Potential of micro-exercise to prevent long-term sickness absence in the general working population: prospective cohort study with register follow-up.

This study assesses the potential of workplace-based micro-exercise (brief and simple exercise bouts) to prevent long-term sickness absence (LTSA) at the population level. In the Work Environment and Health in Denmark Study (2012-2018), we followed 70,130 workers from the general working population, without prior LTSA, for two years in the Danish Register for Evaluation of Marginalisation. We used Cox regression with model-assisted weights and controlled for various confounders. From 2012 to 2018, the percentage of workers in Denmark using workplace-based micro-exercise during and outside of working hours increased from 7.1 to 10.9% and from 0.8 to 1.4%, respectively. The incidence of long-term sickness absence (at least 30 days) was 8.4% during follow-up. The fully adjusted model showed reduced risk of long-term sickness absence from using micro-exercise during working hours, (HR 0.86, 95% CI 0.77-0.96), but not when used outside of working hours. If used by all workers, micro-exercise during working hours could potentially prevent 12.8% of incident long-term sickness absence cases (population attributable fraction). In conclusion, micro-exercise performed during working hours holds certain potential to prevent incident long-term sickness absence in the general working population. Large-scale implementation of workplace-based micro-exercise may represent an unexploited opportunity for public health promotion.

Importance of the Working Environment for Early Retirement: Prospective Cohort Study with Register Follow-Up.

BACKGROUND: This study investigates the role of physical work demands and psychosocial work factors for early retirement among older workers. METHODS: Data from three Danish surveys on work environment and health among employed older workers (age 55-59) were merged with a national register containing information on labour market participation. Robust Poisson regression modelled the risk ratios (RR) and 95% confidence intervals (CI) for the association between physical and psychosocial work factors and early retirement, that is, not working after the age of 64. RESULTS: Of the 2800 workers, 53% retired early. High physical work demands (RR 1.33, 95% CI 1.19-1.48), poor overall psychosocial working conditions (RR 1.43, 95% CI 1.26-1.61), and access to early retirement benefits (RR 1.79, 95% CI 1.53-2.10) predicted early retirement. Subgroup analyses revealed that poor overall psychosocial working conditions were a stronger predictor for early retirement among workers with seated jobs than those with physically active jobs. CONCLUSIONS: High physical work demands and poor psychosocial working conditions are factors that can push older workers out of the labour market prematurely. Poor psychosocial working conditions seem to be a particularly strong push factor among workers with seated work.

Combined ergonomic exposures and development of musculoskeletal pain in the general working population: A prospective cohort study.

OBJECTIVE: This study aimed to investigate the importance of combined ergonomic exposures at work for the development of musculoskeletal pain. METHODS: Through four rounds (2012-2018) of the Work Environment and Health in Denmark Study, 18 905 employees of the general working population replied to a baseline and 2-year follow-up questionnaire. First, a k-means cluster analysis of seven ergonomic factors (back bending, arm above shoulders, lifting etc., from 'never' to 'almost all the time') identified nine naturally occurring clusters. Second, using a weighted survey regression model controlling for age, gender, survey year, education, lifestyle, influence at work, and pain intensity at baseline, we estimated development of pain intensity (0-10) in the neck-shoulder and low-back in these clusters. The largest cluster served as reference to the other clusters and was characterized by low ergonomic exposures. RESULTS: Clusters characterized by multiple combined ergonomic exposures for a relatively high percentage of the working time showed the largest increase in neck-shoulder as well as low-back pain intensity from baseline to follow-up. However, clusters characterized by high exposure to a few specific ergonomic factors also increased pain significantly, eg, standing/walking combined with lifting/carrying or twisted/bent back for the majority of the working time increased low-back pain, whereas repetitive arm movements for the majority of the working time with or without standing/walking increased neck-shoulder pain. CONCLUSION: Combined occupational ergonomic exposures play an important role in the development of musculoskeletal pain. Workplace preventive approaches should consider this in risk assessments and organization of the work.

Work factors facilitating working beyond state pension age: Prospective cohort study with register follow-up.

Objectives The demographic changes in Europe underline the need for an extension of working lives. This study investigates the importance of physical work demands and psychosocial work factors for working beyond the state pension age (65 years). Methods We combined data from three cohorts of the general working population in Denmark (DWECS 2005 and 2010, and DANES 2008), where actively employed workers aged 55-59 years replied to questionnaires about work environment and were followed until the age of 66 years in the Danish AMRun register of paid employment. Using logistic regression analyses, we calculated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between physical and psychosocial work factors and working beyond state pension age, adjusted for age, sex, cohort, cohabiting, sector, income, vocational education, working hours, lifestyle, and previous sickness absence. Results Of the 2884 workers aged 55-59 years, 1023 (35.5%) worked beyond the state pension age. Higher physical work demands was associated with a lower likelihood (PR 0.69, 95% CI 0.58-0.82) and a good psychosocial work environment was associated with higher likelihood (average of 7 items: PR 1.81, 95% CI 1.49-2.20) of working beyond state pension age. Stratified analyses did not change the overall pattern, ie, a good overall psychosocial work environment - as well as several specific psychosocial factors - increased the likelihood of working beyond state pension age, both for those with physically active and seated work. Conclusion While high physical work demands was a barrier, a good psychosocial work environment seems to facilitate working beyond state pension age, also for those with physically active work.

Long-term sickness absence from combined factors related to physical work demands: prospective cohort study.

Background: The working environment plays an important role in public health. This study investigates the risk for long-term sickness absence (LTSA) from the combination of factors related to physical work demands. Methods: Employees (n = 22 740) of the general population (the Danish Work Environment & Health study 2012) were followed for two years in the Danish Register for Evaluation of Marginalisation. Using Cox regression analyses we determined the risk of LTSA from four factors; (i) physical work demands, (ii) physical exertion during work, (iii) fatigue after work and (iv) work-limiting pain. Results: During follow-up 10.2% experienced LTSA. Each of the four factors increased the risk of LTSA with hazard ratios (HR) ranging from 1.30 to 1.57. Scoring high on one (30.3% of the respondents), two (24.4%), three (19.9%) and all four factors (9.2%) gradually increased the risk of LTSA (HR's of 1.39 [95% CI 1.16-1.66], 1.66 [95% CI 1.39-1.99], 1.90 [95% CI 1.57-2.29] and 3.02 [95% CI 2.47-3.68], respectively). Risk estimates remained robust in stratified analyses of age, sex and socioeconomic position. Population attributable fractions were high across all subgroups; 39% (general population), 36% (younger workers), 45% (older workers), 36% (men), 41% (women), 30% (higher socioeconomic position) and 45% (lower socioeconomic position). Conclusion: The risk of LTSA gradually increased with number of factors related to high physical work demands, underlining the importance of targeting combined factors in risk assessment and preventive interventions.

Joint association of sleep problems and psychosocial working conditions with registered long-term sickness absence. A Danish cohort study.

OBJECTIVES: Sleep problems and adverse psychosocial working conditions are associated with increased risk of long-term sickness absence. Because sleep problems affect role functioning they may also exacerbate any effects of psychosocial working conditions and vice versa. We examined whether sleep problems and psychosocial working conditions interact in their associations with long-term sickness absence. METHODS: We linked questionnaire data from participants to two surveys of random samples of the Danish working population (N=10 752) with registries on long-term sick leave during five years after questionnaire response. We defined sleep problems by self-reported symptoms and/or register data on hypnotics purchases of hypnotics. Psychosocial working conditions included quantitative and emotional demands, influence, supervisor recognition and social support, leadership quality, and social support from colleagues. Using time-to-event models, we calculated hazard ratios (HR) and differences and examined interaction as departure from multiplicativity and additivity. RESULTS: During 40 165 person-years of follow-up, we identified 2313 episodes of long-terms sickness absence. Sleep problems predicted risk of long-term sickness absence [HR 1.54, 95% confidence interval (95% CI) 1.38-1.73]. This association was statistically significantly stronger among participants with high quantitative demands and weaker among those with high supervisor recognition (P<0.0001). CONCLUSIONS: High quantitative demands exacerbated the association of sleep problems with risk of long-term sickness absence whereas high supervisor recognition buffered this association. To prevent long-term sickness absence among employees with sleep problems, workplace modifications focusing on quantitative demands and supervisor recognition may be considered. Workplace interventions for these factors may more effectively prevent sickness absence when targeted at this group. The efficacy and effectiveness of such interventions needs to be established in future studies.

A multi-wave study of organizational justice at work and long-term sickness absence among employees with depressive symptoms.

OBJECTIVES: Mental health problems are strong predictors of long-term sickness absence (LTSA). In this study, we investigated whether organizational justice at work - fairness in resolving conflicts and distributing work - prevents risk of LTSA among employees with depressive symptoms. METHODS: In a longitudinal study with five waves of data collection, we examined a cohort of 1034 employees with depressive symptoms. Depressive symptoms and organizational justice were assessed by self-administered questionnaires and information on LTSA was derived from a national register. Using Poisson regression analyses, we calculated rate ratios (RR) for the prospective association of organizational justice and change in organizational justice with time to onset of LTSA. All analyses were sex stratified. RESULTS: Among men, intermediate levels of organizational justice were statistically significantly associated with a decreased risk of subsequent LTSA after adjustment for covariates [RR 0.49, 95% confidence interval (95% CI) 0.26-0.91]. There was also a decreased risk for men with high levels of organizational justice although these estimates did not reach statistical significance after adjustment (RR 0.47, 95% CI 0.20-1.10). We found no such results for women. In both sexes, neither favorable nor adverse changes in organizational justice were statistically significantly associated with the risk of LTSA. CONCLUSIONS: This study shows that organizational justice may have a protective effect on the risk of LTSA among men with depressive symptoms. A protective effect of favorable changes in organizational justice was not found.