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The risk of having a depressive or anxiety disorder was 2.8 times higher in the low-income group than in the high-income group among men and 2.0 times higher among women. For men, non-work and work factors explained 20% and 31% of this association, respectively. For women, the corresponding figures were 65% and 23%. Conclusions: Low income is associated with frequent mental disorders among a working population. In particular, work factors among men and non-work factors among women contribute to the income differences in mental health. Mental disorders, such as depressive and anxiety disorders, are relatively common and predict work disability as much or even more than many other chronic conditions such as cardiovascular diseases. 1 2 The 12-month prevalence of depressive and anxiety disorders in general populations varies between 4% and 11%, and 4% and 19%, respectively. 3-5 Socioeconomic inequalities in mental health are well documented and indicate a higher prevalence and incidence of mental health problems in socially disadvantaged populations. 5-21 However, only a few studies have used the Composite International Diagnostic Interview (CIDI) or other standardised diagnostic interview methods to study the association between socioeconomic position and the most common mental disorders. 5-12 15 21 The Finnish Health 2000 Study showed no association between educational level and mental disorders. 19 In one study, socioeconomic position was measured by means of income per consumption unit which predicted incidence of psychiatric disorder. 7 While earlier studies have included unemployed and economically inactive subjects, it is not known whether socioeconomic inequalities in mental health can also be found among the working population. Socioeconomic inequalities in mental health have been explained by two theoretical frameworks. The social causation hypothesis states that barriers (eg, low income) to achieving highly valued goals (eg, goods, services, honour, job control) produce socioeconomic inequalities in health. 22 23 However, according to the social selection hypothesis, the rate of psychopathology among people in low socioeconomic positions is a function of an inter-and intragenerational sifting process in which unhealthy individuals tend to drift down from a high socioeconomic position or fail to rise from a low position. 36 Women seem to be more affected by crises involving children, housing and reproduction (eg, postpartum depression) rather than those involving work. In fact, work characteristics have been shown to be more strongly related to socioeconomic differences in psychological distress among men than among women. 14 16 20 However, as earlier reports have concerned self-reported psychological distress or symptoms, it is unclear if these results apply to clinically significant depressive and anxiety disorders, as defined by DSM-IV diagnostic criteria in a population-based sample. This study examined the contribution of non-work and work factors to the association between income and DSM-IV depressive and anxiety disorders in a working population. Based on earlier literature, we stratified our analyses by gender. The stratification and sampling were conducted as follows. The strata were five university hospital districts, each serving about 1 million inhabitants and differing in several features relating to geography, economic structure, health services and the socio-demographic characteristics of the population. First, the 15 largest cities were included with a probability of 1. Next, within the five districts, 65 other areas were sampled according to the probability proportional to population size (PPS) method. Finally, from each of these 80 areas, a random sample was drawn from the National Population Register. A total of 75% of the original sample participated in the CIDI interview. Compared to participants in the CIDI interview, those who only attended the home interview were found to score significantly more symptoms on the Beck Depression Inventory (BDI), were older, were more often single or widowed, and had a low level of education. METHODS Sample and procedure 37 The data collection phase started in August 2000 and was completed in June 2001. A total of 7419 persons (93% of the 7977 persons alive on the first day of the first phase of the survey) attended at least one phase of the study. They were interviewed at home, where they were also given a questionnaire to be returned at the clinical health examination. During the interview, the respondents received an information leaflet and their written informed consent was obtained. The Health 2000 Study was approved in 2000 by the Ethics Committee for Epidemiology and Public Health in the Hospital District of Helsinki and Uusimaa in Finland. Of the total sample, 5871 persons were of working age (30-64 years old). Of this base population, 5152 persons were interviewed (88%), 4935 persons returned the questionnaire (84%) and 4886 (83%) participated in the health examination, including the structured mental health interview (CIDI). The final sample of our study comprised the 3374 participants (1667 men, 1707 women) who were employed at the time of the interview. Income level We determined the income level of the participants using the definition of low income as suggested by the Organisation for Economic Co-operation and Development (OECD). In that definition, people have a low income if they belong to a household in which the income per consumption unit is either lower than 50% or lower than 60% of the national median income. In Finland, there is no official definition for low-income level. In this study, we used 50% of the median income as a cutoff point for low income. The cut point for the low-income consumption unit (J7340/year for 2001) was obtained from Statistics Finland (the government's official statistical office, personal information, June 2007). Because no official cut-off points have been defined for high income, the high-income group was derived from the highest tertile of the working population in our dataset, and the intermediate income group comprised those who fell between the low-and high-income groups. Information on household income and the number of adults and children in the household was derived from the home interview. Gross income was transformed to net income using a tax calculation programme (year 2001) developed for this purpose. As suggested in the OECD directive, the number of consumption units was calculated as follows: the first adult in the household was weighted by 1 and each following adult was weighted by 0.7. Each child in the household was weighted by 0.5. The income per consumption unit was calculated by dividing the household income by the number of consumption units. DSM-IV depressive and anxiety disorders Mental health status was based on a computerised version of the WHO Composite International Diagnostic Interview (M-CIDI) as a part of the comprehensive health examination. The standardised CIDI interview has been shown to be a valid instrument to assess common non-psychotic mental disorders. 38 The program uses operationalised criteria for DSM-IV diagnoses and allows the estimation of DSM-IV diagnoses for major mental disorders. Demographic factors Information on gender and age was collected in the home interview. Non-work factors Home interview Information on marital status was collected in the home interview and subjects were divided into two groups: those who were married or cohabiting and those who were divorced, widowed or single. Housing disadvantages were examined in the home interview with 12 questions with yes/no alternatives considering pro- Smoking status was obtained from home interview and subjects were classified as non-smokers versus current smokers. Survey Four survey questions based on the scale by Sarason et al 40 assessed social support outside work. In that measure, the participants marked who (spouse, close relative, friend, close neighbour, someone else close) would help or support them (1) when they were exhausted, (2) when they were depressed, (3) when they needed practical help, or (4) in any event. A sum score was calculated ranging from 0 to 20 and reversed to indicate lack of social support. In the survey, the participants were asked how many times during the past 12 months they had become a victim of violence which left visible signs or were victims of threatening intimidation. The respondents who had become victims of either of these alternatives at least once were identified as cases. Clinical health examination Somatic health was determined in a standard 30-min clinical health examination carried out by a physician. Abnormal somatic health meant an abnormal status of the skin, respiratory, cardiovascular, abdominal, musculoskeletal or neurological systems. Physical symptoms were queried during an interview before the physician's examination. Altogether, 13 questions with yes/ no alternative answers concerned respiratory symptoms (three questions), cardiovascular symptoms (four questions), allergic and other skin symptoms (four questions) and musculoskeletal symptoms (two questions). The number of symptoms was calculated as a simple sum of positive answers

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ABSTRACT Residues of pesticide fumigants and toxic industrial chemicals in freight containers represent a health hazard to employees and consumers, especially since freight containers are sealed for transport and distributed widely throughout the importing countries before being opened for unloading. We investigated 2113 freight containers arriving at the second largest container terminal in Europe, Hamburg, Germany, over a 10-week period in 2006. The countries of origin, type of contents and the pesticide fumigation history declared on labels attached to the container were recorded. We determined that 1478 (70%) containers were contaminated with toxic chemicals above chronic reference exposure levels (RELs), 761 (36%) even exceeded the higher acute REL thresholds. Benzene and/or formaldehyde contamination was 4-times greater than for fumigants. Our findings indicate a health risk for dockworkers, container unloaders and even end-consumers, especially as many of the cancerogenic or toxic gases elude subjective detection. benzene, bromomethane, hydrogen phosphide, pesticide

pain and functional status in construction workers Effects of a home exercise programme on shoulder Rapid responses Topic collections Effects of a home exercise programme on shoulder pain and functional status in construction workers

Background: Repetitive or sustained elevated shoulder postures have been identified as a significant risk factor for occupationally related shoulder musculoskeletal disorders. Construction workers exposed to routine overhead work have high rates of shoulder pain that frequently progresses to functional loss and disability. Exercise interventions have potential for slowing this progression. Aims: To evaluate a therapeutic exercise programme intended to reduce pain and improve shoulder function. Methods: Construction worker volunteers were screened by history and clinical examination to test for inclusion/exclusion criteria consistent with shoulder pain and impingement syndrome. Sixty seven male symptomatic workers (mean age 49) were randomised into a treatment intervention group (n = 34) and a control group (n = 33); asymptomatic subjects (n = 25) participated as an additional control group. Subjects in the intervention group were instructed in a standardised eight week home exercise programme of five shoulder stretching and strengthening exercises. Subjects in the control groups received no intervention. Subjects returned after 8-12 weeks for follow up testing. Results: The intervention group showed significantly greater improvements in the Shoulder Rating Questionnaire (SRQ) score and shoulder satisfaction score than the control groups. Average post-test SRQ scores for the exercise group remained below levels for asymptomatic workers. Intervention subjects also reported significantly greater reductions in pain and disability than controls. Conclusions: Results suggest a home exercise programme can be effective in reducing symptoms and improving function in construction workers with shoulder pain

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