Exposure assessment : Gender and context, and target groups for prevention of neck/shoulder and low back pain

Neck/shoulder and low back pain are the most frequent sources of pain complaints, health care utilization, and lost work time. The etiology is multifactorial, and includes physical and psychosocial working conditions, outside work conditions, and psychological factors. The sizable number of females and males suffering from neck/shoulder and low back pain underscores the societal importance of the problem, emphasizing that there is urgent need for effective strategies to address it. The main aim of this thesis is to broaden the understanding of gender and context in both the assessment of physical load exposure and the identification of target groups of prevention of neck/shoulder and low back pain. This thesis is based on the MOA Study and the MUSIC-Norrtälje Study. In Paper I, the reproducibility and the validity of eight physical load questions in a public health questionnaire were evaluated by the test-retest method and by a structured personal interview (n=203). Paper II investigated if and how exposure to awkward work postures is associated with occupational gender segregation. Direct measurements of sitting, arm and trunk postures were taken with two different technical instruments on 78 matched pairs of one female and one male worker over one full workday in diverse labor markets (n=156). Paper 3 took an exploratory approach to identification of potential target groups for prevention of neck/shoulder and low back pain, using cluster analysis of 15 variables on different aspects of working and living conditions (n=1,341). In Paper 4 these clusters or groups were followed up after 5 years with respect to neck/shoulder and low back pain, and care seeking during the follow-up period (n=1,095). Six of the eight questions had high or moderate accuracy and thus can be recommended for questionnaires to study health effects in epidemiological studies. Two questions on bent/twisted work posture and repetitive movements had low accuracy and should be avoided, at least in general population studies. Gender, type of work, and musculoskeletal complaints did not influence the ability to respond to the physical load questions. Level of exposure to awkward work postures was associated with vertical occupational segregation, and this appeared to be most prominent in female-dominated jobs. Female and male workers in such jobs with low status and authority had the overall highest exposure levels. Eleven groups with different working and living conditions were identified. Four of the groups had an increased risk for persistent neck/shoulder or low back pain 5 years after the baseline measurements (OR 2.4 2.6). The working and living conditions of these four groups had quite different features, but were all characterized by an overstrained situation. In three of them, the working and living conditions were rather gender-specific. In conclusion, this thesis emphasizes the need for both reevaluation and redesign of old questionnaire instrument, as well as the requirement for new questions relevant for contemporary work situations. Structural factors in the labor market, such as occupational gender segregation, need to be addressed in order to decrease physical load exposure, especially in female-dominated jobs. Gender sensitive methods are essential in both research and prevention. Different broad-based prevention strategies are needed for different groups, i.e., a selective public health approach in prevention. Cluster analysis seems to be a practicable method for identifying target groups for primary/secondary prevention

Development of structural components for ANTLE and CLEAN, the European technology validator engines

Volvo Aero is responsible for design, development and manufacturing of the rear turbine structures in ANTLE and CLEAN as well as for the CLEAN LP turbine case and CLEAN engine assembly. This paper gives an outline to all Volvo Aero activities in ANTLE and CLEAN. Subsequent papers will go more into the details of welding 1,2 and heat treatment 2 as developed by Volvo Aero in EEFAE. The EEFAE engines are now tested and all Volvo Aero components performed well.Godkänd; 2005; Bibliografisk uppgift: 1 CD-ROM; 20071202 (tobias

Hur kan könsskillnader i arbets- och livsvillkor förstås? : Metodologiska och strategiska aspekter samt sammanfattning av MOA-projektets resultat ur ett könsperspektiv

How can gender differences in work and living conditions be understood? Aspects on methods and strategies in research and a summary of the results of the MOA-project from a gender perspective To investigate and compare women's and men's work and living conditions is not an easy task. This is, among other things, due to the fact that gender research is an area where many different theories and models of explanations are claimed. Sometimes there are great differences both in ideology and scientific frames of reference and point of departure. It is also a question of the widespread gender segregation in our society. The objective of the MOA-study ÒModern Work and Living Conditions for Women and Men" has been to develop methods better adjusted to modern work and living conditions. In this work the gender perspective was of central interest. The report summarises results and conclusions of earlier as well as new qualitative and quantitative analyses which are relevant for gender comparative studies of work and life conditions. Through the combination of different theoretical and methodological strategies in an empirical study we wish to contribute to a deeper understanding in what constitutes the gender differences and how they can be explained. The strategies used and discussed in the report are: The selection design; particularly gender matched sampling. Methodological testing; using different methods for data collection and analyses (triangulation); investigating the reliability, validity, relevance and meaning of questionnaire items and classification of occupations as indicator on exposure and position for women and men. Variable oriented and person oriented approaches in gender comparative analyses. Combining quantitative and qualitative methods of analyses. Structural perspective. The meaning of the gender segregation is analysed. Women's and men's work conditions in different sectors on the labour market are investigated and compared. Data are collected on different levels and combined. Interaction between levels is analysed. Overall perspective is applied on women's and men's work- and living conditions in order to study the consequences of total work load, the distribution of responsibility in the family, the interface between the work sphere and the private sphere and the time allocated in paid and not paid activities. Interdisciplinary perspective (social, psychological, ergonomical and chemical/physical working conditions). The empirical results from the MOA-project's many different analyses are used as an illustration on how similarities and differences between gender can be studied. Data on individual level and organisational and labour market levels have been combined and analysed in different constellations. The report starts with methodological and strategic questions relevant to studies on gender and work. After that the results from the MOA-project are concluded in relation to the chosen strategies. The report continues with two sections where the results of deeper analyses are summed up. Furthermore, methods and strategies for gender comparative studies as well as mechanisms of reshaping gender segregation are discussed. Finally, proposals are given on strategies and questions for continuing research. Our hope is that the chosen approach, i.e. to Òcut" a project from how the gender perspective has been highlighted in a variety of questions, can bring useful knowledge to coming research in the area gender, work and health.Att undersöka och jämföra kvinnors och mäns arbets- och livsvillkor är ingen lätt uppgift. Det beror bland annat på att genusforskning är ett värdeladdat område där många olika teorier och förklaringsmodeller hävdas, ibland med stora skillnader i såväl ideologi som vetenskapliga referensramar och utgångspunkter. Det beror också på att könssegregeringen är så omfattande i vårt samhälle. Syftet med MOA-projektet "Moderna arbetsvillkor och angränsande livsvillkor för kvinnor och män" var att utveckla metoder anpassade till dagens arbets- och livsvillkor. I detta arbete var könsperspektivet en central fråga. I denna rapport sammanfattas projektets resultat och slutsatser av relevans för könsjämförande studier av arbets- och livsvillkor. Här presenteras också nya resultat av fördjupade kvantitativa och kvalitativa analyser. Genom att kombinera olika teoretiska och metodologiska strategier i en empirisk studie vill vi bidra till att fördjupa förståelsen vari könsskillnaderna består och hur de kan förklaras. De strategier som används och som diskuteras i rapporten är: Urvalsdesign, särskilt könsmatchat urval. Metodprövning: Användning av olika metoder för datainsamling och analys (triangulering). Undersökning av mätmetoders reliabilitet, validitet, relevans och innebörd samt klassifikation av yrken som indikator på exponering och position för båda könen. Könsjämförande analyser med variabelansats och personansats av enskilda variabler respektive samband mellan variabler. Kombination av kvalitativa och kvantitativa analysmetoder. Strukturellt perspektiv: Betydelsen av könssegregering analyseras. Kvinnors och mäns arbetsförhållanden i olika sektorer av arbetsmarknaden undersöks och jämförs. Data insamlade på olika nivåer kombineras och interaktion mellan nivåer analyseras. Helhetsperspektiv på kvinnors och mäns arbets- och livssituation för att studera betydelsen av total arbetsbelastning, ansvarsfördelning i familjen, gränsen mellan arbetssfären och den privata sfären samt tidsfördelningen i betalda och obetalda aktiviteter. Tvärvetenskapligt perspektiv (sociala, psykologiska, ergonomiska och yrkeshygieniska arbetsförhållanden). De empiriska resultaten från MOA-projektets många olika analyser används som en illustration på hur likheter och skillnader mellan könen kan studeras. Data på individnivå, organisationsnivå och arbetsmarknadsnivå kombineras och analyseras i olika konstellationer. Rapporten inleds med ett avsnitt om metodologiska och strategiska frågeställningar av relevans för studier av kön och arbete. Därefter sammanfattas resultaten från MOA-projektet i relation till de valda strategierna. Rapporten fortsätter med två avsnitt där resultat från fördjupade analyser sammanfattas. Till sist diskuteras hur könsskillnader och könssegregeringens mekanismer kan studeras och förstås och förslag ges på strategier och frågeställningar för fortsatt forskning. Vår förhoppning är att den valda ansatsen, dvs att "skära" ett projekt utifrån hur könsperspektivet har belysts i en mängd olika frågeställningar, kan tillföra användbar kunskap för kommande forskning i området kön, arbete och hälsa

Work and health among immigrants and native Swedes 1990-2008 : a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality

Background There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. Methods This study included migrants to Sweden since 1960 who were 28--47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. Results Nordic immigrants had increased risks for all investigated disorders and mortality, while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. Conclusions Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers

Work and health among immigrants and native Swedes 1990-2008 : a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality

Background There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. Methods This study included migrants to Sweden since 1960 who were 28--47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. Results Nordic immigrants had increased risks for all investigated disorders and mortality, while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. Conclusions Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers

LOW-BACK PAIN DISORDERS AS OCCUPATIONAL DISEASES IN THE CZECH REPUBLIC AND 22 EUROPEAN COUNTRIES: COMPARISON OF NATIONAL SYSTEMS, RELATED DIAGNOSES AND EVALUATION CRITERIA

Low-back pain diseases (LBPD) belong to the most frequent diagnoses determined by general practitioners, and constitute one of the most common reasons for sick leave and permanent disability pension in the Czech Republic and other European countries. Epidemiological studies have shown a statistically significant association between LBPD and certain types of occupational burden. However, in the Czech Republic, LBPD caused by overload and/or whole-body vibrations have not yet been included in the list of occupational diseases. The aim of this study was to collect and compare the systems, criteria and diagnoses used to recognize LBPD as occupational diseases in other European countries.status: publishe