ORAL PRESENTATIONS
4. In longitudinal studies the time‐varying interaction between working conditions, onset and
aggravation of disease, and consequences for sustained employability is difficult to disentangle. How long does it take before strenuous working conditions lead to ill health? When do consequences of ill health for work participation become visible? How fast do workers with ill health adjust their work and work environment in order to remain productive?
The line of the last presentation will be:
a. Should we focus on classical measures of association (HR, OR etc.) or take a lifecourse perspective.
b. Introduction of working life expectancy as measure and working years lost as gap measure.
c. Illustration with research on disability in the Swedish construction industry.
d. Cconsiderations for future research, such as need to model exit from paid employment but also re‐entry, human capital or friction cost methods for societal consequences, working life
expectancy relative to life expectancy etc.With the audience we would like to discuss this broader interpretation of wellbeing at work and how we can organise in the future to be able to support effective solutions for workplaces and society.
Parallel session 3D
Symposium. Interaction between psychosocial and physical work environment on health and wellbeing at work
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Interaction between psychosocial and physical work environment on health and wellbeing at work: towards an investigation of the work environment ‘as it really is’
Thomas Clausen1, Stein Knardahl2, Reiner Rugulies1, Lars L Andersen1
1The National Research Centre for the Working Environment, Copenhagen, Denmark, 2National Institute of Occupational Health, Norway
When workers go to work they are simultaneously exposed to physical and psychosocial challenges and these combined exposures are likely to have an impact in their health and wellbeing. Much research has been conducted on (i) the impact of physical exposures during work on health and on (ii) the contribution of psychosocial work environment exposures on the health and wellbeing of
individuals. However, little, if any, research has been conducted on the interaction between physical and psychosocial work environment exposures in predicting outcomes pertaining to health, wellbeing and productivity of individuals.
The aim of this symposium is to present state‐of‐the art knowledge on this topic. First, we will present a conceptual framework for understanding the interrelatedness of psychosocial and physical work environment exposures and how this interrelatedness may be of importance for understanding work‐
related outcomes, such as productivity, wellbeing and sickness absence. Second, evidence from research will be presented. The aim of the symposium is to move forward integrated research in the simultaneous effects of physical and psychosocial work exposures to move work environment research closer to the actual work‐lives of working people.
The symposium will start with a presentation by Stein Knardahl, who discusses the interrelatedness of physical and psychosocial factors with particular emphasis on how exposures in the psychosocial work environment may affect risk for musculoskeletal disorders, e.g. in the low‐back or the neck‐ and
shoulder region.
In the second presentation Reiner Rugulies will present results from a meta‐analysis on the impact of exposures in the psychosocial work environment on the onset of muculoskeletal disorders in specific body‐regions. This metaanalysis inspired a new prospective study on the association psychosocial work environment and risk of onset of low‐back pain in eldercare workers that took potential
cofounding by the physical work environment and reporting bias into account. This study will also be presented in the symposium.
In the third presentation Lars L. Andersen will present new results from the Healthcare Worker Cohort on the prognosis for recovery from musculoskeletal pain among healthcare workers in relation to different psychosocial and physical work exposures.
Finally, Thomas Clausen will present results from new studies investigating whether exposures in the physical and psychosocial work environment jointly predicts outcomes related to sickness absence, productivity and organizational commitment. These results will contribute towards deepening our understanding on the interplay between psychosocial and physical work environment exposures in predicting wellbeing of employees.
72 KEYNOTE III
Integrated brain/body designs for improved wellbeing at work
mc Schraefel
University of Southampton, Hampshire, UK
We know, globally, our cultural practices at home and at work have become increasingly sedentary.
Our technology has likewise developed to support and reinforce these practices from ergonomic workstations at the workplace to networked video games at home. This sedentarism and its adverse health consequences are likewise becoming acknowledged in effects to GDP, from lost time at work due to chronic pain and stress, decreasing cognitive performance and increased costs to healthcare systems for lifestyle diseases, which show a major and growing impact on our future workforce.
There is, consequently, growing interest in interactive technology research to see how mobile and pervasive technology can be designed to address the body in a positive way. There are over 3000 smartphone apps in the health area. But what are the parameters of such designs? The current species are mainly informational, behaviour nudging or activity logs. These tools leave open questions like: are these kinds of tools effective? Are they optimal or even sufficient for their task? How evaluate them?
And in particular, is the space for interactive technology intervention broader than what is mostly self‐
monitoring of behaviour change?
In this keynote, Iʹll review a four part framework we have developed to help explore in a principled way this wellbeing performance design space. From the talk, participants will have a set of parameters from which to explore new opportunities for intervention and new challenges for design and
evaluation to support moving us culturally from homo sedentarius to homo praesignis or perhaps homo laetabilis.
Biography
Professor mc Schraefel, ph.d., cscs, c.eng, f.bcs is a Professor of Computer Science and Human
Performance at the University of Southampton in the UK where she is the deputy head of the Agents Interaction and Complexity Group and directs the Human Performance Design Lab, and where she holds a joint Royal Academy of Engineering / Microsoft Research Chair in Innovation Creativity and Discovery. Her work is focused on interrogating both where and how internet based, interactive technology can be designed to enhance wellbeing. One of the projects she leads is the five year ReFresh project from the Engineering and Physical Sciences Research Council in the UK to consider how
interactive technology may be situated in the work environment to cue physical and cognitive performance benefit, as well as help inform better environments for workplace wellbeing.
KEYNOTE IV
Well-being at work: creating a positive work environment
Boglárka Bóla
Prevention and Research Unit European Agency for Safety and Health at Work
Biography:
Ms Boglárka Bóla joined the European Agency for Safety and Health at Work in 2006 as a Network Manager for pre‐accession supporting candidate countries. She took up new duties at the Agency’s Prevention and Research Unit as a Project Manager a year ago to work on a project on Older workers delegated to the Agency by the European Parliament. Within the Older workers project she is
responsible for rehabilitation and return‐to‐work. Before joining the Agency she coordinated PHARE national programmes in Hungary. Ms Boglárka Bóla holds a Master’s degree in Economic Science in European Economic and Public Affaris from the University College Dublin, Dublin European Institute, Ireland.
Parallel session 4A
6 (I). Wellbeing and the management of ill health and disability at the workplace
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Influence of poor health on exit from paid employment: a systematic review
Rogier M van Rijn
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
Background: In most Western countries a higher and prolonged labour force participation throughout a worker’s life is necessary to safeguard the social and economic realities of an aging society. In order to achieve this ambition, governments are developing policies to stimulate labour force participation.
The success of the developed policies depends on better understanding of the relationship between the impact of health on labour force participation. In order to understand and quantify the importance of different health measures on labour market exit pathways, the literature needs to be synthesised.
Aim: To provide a systematic literature review on associations between poor health and exit from paid employment through disability pension, unemployment, and early retirement and to estimate the magnitude of these associations using meta‐analyses.
Methods: MEDLINE and EMBASE databases were searched for longitudinal studies on the relationship between health measures and exit from paid employment.
Studies were included if they fulfil all of the following criteria:
1. a health measure was described
2. exit from paid employment was defined as receiving disability pension, unemployment or early retirement
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3. the association between health and exit from paid employment was expressed in an odds ratio (OR), relative risk (RR) or hazard ratio (HR), or sufficient raw data was available to calculate associations
4. a longitudinal study design was used
5. the study had to involve a non‐patient population
6. the article was published in a peer reviewed scientific journal written in English.
Heterogeneity of the included studies was determined using I2 statistics. Due to the observed heterogeneity a random‐effects models was conducted to estimate the pooled effects.
Results: In total, 29 studies were included. Self‐perceived poor health was a risk factor for transition into disability pension (RR 3.61; 95 %CI 2.44, 5.35), unemployment (RR1.44; 95 %CI 1.26, 1.65), and early retirement (RR 1.27; 95 %CI 1.17, 1.38). Workers with mental health problems had an increased likelihood for transition into disability pension (RR 1.80; 95 %CI 1.41, 2.31) or unemployment (RR 1.61;
95 %CI 1.29, 2.01). Chronic disease was a risk factor for transition into disability pension (RR 2.11; 95
%CI 1.90, 2.33) or unemployment (RR 1.31; 95 %CI 1.14, 1.50), but not for early retirement.
Conclusion: This meta‐analysis showed that poor health, particularly self‐perceived health, is a risk factor for exit from paid employment through disability pension, unemployment and, to a lesser extent, early retirement. To increase sustained employability, it should be considered to implement workplace interventions that promote good health.
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Health inequalities in maintaining paid employment; a life course perspective based on working life expectancy in the Netherlands
Suzan J.W. Robroek1, Marieke Jesse2, Coos H. Arts3, Ferdy W.J. Otten3, Leo W. Bil2, Raymond G. Brood2, Alex Burdorf1
1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, 2Mercer Marsh Benefits, Amstelveen, the Netherlands, 3Statistics Netherlands, Heerlen, The Netherlands
Background: The concept of working life expectancy (WLE) can provide insight into the long‐term consequences of ill health on labour force participation.
Aim: This study aims to estimate the WLE stratified by sex and education, and describes the working time lost through several routes of exit from paid employment and the influence of ill health in the Dutch population.
Methods: In a representative sample of the Dutch population (N=15,152), the relation between ill health and labour force exit was studied using Cox proportional hazards analyses. WLE estimates applied on information of the Dutch population between age 25 and 65 (N=2,107,802) of which
Statistics Netherlands ascertained employment status monthly from the period 2001‐2010. Yearly age‐, gender, and education‐dependent transition probabilities of states of labour force (non‐)participation were calculated. WLE was estimated by using Sullivan lifetables and subsequently compared with a Sullivan lifetable using transition probabilities after full elimination of ill health, using population attributable fractions, to calculate the loss in WLE due to ill health.
Results: At age 25, lower educated men and women are expected to spend respectively 29.6 and 24.3 years in paid employment. Men and women with a high education have respectively 3.3 and 10.0 years
higher WLE at age 25. Most of the working time is lost due to leaving the workforce into no income, unemployment, disability benefits and early retirement. The loss in WLE due to self‐perceived poor or moderate health ranged between 20 weeks (men, high education) and 154 weeks (women, low
education).
Conclusions: WLE differs substantially between educational groups. Ill health is a determinant of working time lost, particularly among workers with a low educational level. Programmes to tackle determinants of ill health and to support those with ill health to remain at work are needed, particularly among workers with a low educational level.
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Work, Well-being and Wealth: The Indirect Cost of Socioeconomic Health Inequalities for Canadian Society
Emile Tompa
Institute for Work & Health, Canada
Aim: This study draws on a methodology developed by the lead author for the Public Health Agency of Canada to estimate the indirect cost of socioeconomic health inequalities for Canadian Society. The framing question for the study is: How much of a reduction in indirect health costs might be achieved if individuals in lower socioeconomic quintiles had the same health as the highest quintile?
Method: The indirect health costs considered in this study are of two forms: 1) loss of market output due to lower labour‐market participation and productivity associated with poor health, and 2) loss of health‐related quality of life associated with compromised social role functioning and the reduced intrinsic value of health. Regression modeling analysis was undertaken to estimate the impact of health status on labour‐market earnings for each quintile at baseline. Data on Health Utility Index values and mortality/life expectancy by socioeconomic quintile, age group and gender were used to identify baseline morbidity and mortality levels. Cost of reduced work and well‐being were estimated for Canadian society for calendar year 2007.
Results: Our estimate for calendar year 2007 of the indirect costs of socioeconomic status related health inequalities associated with paid labour‐force activity is $5.4 billion, which is approximately 0.4 % of GDP. Our estimate of the indirect costs associated with morbidity is $57.7 billion, or 3.77 % of GDP.
Our estimate for premature mortality is $97.3 billion, or 6.36% of GDP.
Conclusions: The total value of work and well‐being losses associated with socioeconomic health inequalities in Canada in 2007 is $160.4 billion, or 10.14 % of GDP. This value is comparable to a similar study by Mackenbach and colleagues that estimated a similar loss for Europe. Many indirect costs are not captured in our analysis, so the identified values are likely a conservative estimate of the true burden to Canadian society. Overall, the study substantially advances the measurement of the indirect costs of socioeconomic health inequalities. The findings have important implications for the provision of social supports to mitigate socioeconomic health inequalities.
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Effect of unhealthy behaviors on work ability: A prospective cohort study
Nina Nevanperä1, Jouko Remes1, Jorma Seitsamo2, Leila Hopsu2, Leena Ala-Mursula3, Jaana Laitinen1
1Finnish Institute of Occupational Health, Oulu, Finland, 2Finnish Institute of Occupational Health, Helsinki, Finland, 3Institute of Health Sciences, University of Oulu, Oulu, Finland,
Background: Very little evidence exists of the cumulative effects of unhealthy behaviors on work ability and of the longitudinal associations between unhealthy behaviors and work ability.
Objectives: To investigate the cumulative effects of unhealthy behaviors at the age of 14–46 on work ability at the ages of 31 and 46.
Participants and methods: The study population included employed 46‐year‐old men and women (n~2000) who were born in Northern Finland in 1966. Data on their current perceived work ability compared to lifetime best (scale 0 to 10; the first item of the Work Ability Index), and health behaviors (leisure time physical activity, smoking, alcohol consumption and stress‐related eating and drinking) were assessed by postal questionnaires at the ages of 14, 31 and 46. Sum scores of unhealthy behaviors were calculated.
Linear regression models were used to investigate the effects of cumulative unhealthy behaviors during different lifetime periods on work ability. The analyses were controlled for basic education, physical strenuousness of work and job stress.
Results: Sum scores of unhealthy behaviors (at the age of 14 to 46) significantly predicted the level of work ability at the age of 46. The more unhealthy behaviors a participant had, the greater the decrease in work ability score. Accordingly, unhealthy behaviors from the age of 14 to 31 affected work ability at 31 years and unhealthy behaviors from the age of 31 to 46 years explained work ability at 46 years.
Conclusions: A cluster of unhealthy behaviors increase the risk of deteriorated work ability, especially when they continue from adolescence.
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Workplace interventions for preventing work disability
Myrthe van Vilsteren
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Introduction: Work disability has serious consequences for individuals as well as society. Workplace interventions are considered appropriate to facilitate return to work by reducing barriers to return to work and promoting collaboration with key stakeholders. The aim of this updated Cochrane review was to determine the effectiveness of workplace interventions compared to usual care on work‐related outcomes and health outcomes.
Methods: We searched the Cochrane Occupational Safety and Health Field Trials Register, CENTRAL, MEDLINE and Embase and PsycINFO databases till July 2012. We included randomised controlled
trials of workplace interventions aimed at return to work for workers where sickness absence was reported as a continuous outcome. Meta‐analysis and analysis of quality (using GRADE levels of evidence) were performed.
Results: In total we included eight RCTs concerning workers with musculoskeletal disorders, four concerning workers with mental health problems, and one concerning workers with cancer. There is low‐quality evidence to support that workplace interventions are more effective than usual care in reducing sickness absence, due to large heterogeneity between studies. We found moderate‐quality evidence to support that workplace interventions are more effective than usual care to reduce sickness absence among workers with musculoskeletal disorders. Workplace interventions were also effective in improving health outcomes among workers with musculoskeletal disorders, with low‐quality evidence. The four studies on mental health problems and one study on cancer showed no beneficial effects of workplace interventions on sickness absence.
Conclusions: We observe that the effectiveness of workplace interventions differs among workers with specific health conditions, therefore, we do not recommend to apply workplace interventions for all causes of sickness absence. Workplace interventions may be considered for work disabled workers with musculoskeletal disorders if the main goal is to return to work.
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Strength training reduces pain and prevents deterioration of work ability among slaughterhouse workers with chronic pain and work disability: single-blind, randomized controlled trial
Emil Sundstrup1, Markus Due Jakobsen1, Mikkel Brandt1, Kenneth Jay1, Roger Persson2, Per Aagaard3, Lars Andersen1
1National Research Centre for the Working Environment, Copenhagen, Denmark, 2Departmentof Psychology, Lund University, Sweden, 3Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
Background: Work related musculoskeletal disorders are often accompanied by an escalating
imbalance between work demands and individual resources consequently affecting work participation and overall working life.
Aim: The aim of this study was to evaluate the effect of two contrasting intervention modalities on pain intensity and work ability among slaughterhouse workers with chronic pain and work disability.
Method: Sixty‐six slaughterhouse workers with upper limb chronic pain and work disability were randomly allocated to 10 weeks of specific strength training for the shoulder, arm and hand muscles for 3 x 10 minutes per week, or ergonomic training (usual care control group). The outcome measures were the change from baseline to 10‐week follow‐up in pain intensity (average of shoulder, arm and hand, scale 0‐10) and work ability index (WAI).
Results: Pain intensity and work ability improved more following strength training than usual care ergonomic training (p<0.001 and p<0.05, respectively). Pain intensity decreased 1.5 (95% confidence interval ‐2.0 to ‐0.9) and WAI increased 2.3 (0.9 to 3.7) following strength training compared with usual care, corresponding to a large and moderate effect size, respectively (Cohen’s d). Within‐group
changes indicated that between‐group differences in work ability were mainly caused by a reduction in WAI in the ergonomic group. Of the seven items of WAI, item two (work ability in relation to the
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demands of the job) and item seven (mental resources) increased following strength training compared with ergonomic training (P<0.05).
Conclusions: Implementation of strength training at the work place results in clinical relevant
improvements in pain and prevents further deterioration in work ability among workers with chronic pain and work disability exposed to forceful and repetitive job tasks.
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Workplace services and help-seeking for negative emotional consequences of working with aggressive clients
Jennifer M. Hensel1, Carolyn S. Dewa2
1University of Toronto, Canada, 2Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Ontario
Background: Among human service workers who care for adults with intellectual and developmental disabilities (IDD), exposure to violent client behaviour may be an inevitable part of the job.
Associations have been reported between exposure to aggression and negative emotional outcomes such as stress and burnout. Recent legislation in Ontario, Canada requires that workplaces have policies and procedures to assess, manage and respond to the risk and consequences of exposure to violence in the workplace.
Aim: This study sought to further the understanding of the help‐seeking behaviours for emotional problems among residential staff caring for adults with IDD and aggressive behaviour, as well as their perceived needs.
Methods: This study used a cross‐sectional exploratory design with mixed methods. The target population was front‐line support staff from a region in Ontario, Canada, who work in community residential settings and were exposed to, or at risk of exposure to aggressive client behaviour. Survey data and qualitative data from semi‐structured interviews were collected and analyzed. Survey data assessed demographic and occupational factors, exposure to aggressive client behaviour, emotional outcomes, burnout, self‐efficacy and positive perceptions staff have for their work. A logistic regression analysis was conducted to examine predictors of resource use. Interviews focused on identifying the barriers and facilitators of help‐seeking for emotional sequelae of exposure to aggression and staff perceived needs. Qualitative data were analyzed thematically using grounded theory techniques.
Results: Survey results (N=110) showed that having access to sick benefits was the only significant predictor of workplace service use. Qualitative interviews (N=19) highlighted the roles of innate abilities to care for people to act aggressively, finding relief through regulating exposure and
psychological distancing, team support, workplace culture, personal illness beliefs, personal impact of symptoms and personal resources, workplace resource availability and utility and the perception of an organizational focus on client care. Staff described perceived needs at multiple levels of the
organization, however most often they desired team and management‐level interventions.
Conclusions: Many factors influence help‐seeking among front‐line staff who support adults with IDD. Little expressed need for individual interventions, suggests the need to consider a more top‐
down approach whereby the organizational culture shifts first, followed by team and individual level interventions as indicated.