Notified occupational mental disorders: associations with health and income.

BACKGROUND: Studies indicate that workers' compensation claim processes may affect patients' health negatively. However, few studies focus on patients with mental health claims, and the claim process varies between countries. AIMS: The aims of this study were to examine whether being notified to the Danish Labour Market Insurance with an occupational mental health condition was associated with changes in visits to the general practitioner (GP), use of medicine and annual income. METHODS: Study participants were 965 patients with a mental disorder examined at a department of occupational medicine. Of these, 669 patients were notified with an occupational mental disorder, 296 were not. Health-related outcomes, including GP visits and prescriptions of psychotropic drugs, were estimated at baseline during the year of medical examination, while annual income was estimated a year before the examination. The follow-up was the year after the year of examination for all outcomes. Outcomes were collected from the Danish National Bureau of Statistics. Analyses were conducted using Poisson regression and conditional logistic regression. RESULTS: All measured outcomes decreased from baseline to follow-up in both groups. These changes were not significantly different depending on notification status at baseline. CONCLUSIONS: This study suggests that being notified with an occupational mental disorder does not significantly affect health-related outcomes. A significant decrease in annual income over time was seen in both groups, the notified and the unnotified group, highlighting the importance of providing support to all employees with a mental disorder.

Physiological reactions to long-term fishing in the Barents Sea.

Background: Fishing in distant waters for months may induce physiological stress. Aims: To assess the physiological stress reactions in fishermen working for 2-3 months continuously in 6-h shifts on trawlers in the Barents Sea. Methods: The crew of five trawlers fishing in the Barents Sea from January to April 2004 were invited to participate. In the week before and 5-7 days after the trip, the following measures were collected: salivary cortisol four times a day, 24-h urinary cortisol, blood pressure, heart rate, serum cholesterol, serum high-density lipoprotein (HDL-cholesterol), HbA1c (glycosylated haemoglobin) and weight. In addition, 24-h urinary cortisol, blood pressure and heart rate were measured three times. A questionnaire on health, social conditions and work environment was obtained after the trip. Results: In total, 136 men agreed to participate. Full data were obtained for 96 fishermen (70%). A significant decrease in salivary and urinary cortisol was found during the trip. Adjustment for age, body mass index, smoking, shift work schedule and time of day for sample collection did not change this finding. Systolic and diastolic blood pressure declined significantly and remained significantly lower after the trip compared to before the trip. Serum cholesterol/HDL ratio declined significantly, whereas triglycerides, HbA1c and weight were unchanged. Conclusions: Working up to 3 months on 6-h shifts, 84 h a week, with moderate physical activity, even in artificial light and cold weather on a ship, did not result in increased physiological stress.

Evaluation of a radioimmunoassay and establishment of a reference interval for salivary cortisol in healthy subjects in Denmark.

A commercial radioimmunoassay (RA) for salivary cortisol was evaluated using certified reference material in water and spiked to pooled saliva in the range 2.1-89.1 nmol/L. A variance component model for describing the effects of age, body mass index (BMI), diurnal variation, gender, days of sick leave during the past year, and smoking habits was established. Reference intervals for salivary cortisol in 120 healthy individuals performing their routine work were established according to the International Union of Pure and Applied Chemistry (IUPAC) and the International Federation of Clinical Chemistry (IFCC). The method evaluation of the certified reference material in water did not show any bias of the method, i.e. recovery was 97% [CI: 94%; 100.9%]. LOD (detection limit) was 1.59 nmol/L. The ratio between analytical and within-subject variation (CVa/CVi) was 0.14, indicating that the method was adequate for measurement in healthy subjects. Reference intervals were estimated to be from 3.6 to 35.1 nmol/L for samples at the time of awakening (05.27-07.27), 7.6-39.4 nmol/L for peak level in saliva samples collected 20 min after awakening (05.47-07.47), and LOD 10.3 nmol/L for late afternoon samples (17.00-19.00). Reactivity (increase from awakening to 20 min after awakening) was estimated to be 82% [CI: -179; 345%] and recovery (decrease from 20 min after awakening to 18.00) to be 80% [CI: 51; 109%]. Eighteen percent of the subjects showed a decrease in cortisol in saliva from awakening to 20 min after awakening. Salivary cortisol was not affected by age, body mass index, gender, smoking habits or days of sick leave during the past year.

Cortisol in urine and saliva: relations to the intima media thickness, IMT.

OBJECTIVE: The objective of the study was to analyse the relations between excretion of cortisol in urine and saliva and the intima media thickness (IMT) of the artery carotis communis. DESIGN AND METHODS: In a cross-sectional study, 121 healthy participants completed a comprehensive questionnaire. Additionally, three samples of urine and four samples of saliva were collected in the 24 h before the examination, which included an ultrasound examination of the artery carotis communis, measuring height, weight, hip and waist width, blood pressure after 10 min of rest, and analysis of blood samples for cholesterol, high density lipoprotein (HDL)-cholesterol, and HbA(1c). The highest average of three measurements of IMT immediately before cartosis bulbous from either left or right side was used in the analyses as the dependent variable IMT. RESULTS: Values of cortisol in urine adjusted for creatinine were not related to IMT, but the level of salivary cortisol 1 h after awakening and the reactivity in salivary cortisol the first hour after awakening were significantly associated with IMT in women i.e. high cortisol was associated with low IMT. This result remained significant in multiple regression analysis including age, body mass index (BMI), cholesterol, HbA(1c), and alcohol. CONCLUSION: The reactivity in salivary cortisol the first hour in the morning might be used in research relating to stress, hormonal changes and early atherosclerosis.

Reference intervals and variation for urinary epinephrine, norepinephrine and cortisol in healthy men and women in Denmark.

Reference intervals for urinary epinephrine, norepinephrine and cortisol in 120 healthy individuals performing their routine work were established according to the International Union of Pure and Applied Chemistry (IUPAC) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) for use in the risk assessment of exposure to occupational stress. Reference intervals were established for three different times of the day: in morning samples (05.45-07.15) the limit of detection (LOD) was 2.10 micromol epinephrine/mol creatinine (82 women) and 2.86 micromol epinephrine/mol creatinine (37 men), and the reference interval was 3.6-29.1 micromol norepinephrine/mol creatinine and 2.3-52.8 micromol cortisol/mol creatinine (119 women and men); in afternoon samples (15.30-18.30) the reference interval was 0.64-10.8 micromol epinephrine/mol creatinine (82 women), 1.20-11.2 micromol/epinephrine/mol creatinine (36 men), 11.0-54.1 micromol/ norepinephrine/mol creatinine and LOD was 42.4 micromol cortisol/mol creatinine (117 women and men); in evening samples (21.45-23.45) LOD was 8.66 micromol epinephrine/mol creatinine (81 women) and 7.99 micromol/epinephrine/mol creatinine (36 men), the reference interval was 11.0-54.1 micromol norepinephrine/mol creatinine, and LOD was 42.4 micromol cortisol/mol creatinine (117 women and men). A variance component model for describing the effects of age, body mass index (BMI), diurnal variation, gender, days of sick leave during past year and smoking habits was established. Women showed a higher morning value but excreted lower amounts of epinephrine during the day as compared to men. No gender differences could be demonstrated for the excretion of norepinephrine and cortisol. Excretion of epinephrine and norepinephrine increased with smoking and decreased with increased BMI. No effects were observed in the excretion of cortisol.

The intima media thickness and coronary risk factors.

AIM: to estimate the degree of atherosclerosis in the carotids with different measurements of the intima media thickness (IMT), obtained by ultrasound and to analyze the correlations of these measures to coronary risk factors. DESIGN AND PARTICIPANTS: 130 employed men and women volunteered after public announcement. MEASURES: Health and life-style were charted using a comprehensive questionnaire. Anthropometric measurements, and blood pressure after 10 min of rest were obtained at clinical examination. Blood tests included analyses for fibrinogen, cholesterol, and HDL-cholesterol. The IMT was measured bilaterally three times at the transition of a. carotis to bulbus as well as on a. carotis 0.5 cm proximal thereto. Analyses were conducted with four methodologically different ways of expressing IMT as the dependent variable: IMT(left), IMT(communis), IMT(mean) and IMT(max). RESULTS: Among the measurements of IMT, IMT(max) showed the strongest correlations to coronary risk factors, significantly associated with sex and age. In univariate analyses only the degree of physical activity in the leisure time correlated significantly to IMT(max) among men. When adjusted for age, HDL-cholesterol, BMI, systolic blood pressure and physical activity in leisure time in a multiple linear regression analysis IMT(max) showed significant correlations to physical activity in leisure time and systolic blood pressure among men older than 45 years. Among women IMT(max) was significantly correlated to HDL-cholesterol (inversely), which remained significant in the multiple regression analysis including the same factors as for men. CONCLUSIONS: IMT(max) among four measures of IMT showed the strongest associations to coronary risk factors in otherwise healthy individuals.

Relation between job strain and myocardial infarction: a case-control study.

OBJECTIVES: To study the influence of different job related and socioeconomic factors for development of myocardial infarction (MI). METHOD: The study was a case-control study of 76 male wage earners who had been admitted to hospital with MI. As a control group 176 male wage earners not admitted to hospital who were residents of the same county were used. Both groups were interviewed with an extensive questionnaire on job related conditions. Several indices on job related psychosocial factors were established in accordance with Karasek's job strain model as well as the extension of the model, the isostrain model. RESULTS: The most significant findings were consistent with Karasek's job strain model in that mean with a high degree of demand combined with a low degree of control at work had a significantly increased odds ratio (OR) 95% confidence interval (95% CI) of 2.1 (1.2 to 3.8) for MI after adjustment for age compared with men with a low degree of demand and a high degree of control at work. Further adjustment for smoking, socioeconomic status, employment sector, job category, and social network did not affect the OR substantially (OR 2.3 (1.2 to 4.4)). Other factors significantly associated to MI were job category (blue collar workers v white collar workers, OR 2.8 (1.6 to 5.8)), and employment sector (private v public, OR 3.1 (1.8 to 6.1)). CONCLUSIONS: Thus, the study confirmed the job strain model as well as the well known association between socioeconomic status and risk of MI, whereas the finding of an increased risk among employees in the private sector has not previously been described.

Risk of chronic effects on the central nervous system at low toluene exposure.

This study evaluates the chronic effects on the central nervous system of exposure to low concentrations of toluene (TWA < 20 ppm) on workers in a rotogravure plant. Ninety-eight male workers from a selection pool of 107 (92%) were examined neuropsychologically using a Cognitive Function Scanner, and neurologically by computerized methods measuring co-ordination ability, tremor and position stability. In addition measures of symptoms and former exposure were obtained by questionnaire. The workers were divided into three groups: Group 0 with no exposure to organic solvents (n = 19); Group 1 with exposure to TWA < 20 ppm of toluene for less than 13 years (n = 30) and Group 2 with exposure for more than 12 years (n = 49). Within Group 2, 37 (75%) had been exposed at levels exceeding 100 ppm for 10+ years before 1983. No significant differences were found between Group 0 and Group 1 regarding symptoms and results of the applied tests. Group 2 differed significantly from the two other groups in scoring higher on a symptom index (p = 0.04), particularly regarding concentration ability, reduced memory and fatigue. Group 2 scored significantly poorer on tests for visuospatial function, number learning and word recognition, while no differences regarding neurological functions were observed. The study showed no differences regarding neuropsychological and neurological functions between a non-exposed group of male workers and workers exposed to toluene less than 13 years at TWA < 20 ppm. However, long-term exposure to TWA (time weighted average) of toluene exceeding 100 ppm was associated with impaired neuropsychological function.

Job strain and cardiovascular risk factors among members of the Danish parliament.

Sudden cardiovascular events among well-known politicians attract much attention--from the mass media and from the public. No previous studies have assessed the job strain profile and level of known cardiovascular risk factors among parliamentary politicians. The study was carried out within the frameworks of the Copenhagen City Heart Study. Some 102 members of the Danish parliament (70 men and 32 women) agreed to participate, giving a response rate of 55%. Three sex- and age-matched participants were drawn for each politician from the Copenhagen City Heart Study. In addition to the completion of large questionnaires on health and working conditions, all participants had a thorough examination, including measurements of height and weight and blood pressure and the drawing of a venous blood sample for the determination of serum lipids, ApolipoproteinA1 and ApolipoproteinB and fibrinogen. Job strain factors and established cardiovascular risk factors were the main outcome factors. Politicians reported much higher job demands, but also much more influence on their job than others. Politicians smoked less, consumed more wine, had higher levels of ApolipoproteinA1, and were taller. With respect to other major cardiovascular risk factors, serum lipids, blood pressure and physical activity, there was no difference between politicians and controls. Politicians had greater job demands, but also more control over their job than others, indicating that the job strain phenomenon should not increase their risk of cardiovascular disease. Other cardiovascular risk factors, job related or conventional, which were unevenly distributed between politicians and controls all favoured politicians. In conclusion, politicians had a more beneficial cardiovascular risk factor profile than a matched random sample from a comparable background population.

Acute mercury intoxication examined with coordination ability and tremor.

At a mercury spill, several workers were exposed to mercury vapour concentrations up to 0.15 mg/m3. Two weeks after, 38 exposed workers were examined. Fourteen had a Hg in urine concentration above 25 nmol/l. Two exposed groups (n = 7) and an unexposed control group (n = 15) were formed, based on Hg in urine: a HI group with mean = 106.5 nmol/l (range: 49.5-249); a LO group with mean = 35.2 nmol/l (range: 28.8-48.0), and control group with mean = 10.5 nmol/l (range: 4.5-14.1). The groups were reexamined 3 and 16 months later. The groups were examined with two computer-based portable test systems. CATSYS quantifies hand pronation/supination, finger tapping, and reaction time. TREMOR records and analyses tremor at the finger tips. The results showed reduced coordination ability in the HI group at the first examination compared to the control group. Tremor intensity was very high in the HI group and decreased only slightly during the follow-up period. The study indicates that quantification of coordination ability and tremor intensity can be used within occupational medicine for the assessment of the impact of acute mercury intoxication.

[Self-evaluated job satisfaction and ischemic heart disease. A 10-year follow-up study of bus drivers in a big city]. / Selvvurderet jobtilfredshed og iskaemisk hjertesygdom. En tiårs opfølgningsundersøgelse af storbybuschauffører.

Several studies have shown that bus driving is a high risk occupation for ischaemic heart disease (IHD). In order to study contributing factors in the job, all full-time bus drivers in the three major cities in Denmark were followed for ten years. It was hypothesized that bus drivers who reported job strain and job dissatisfaction would have an excess risk of subsequent death due to IHD. Of 2465 bus drivers, 2045 (83%) responded to a questionnaire distributed in 1978 on psychosocial well-being and work conditions. The men had their mortality recorded during the years 1978-1988. Information on causes of death was obtained from the Danish Register of Causes of Death. Some 212 respondents died during the follow-up period, 59 from IHD Relative risk (RR) for death due to IHD and all other causes of death was calculated. As expected, we found a significantly increased risk of death due to IHD in bus drivers working in high traffic intensity areas, RR = 1.6. In contrast to what was expected, men who reported never experiencing mental exhaustion after work, that their job was very varied, that their job was something special, and those who reported that they would choose the same job again, had an excess risk. Death due to other causes was positively associated with marital status only. We suggest that inconsistencies in the literature on self-assessed job strain and risk of IHD may be partly explained by the fact that studies in general have focused on absence or presence of the psychosocial factor in question. A more differentiated assessment of exposure might prove more useful.

[Accidents and accident mortality in Denmark--a comparison with Scandinavia and Europe]. / Ulykker og ulykkesdødsfald i Danmark--en sammenligning med Norden og EU.

As the development in mean age of the population and life expectancy has been less favourable in Denmark than in the rest of Western Europe, the Ministry of Health decided to investigate statistics for the period, 1972-1990, for the main areas where Danish life expectancy was poorer. A sharp increase in the incidence of accidental poisoning with medical drugs and alcohol during the period was found to be a factor contributing to the poorer Danish statistics during the period. In the subcategory, death after a fall, there was an increase in incidence among the elderly, but the loss of life-years remained constant. The subcategory, fatal road accidents, manifested a marked reduction in incidence, despite the increase in traffic density during the period, and there was a reduction in the loss of life-years. Thus, in the category, accidental deaths, the increase in the incidence of accidental poisonings would appear to be the only factor contributing to the poorer development in mean age and life expectancy in Denmark.

[Work load and cardiovascular risk factors. A cross-sectional study of employed Danish men and women]. / Arbejdsbelastning og kardiovaskulaere risikofaktorer. En tvaersnitsundersøgelse af beskaeftigede danske maend og kvinder.

As part of World Health Organisation initiated MONICA project, 2000 men and women aged 30, 40, 50 and 60 from the general population were invited to undergo a medical examination with special emphasis on cardiovascular disease. A total of 1504 (75%) participated, 1209 of whom were employed. The participants answered a questionnaire on working, social, and health conditions and underwent clinical examinations that included the measurement of blood pressure and serum cholesterol triglycerides, high density lipoprotein, fibrinogen and glycosylated haemoglobin (HbA1C) concentrations. Using the demand control model for measuring job strain suggested by Karasek, the employed people were classified according to those who had suffered job strain and those who had not in two different ways. The subjective classification was based on the participants' statements regarding demand and control in their jobs, whereas the objective classification was based on job title and mode of payment. More women than men were classified as having high strain jobs. After adjusting for age and sex no significant association was found between coronary risk factors and subjective job strain. A tendency for an association between fibrinogen and job strain was found. Body mass index and HbA1C concentration were significantly associated with objective job strain independent of confounders.

Lung function in insulation workers.

To evaluate the effects of working with modern insulation materials (rock and glass wool), the members of the Copenhagen Union of Insulation Workers were invited to participate in a study based on a health examination that included lung function tests. Three hundred and forty men (74%) agreed to participate, and 166 bus drivers served as the control group. Age distribution, height, and smoking habits were similar in the two groups. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were used as tests for lung function. There were no differences in FVC between the study and control groups, but the insulation workers had significantly lower values of FEV1 (mean 2.51) compared with the controls (mean 3.4 1), independent of smoking habits. Six years before the present study, 114 of the insulation workers participated in a similar study, and eight years after the initial study, the lung function of 59 of the bus drivers was tested. The decline in FVC in insulation workers who smoked was significantly higher (7.7 cl/year) than in bus drivers who smoked (3.1 cl/year); the decline in FEV1 was significantly higher in insulation workers independent of smoking habits (17.0 cl/year v 2.9 cl/year). Self assessed former exposure to asbestos was not associated with lung function in insulation workers. The study concludes that working with modern insulation materials is associated with increased risk of developing obstructive lung disease.