Work factors as predictors of persistent fatigue: a prospective study of nurses' aides.

OBJECTIVES: To identify work factors that predict persistent fatigue in nurses' aides. METHODS: The sample comprised 5547 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4645 (83.7%) completed a second questionnaire 15 months later. The outcome measure was the occurrence of persistent fatigue, defined as having felt "usually fatigued" or "always fatigued" in daytime during the previous 14 days. RESULTS: In respondents without persistent fatigue at baseline, medium and high work demands, heavy smoking, being single, and having long term health problems were associated with increased risk of persistent fatigue at follow up. Medium and high rewards for well done work, medium levels of leadership fairness, and regular physical exercise were associated with reduced risk of persistent fatigue at follow up. In respondents with persistent fatigue at baseline, medium and high levels of positive challenges at work, high support from immediate superior, medium feedback about quality of one's work, and changes of work or work tasks that resulted in less heavy work or lower work pace were associated with increased odds of recovery (no persistent fatigue at follow up). Working in a nursing home and being intensely bothered by long term health problems were associated with reduced odds of recovery. CONCLUSIONS: High demands and lack of rewards at work may cause persistent fatigue in nurses' aides. Reduction of demands, adequate feedback, and mental stimulation in the form of support and positive challenges may facilitate recovery in those who have persistent fatigue. Leaders in the health services may be in a position to regulate factors that influence the level of fatigue in nurses' aides.

Do physical leisure time activities prevent fatigue? A 15 month prospective study of nurses' aides.

OBJECTIVE: To test the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue. METHODS: The hypothesis was tested in a sample that was homogeneous with respect to sex and occupation, with a prospective cohort design. Of 6234 vocationally active, female, Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999, 5341 (85.7%) completed a second questionnaire 15 months later. The main outcome measure was the prevalence of persistent fatigue-that is, always or usually feeling fatigued in the daytime during the preceding 14 days. RESULTS: In participants without persistent fatigue at baseline, reported engagement in physical leisure time activities for 20 minutes or more at least once a week during the three months before baseline was associated with a reduced risk of persistent fatigue at the follow up (odds ratio = 0.70; 95% confidence interval 0.55 to 0.89), after adjustments for age, affective symptoms, sleeping problems, musculoskeletal pain, long term health problems of any kind, smoking, marital status, tasks of a caring nature during leisure time, and work factors at baseline. CONCLUSION: The study supports the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue.

Work factors as predictors of intense or disabling low back pain; a prospective study of nurses' aides.

AIMS: To identify the work factors that predict intense low back pain (LBP) and LBP related sick leaves in nurses' aides. METHODS: The sample comprised 4266 randomly selected Norwegian nurses' aides, not bothered or only a little bothered by LBP during the previous three months, and not on sick leave when completing a mailed questionnaire in 1999. Of these, 3808 (89.3%) completed a second questionnaire 3 months later and 3651 (85.6%) completed a third questionnaire 15 months later. Intensity of low back symptoms and certified sick leaves attributed to LBP during the observation period were assessed by self reports at the follow ups. RESULTS: After adjustments for LBP during the three months prior to baseline, baseline health complaints, demographic and familial factors, and a series of physical, psychological, and social work factors, logistic regression analyses revealed the following associations: intense low back symptoms were predicted by frequent positioning of patients in bed, perceived lack of support from immediate superior, and perceived lack of pleasant and relaxing culture in the work unit. LBP related sick leaves were predicted by frequent handling of heavy objects, medium level of work demands, perceived lack of supportive and encouraging culture in the work unit, working night shifts, and working in a nursing home. Long term LBP related sick leaves were associated with changes of work or work tasks during the observation period that resulted in a perceived reduction of support and encouragement at work. CONCLUSIONS: Not only frequent mechanical exposures, but also organisational, psychological, and social work factors, such as night shift work, perceived lack of support from superior, and perceived lack of a pleasant and relaxing or supporting and encouraging culture in the work unit, are associated with an increased risk of intense low back symptoms and LBP related sick leaves in nurses' aides.

Work factors as predictors of sickness absence attributed to airway infections; a three month prospective study of nurses' aides.

AIMS: To identify the work factors that are related to sickness absence attributed to airway infections (AAI) in nurses' aides. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified AAI (>3 days), assessed by self reports at follow up. RESULTS: Working in a paediatric ward (odds ratio (OR) 2.42; 95% confidence interval (CI) 1.39 to 4.21), perceived lack of encouraging and supportive culture in the work unit (OR 1.78; 95% CI 1.21 to 2.61), and reporting medium (OR 1.52; 95% CI 1.09 to 2.12), and high levels (OR 1.60; 95% CI 1.13 to 2.26) of role conflicts at work were associated with an increased risk of AAI, after adjustments for baseline health complaints, demographic and familial factors, smoking, and a series of physical, psychological, and organisational work factors. The individual level factors male gender, smoking 10 cigarettes per day or more, having widespread pain, having had an accident related neck injury, and having long term health problems also predicted AAI. CONCLUSIONS: In nurses' aides, sickness absence attributed to airway infections seems to be related to the type of ward in which the aides are working, and to psychological and social work factors. Declaring airway infections as occupational diseases would have important consequences for the social security system.

Work factors as predictors of sickness absence: a three month prospective study of nurses' aides.

AIMS: To identify the work factors that predict sickness absence in nurses' aides. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified sickness absence (>3 days), as assessed by self reports at follow up. RESULTS: Perceived lack of encouraging and supportive culture in the work unit (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.28 to 2.34), working in psychiatric and paediatric wards, having injured the neck in an accident, and health complaints were associated with higher risk of sickness absence, after adjustments for a series of physical, psychological, and organisational work factors, personal engagement in the work unit, demographic characteristics, and daily consumption of cigarettes. Having untraditional jobs (for nurses' aides) (OR 0.53; 95% CI 0.36 to 0.77), and engaging in aerobics or gym were associated with a lower risk of sickness absence. CONCLUSIONS: The study suggests that the three month effects of work factors on rates of certified sickness absence are modest in nurses' aides. The most important work factor, in terms of predicting sickness absence, seems to be perceived lack of encouraging and supportive culture in the work unit.

Localized low back pain and low back pain as part of widespread musculoskeletal pain: two different disorders? A cross-sectional population study.

In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker county born 1918-20, 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70 were sent a questionnaire in 1994. The study population comprised 2,893 responders. LBP as part of widespread pain indicated reduced functional ability, and the groups differed in several demographic and lifestyle characteristics.

Sleep problems: a predictor of long-term work disability? A four-year prospective study.

AIMS: This study investigates sleep problems as a predictor of long-term work disability. METHODS: Data from a community-based four-year prospective study were used. In 1990, all inhabitants of the municipality of Ullensaker, Norway, belonging to six age cohorts (20-22, 30-32, 40-42, 50-52, 60-62, and 70-72 years), were mailed a questionnaire. Of the 1,788 responders who were working and not older than 62 years, 1,426 (80%) returned a second questionnaire four years later (1994). RESULTS: Reporting mediocre or poor sleep (in contrast to good) in 1990 was significantly related to long-term work disability (> 8 weeks) during the previous 12 months in 1994 (odds ratio = 2.16; 95% confidence interval = 1.26-3.72), after adjustments for age, gender, civil status, body mass index, emotional symptoms, musculoskeletal pain, self-evaluated health, smoking, physical exercise, job satisfaction, and work characteristics. CONCLUSION: The study indicates that sleep problems are a predictor of long-term work disability.

Smoking and the functional status of young adults.

OBJECTIVE: To investigate the relationship between smoking and the functional status of young adults. DESIGN: A 4-year prospective questionnaire study. SETTING: The municipality of Ullensaker, Norway. SUBJECTS: 1084 subjects, 20-22 years or 30-32 years of age (the two youngest age-cohorts in a larger population study), completed a mailed questionnaire in 1990. A second questionnaire, mailed to the respondents in 1994, was completed by 753 (69.5%) individuals. MAIN OUTCOME MEASURES: Self-evaluated functional status as measured with the COOP/Wonca Charts. RESULTS: In 1994, respondents who were daily smokers in 1990 reported lower physical fitness, poorer overall health, and more pain, emotional problems, limitations of social activities, and problems in performing daily tasks than nonsmokers. Smoking in 1990 was associated with moderate or low physical fitness (OR = 2.21; 95% CI: 1.19-4.11) and moderate or severe pain (OR = 2.28; 95% CI: 1.32-3.94) in 1994, after adjustment for age, gender, civil state, workplace characteristics, physical exercise, and emotional symptoms. CONCLUSION: Even young adults report a lower functional status if they smoke. If this reflects a causal relationship it could be an important argument when trying to persuade young people to avoid smoking.

Job characteristics as predictors of neck pain. A 4-year prospective study.

Data from a community-based 4-year prospective study were used to investigate job characteristics as predictors of neck pain. Of 1791 working responders who completed a questionnaire in 1990, 1429 (79.8%) returned a second questionnaire 4 years later (1994). In responders without neck pain during the previous 12 months in 1990, the "little influence on own work situation" factor predicted neck pain during the previous 12 months (odds ratio = 2.21; 95% confidence interval, 1.18 to 4.14) and previous 7 days in 1994 (OR = 2.85; 95% confidence interval, 1.21 to 6.73) after adjustment for a series of potential confounders. In responders with neck pain in 1990, the little influence on own work situation factor was associated with persistent neck pain 4 years later. The study indicates that having little influence on one's own work situation is a predictor of neck pain.

Marital disruption and long-term work disability. A four-year prospective study.

Data from a community-based four-year prospective study were used to investigate the relationship between marital disruption and long-term work disability. In 1990, all inhabitants of the municipality Ullensaker, Norway, belonging to six cohorts (20-22 years, 30-32 years, 40-42 years, 50-52 years, 60-62 years and 70-72 years) were sent a questionnaire. Of the 1,359 respondents who were working, married or cohabiting, and not older than 62 years, 1,115 (82%) returned a second questionnaire four years later (1994). Separation or divorce between 1990 and 1994 was related to long-term work disability in 1994 (OR = 3.02; 95% CI: 1.57-5.81), even after adjustments for age, sex, work characteristics, number of work hours per week, job satisfaction, body mass index, having pre-school children, smoking, physical leisure activity, emotional symptoms and musculoskeletal pain (all measured in 1990). Emotional problems evoked by the marital disruption may be part of the explanation.

Smoking, heavy physical work and low back pain: a four-year prospective study.

Data from a community-based four-year prospective study were used to test the hypothesis that heavy physical work is a stronger predictor of low back pain in smokers than in non-smokers. Of 708 working responders without low back pain during the entire year prior to 1990, 562 (79%) completed a questionnaire four years later in 1994. A job involving heavy lifting and much standing in 1990 was a strong predictor of low back pain in smokers four years later [odds ratio (OR) = 5.53, 95% confidence interval (CI) = 1.93-15.84, p < 0.01) after having adjusted for other job characteristics, demographic factors, emotional symptoms, physical exercise and musculoskeletal pain elsewhere. In non-smokers, having a job with heavy lifting and much standing was not associated with low back pain. One explanation may be that smoking leads to reduced perfusion and malnutrition of tissues in or around the spine and causes these tissues to respond inefficiently to mechanical stress.

Physical leisure activity level and physical fitness among women with fibromyalgia.

To determine selfreported physical leisure activity level and physical fitness in women with fibromyalgia we sent questionnaires to the female members of a local fibromyalgia association and the same questionnaire to the women in a population based cohort study. The fibromyalgia patients had higher physical leisure activity level, but lower physical fitness than the women in the population survey. The difference in physical leisure activity persisted even after controlling for a series of possible confounders, including employment status and work load in a logistic regression analysis.

Smoking as a predictor of long-term work disability in physically active and inactive people.

Data from a Norwegian 4-year prospective questionnaire study were used to test our hypothesis that smoking is a weaker predictor of long-term work disability in physically active than inactive persons. Of 1,788 respondents who were working and not older than 62 years in 1990, 1,426 (80%) also returned a questionnaire in 1994. For respondents who were taking physical exercise less than once a week, smoking predicted long-term work disability four years later [odds ratio (OR) = 2.24; 95% confidence interval (CI) = 1.30-3.87; p < 0.01], when adjusting for age, sex, work-hours per week, heavy lifting at work, emotional symptoms and musculoskeletal pain at time 0. In respondents who were exercising at least once a week, there was no association between smoking and long-term work disability.

Social support and the smoking behaviour of parents with preschool children.

In a study of the relationship between social support and smoking behaviour, 1046 parents coming with their children for well-child control at health centres in Oslo, Norway, completed a questionnaire. The prevalence of daily smoking increased with decreasing social support. However, this association did not remain significant when adjusting for demographic and household characteristics. Among smoking parents, indoor smoking at home was related to medium (OR = 1.97; CI: 1.01-3.81) and low social support (OR = 2.35; CI: 1.19-4.63) when adjusting for demographic and household characteristics. Smoking parents smoked more cigarettes per day when they had low social support. However, this association was only seen in parents with several children. In this group, smoking 10 cigarettes per day or more was strongly related to medium (OR = 5.05; CI: 1.66-15.35) and low social support (OR = 7.81; CI: 2.44-25.01).

Does smoking aggravate musculoskeletal pain?

The present study was based on data from the Norwegian Health Survey 1985, a nationwide interview survey with members of a representative sample of households. Our sample comprised all adult respondents who had reported musculoskeletal pain (n = 4490). Smokers experienced more intense pain than nonsmokers. The association between smoking and considerable/intense pain was, however, only seen in persons younger than 67 years. In this age group, smoking was related to intense pain in a logistic regression analysis (OR = 1.58; 95% CI: 1.24-2.00; p < 0.001), adjusting for age, gender, socioeconomic status, civil status, having children under 16, physical exercise, the presence of a musculoskeletal disease, and mental distress. The association remained significant after adjusting for workplace factors, social network factors, alcohol consumption, and intake of cod liver oil as dietary supplement.

Breastfeeding, smoking and the presence of the child's father in the household.

The breastfeeding practice of 312 mothers attending mother and child health centres in Oslo, Norway, was measured using self-administered questionnaires. Having started with supplements at 3 months postpartum was related to having a spouse/cohabitant, smoking, and having only one child (logistic regression with civil state, age, education, smoking, number of children, social support, smoking x civil state, and education x civil state as independent variables). The frequency of having started with supplements increased with increasing maternal cigarette consumption. Among non-smoking, married/cohabiting mothers, the frequency of having started with supplements at 3 months postpartum was 41% if the spouse/cohabitant smoked, compared with 18% if he did not smoke (p < 0.01).

Does dietary supplementation of cod liver oil mitigate musculoskeletal pain?

OBJECTIVE: To investigate the relationship between dietary supplementation of cod liver oil and the intensity of pain in people with musculoskeletal pain. DESIGN: Cross-sectional study. SETTING: Data from the Norwegian Health Survey 1985. SUBJECTS: All adult respondents who had reported musculoskeletal pain (n = 4490). MAIN OUTCOME MEASURES: Intensity of musculoskeletal pain as assessed by self reports during an interview. RESULTS: In logistic regression analyses (adjusting for age, gender, socioeconomic status, civil status, smoking habits, physical exercise, mental distress, and use of medicines), there was a negative association between regular intake of cod liver oil during the previous week and intense pain (OR = 0.75; 95% CI: 0.56-1.00; P = 0.048) and considerable/intense pain (OR = 0.81; 95% CI: 0.67-1.00; P = 0.045). The association was stronger in the 33% of the respondents who reported a musculoskeletal disease, as expressed by the relationship of cod liver oil to intense pain (OR = 0.64; 95% CI: 0.43-0.95; P = 0.028) and considerable/intense pain (OR = 0.74; 95% CI: 0.54-1.03; P = 0.076). The association varied between diagnostic groups, and was not seen in people who did not report a musculoskeletal disease. CONCLUSION: The study suggests that people with musculoskeletal pain experience less pain if they take cod liver oil.

Is there an increased lability in parents' smoking behaviour after a childbirth?

OBJECTIVE: To test our hypothesis that there is an increased lability in parents' smoking behaviour after a childbirth, and to search for demographic factors associated with lability in parents' smoking behaviour. DESIGN: A one month, prospective questionnaire study. SETTING: Maternal and child health centres in Oslo, Norway. SAMPLE: 222 families in which at least one adult was smoking were enrolled in the study. 37 families dropped out (16.7%) and 185 families completed both questionnaires. MEASUREMENTS: Changes in daily smoking, smoking quantity, and practical measures to prevent passive smoking by the children, as assessed by parental reports. RESULTS: Families with a child aged less than one year (infant) were more likely to make one or another positive change (quit, reduce, stop smoking indoors, stop smoking in living rooms) than families with only older children. There was a trend for families with an infant to make negative changes more often (start smoking, increase) as well. Older parents made positive changes more often than younger ones. Single parents were less likely to make positive changes. CONCLUSIONS: The study indicates that there is an increased lability in parents' smoking behaviour after a childbirth.

Effects of information on smoking behaviour in families with preschool children.

An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested. A total of 443 consecutive families with one or two smoking parents, attending mother and child health centres in Oslo, Norway, were randomly allocated to an intervention group (n = 221) and a control group (n = 222). Eighty families (18%) dropped out during the study period. For the intervention group, the communication between the health visitor and the family was prolonged at one well-child visit with a brief session on smoking, and the parents were given three brochures. The families in the control group received no information on smoking. Changes in practical measures to prevent passive smoking by the children (e.g. no smoking indoors) as well as changes in daily smoking and smoking quantity were assessed by parental reports. We found no significant differences between the groups with respect to change in smoking behaviour.