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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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Occup Environ Med Objectives: To explore the associations of working hours (paid, domestic, commuting, and total) with sickness absence, and to examine whether these associations vary according to the level of employee control over daily working hours. Methods: Prospective cohort study among 25 703 full-time public sector employees in 10 towns in Finland. A survey of working hours and control over working hours was carried out in 2000-01. The survey responses were linked with register data on the number of self-certified ((3 days) and medically certified (.3 days) sickness absences until the end of 2003. Poisson regression analyses with generalised estimating equations were used to take into account the fact that the employees were nested within work units. Adjustments were made for work and family characteristics and health behaviour. The mean followup period was 28.1 (SD 8.1) months. Results: Long domestic and total working hours were associated with higher rates of medically certified sickness absences among both genders. In contrast, long paid working hours were associated with lower rates of subsequent self-certified sickness absences. Long commuting hours were related to increased rates of sickness absence of both types. Low control over daily working hours predicted medically certified sickness absences for both the women and men and self-certified absences for the men. In combinations, high control over working hours reduced the adverse associations of long domestic and total working hours with medically certified absences. Conclusions: Employee control over daily working hours may protect health and help workers successfully combine a full-time job with the demands of domestic work. R ecent reviews 1-3 suggest a weak positive relation between long working hours and ill health. Long working hours may affect health by impairing the employee's possibilities for sufficient recovery, both mentally and physiologically. Long hours may also pose health risks if exposure to adverse work conditions is prolonged and if health related behaviour is affected. 1-3 The health effects of working hours are not necessarily similar for men and women, yet the greater part of the evidence stems from all-male or predominantly male samples. 1-3 Some studies have found the effects of long working hours more detrimental to women's health. 4 5 The reasons for such gender differences are unclear, but the importance of exploring workloads in both paid and domestic work has been acknowledged. 1-3 6 Women are generally exposed to longer working hours at home than men, 7 but whether there are gender differences in vulnerability to the possible adverse effects of these hours 14 The possibilities of influencing one's working hours may enable workers to adjust their working hours to prevailing resources at work and also to the demands of their private lives. Therefore perceived control over working times, reflecting the practical possibilities, may reduce health problems rising from work stress and also from stress due to conflicting demands from paid and domestic work. Indeed, high employee worktime control has been shown to predict good subjective health and less sickness absence. 15 16 Such control has also been found to be associated with reduced stress related absenteeism. 17 The earlier finding that particularly women seem to profit from worktime control has been assumed to stem from gender differences in non-work demands. 15 16 However, this hypothesis has not been directly addressed. As non-work demands are reflected in the number of domestic working hours, the employees with the most hours of domestic work could benefit the most from high control over hours in paid work. On the other hand, as suggested in earlier crosssectional studies, employees who work the longest hours in paid work could benefit from high worktime control more than those with fewer hours. 18 19 Obviously, worktime control could also help in optimising commuting hours. In this prospective study of a large cohort of public sector employees with a wide variety of occupations, we explored the associations of self-reported paid and domestic working hours, commuting hours, and control over daily working hours with registered sickness absence. Our aim was to determine whether the associations between paid, domestic, commuting, and total working hours and subsequent sickness absence vary by the level of control over daily working hours. To detect gender differences, the analyses were performed separately for women and men. employees who had a contract of employment lasting at least until the end of the survey year. Of the 32 299 (67%) responders we included in this study the 25 703 responders in 2543 identifiable work units who provided information on their control over working hours, had more than 6 months of follow-up and gave their consent for their questionnaire responses to be linked to their records on sickness absence (87% of the respondents who fulfilled other criteria gave consent). Health problems in the years following the survey, as indicated by sickness absence, were monitored until the end of 2003. The mean follow-up time was 28.1 (SD 8.1) months. METHODS Design and participants The sample did not substantially differ from the eligible population in terms of age, occupational status, and sickness absence. In the sample, the mean age was 45 years, the proportion of upper non-manual workers 36%, lower nonmanual workers 46%, and manual workers 18%; rates for self-certified and medically certified sickness absence per person-year were 1.37 and 0.78, respectively. In the eligible population, the mean age was 45 years, 34% were upper nonmanual workers, 44% were lower non-manual workers, and 22% were manual workers; corresponding absence rates were 1.46 and 0.86. The proportions of women (77%) and permanent employees (85%) were somewhat higher in the sample than in the eligible population (73% women, 81% permanent). The Ethics Committee of the Finnish Institute of Occupational Health approved the study. Working hours Paid working hours were summed from the respondents' reports of their (i) official working hours per day and (ii) mean hours of paid or unpaid overtime and their mean hours in another job per day. Reports of daily two-way commuting hours were multiplied by 5, for the weekly hours spent in commuting between work and home (women: mean 4.1, SD 2.9; men: mean 3.9, SD 2.8). Corresponding to one-way travelling times of up to 15 minutes, over 15 to 45 minutes, and over 45 minutes, the weekly commuting hours were grouped into the categories of up to 2.5 hours, over 2.5 to 7.5 hours, and over 7.5 hours per week, the latter cut-off point set as in a previous EU survey. The total working hours per week included hours in paid and domestic work added to hours spent in commuting between home and work (women: mean 61.3, SD 11.7; men: mean 56.9, SD 12.6). The components of total working hours were not inter-correlated (between paid and domestic hours, Pearson's r = 20.02; between paid and commuting hours, r = 20.00; and between domestic and commuting hours, r = 0.06), enabling them to be studied separately. To explore the effects of the differential exposures and to enable comparisons by gender, we divided the total working hours into the three categories of up to 50, over 50 to 75, and over 75 hours per week. Control over daily working hours Using a 1-5 scale (very little-very much), the responders rated their ability to influence the length of their workday and the starting and ending times of their workday, measuring control over daily working hours. The items focused on the employees' perception of the extent of personal control over daily working hours, a correlate of the practical possibilities of exerting such control. The mean of the two items was used (2.21, SD 1.2) and further divided into quartiles and median splits. A more detailed description of the worktime control instrument has been published elsewhere. 1