR 145) manufacturing among the women. Computer activities (SRR 44) among the men and insurance and pension funding (SRR49) among the women had the lowest SRR values. The occupations reindeer breeders and herders (SRR 495), agricultural workers (SRR 232), and paper product workers (SRR 205) among the men and plastic product (SRR 233), laundry (SRR 224), and agricultural (SRR 219) workers among the women had the highest SRR values. The lowest SRR values were observed for upper white-collar employees in public administration [men (SRR 40) and women (SRR 61)]. Hospitalization rates for back disorders were high for several physically strenuous industries and occupations.

Relation of occupation to presence or absence of coronary artery disease: an angiographic study.

To determine the relation of occupation to the presence or absence of coronary artery disease (CAD) and cardiovascular risk factors, the authors compared the occupations of a series of 116 consecutive patients who underwent coronary angiography and were found to have normal or near-normal coronary arteries (< 30% stenosis of all major coronary arteries) with those of a series of 116 patients with moderate to severe CAD (> or = 60% stenosis of one or more major coronary artery). The usual lifetime occupational status of each study participant was classified as sedentary, intermediate, or strenuous. The presence of the usual cardiovascular risk factors in the patients was also recorded. There was no significant difference in the frequency of the three occupational categories between the two groups (those with or without CAD) when subjects of all ages were considered or when subjects less than 40 years or more than 60 years old were considered. However, the results indicate that among 40-60-year-old individuals CAD occurred significantly more frequently in those engaged in strenuous occupations than in those engaged in sedentary occupations. Cardiovascular risk factors occurred significantly more frequently in patients with CAD than in those with normal coronary arteries and in those engaged in strenuous occupations compared with those in sedentary occupations.

Trends and Contexts: The Principle of Singularity

Introduction This paper deals with certain aspects of the major social trends observed in the six largest North Atlantic nations (France, Germany, Spain, United Kingdom, Canada, United States) since 1960. It is largely based on data assembled by the Comparative Charting Group, an international organization of social scientists who have been meeting semi-annually since 1987 to develop comprehensive profiles of social trends in their respective national societies and to subject them to comparative analysis. The Group has produced or stimulated an entire shelf of published reports(1) and more are in preparation. The North Atlantic societies covered in this paper differ slightly from those in the Comparative Charting Group; I include the United Kingdom and all of Canada, rather than Quebec alone.(2) One of the tasks the Comparative Charting Group set for itself was to examine trends in cross-national perspective in order to ascertain whether these national societies are following common or separate paths of development. As it turns out, there are far more shared than unshared trends in this subset of national societies but that finding must be qualified by the principle of singularity which, in barest terms, states that the sharing of trends by two or more national societies does not imply shared outcomes. The purpose of this paper is to review and discuss the shared and unshared trends observed in these six national societies since 1960(3) and to explain the principle of singularity. Shared Trends In all of these highly modernized national societies, modernization continued without interruption after 1960, as reflected by continuously increasing volumes of goods produced and goods consumed, steady increases in the volume and speed of internal transportation and communication, extended life expectancy and diminishing infant mortality, rising levels of education and dozens of other familiar indicators. At the same time, they drew closer together with respect to these measures, erasing most of the previously existing differences among themselves. Perhaps the single best indicator of modernization level is the telephone index - the number of working telephone lines per capita. Unlike measures of GNP or GDP, this index requires no questionable currency conversions, and because telephone systems can not operate without an accurate directory, the validity and reliability of the telephone index is superior to most other measures of modernization, although it shows high correlations with virtually all of them. The following table uses the telephone index to show how the differences in modernization level among our six national societies narrowed between 1960 and 1990. Table 1 Telephone Lines per Capita(4) 1960 1990 United States .410 .502 Canada .320 .554 United Kingdom .157 .430 France .095 .519 West Germany .108 .470 Spain .059 .303 The convergence of modernization levels among these six societies was accompanied by a great increase of traffic in goods, ideas and persons among them, so that their mutual dependence and their mutual visibility increased concurrently. In the sphere of work, there were massive shifts from blue-collar to white-collar employment and from agriculture to industry to service. By 1995, the agricultural component of the labor force had been reduced to numerical insignificance in all of these societies while the distinctive peasant cultures of France, Germany, Spain and French Canada had disappeared. Married women - especially women with small children - entered each labor force in unprecedented numbers and began to appear in occupations and management positions formerly monopolized by men. Many dangerous and strenuous occupations were mechanized or eliminated. Labor unions declined in membership and influence. …

Physical load in ship maintenance: Hazard evaluation by means of a workplace survey

In a population of male workers in two ship maintenance companies ( n = 32), a workplace survey was conducted in order to quantify their physical load. Postural load was measured by using the Ovako Working posture Analyzing System. During 7480 observations, working postures, exertion of force and working activities were recorded. Awkward postures of the back occurred in 38% of the worktime, stress on the neck/shoulder region due to one or both arms above shoulder level was present in 25% of the worktime. Forceful exertions during lifting, pushing and pulling activities sometimes exceeded published guidelines for manual material handling. Determinants of physical load could be identified and a hazard evaluation procedure was designed by applying rating schemes to weight various patterns of physical load. Ship maintenance work compared well with other strenuous occupations. Considering the high prevalence of back pain (80%) and neck/shoulder pain (60%), as well as the results of the observation method ergonomic improvements are warranted. Physical load can be reduced by several technical adaptations and applications, and by enlarging task rotation.

Type of occupation and near-future hospitalization for myocardial infarction and some other diagnoses.

Using three different registers a cohort study was undertaken to describe the relationship between type of occupation and hospitalization. A total of 958 096 subjects aged 20-64 years were followed-up for one year regarding inpatient care. Several significant associations between type of occupation and incidence of hospitalization for different diagnoses were observed. Male subjects employed in occupations where a high proportion reported a combination of hectic work and few possibilities to learn new things were more frequently hospitalized for myocardial infarction than other working men. The relative 'hospitalization' ratio for men 20-54 years of age in these strenuous occupations was estimated as 1.6 with a 95% confidence interval of 1.3-1.9. For women, the relative 'hospitalization' ratio in the ages 20-64 in occupations where a high proportion reported a combination of hectic and monotonous work was estimated as 1.6 with a 95% confidence interval of 1.1-2.3. Both these associations were statistically significant even after controlling for 12 possible confounding factors.