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Objectives The aim of this study was to determine the joint association of multimorbidity and work ability with the risk of long-term sickness absence (LTSA) in the general working population. Methods Cox regression analysis censoring for competing events (statutory retirement, early retirement, disability pension, immigration, or death) was performed to estimate the joint association of chronic diseases and work ability in relation to physical and mental demands of the job with the prospective risk for LTSA (defined as ≥6 consecutive weeks during 2-year follow-up) among 10 427 wage earners from the general working population (2010 Danish Work Environment Cohort Study). Control variables were age, gender, psychosocial work environment, smoking, leisure physical activity, body mass index, job group, and previous LTSA. Results Of the 10 427 respondents, 56.8% had experienced ≥1 chronic disease at baseline. The fully adjusted model showed an association between number of chronic diseases and risk of LTSA. This association was stronger among employees with poor work ability (either physical or mental). Compared to employees with no diseases and good physical work ability, the risk estimate for LTSA was 1.95 [95% confidence interval (95% CI) 1.50-2.52] for employees with ≥3 chronic diseases and good physical work ability, whereas it was 3.60 (95% CI 2.50-5.19) for those with ≥3 chronic diseases and poor physical work ability. Overall, the joint association of chronic disease and work ability with LTSA appears to be additive. Conclusions Poor work ability combined with ≥1 chronic diseases is associated with high risk of long-term sickness absence in the general working population. Initiatives to improve or maintain work ability should be highly prioritized to secure sustainable employability among workers with ≥1 chronic diseases.

Although the hazardous health effects of a sedentary lifestyle are well known, many adults struggle with regular physical activity. Simple and efficient encouragements for increased physical activity are needed. To determine the effect on cardiovascular health of email-based encouragements to do daily stair-walks at work together with colleagues among adults in sedentary occupations. A single-blind randomized controlled trial was performed at a large administrative company in Copenhagen, Denmark. Participants were 160 office workers (125 women, 35 men; mean age 42 years, SD 10; sitting 89.5% of work time). At baseline, aerobic fitness was 37 mL/min/kg (SD 9), mean blood pressure was 118/79 mmHg (SD 14/9), and mean body mass index (BMI) was 23 kg/m(2) (SD 4). Participants were randomly assigned (2:1 ratio) to an email group receiving weekly email-based encouragements to walk the stairs for 10 minutes a day or to a control group receiving weekly reminders to continue their usual physical activities. The primary outcome was the change from baseline to 10-week follow-up in aerobic fitness determined from a maximal cycle test. The examiner was blinded to group allocation. Adherence to the email encouragements was fairly high with 82.7% of the participants performing at least 3 sessions of 10-minute stair-walks per week (mean 3.3, SD 1.3). Mean heart rate reached 167 beats/min (SD 10) during stair-walks. In the intention-to-treat analysis, aerobic fitness increased 1.45 mL/min/kg (95% CI 0.64-2.27) at 10-week follow-up in the email group compared with the control group. In participants with low aerobic fitness at baseline (n=56), aerobic fitness increased 1.89 mL/min/kg (95% CI 0.53-3.24), and systolic and diastolic blood pressure decreased 4.81 mmHg (95% CI 0.47-9.16) and 2.67 mmHg (95% CI 0.01-5.32), respectively, in the email group compared with the control group. Body weight decreased in the email group of those with low aerobic fitness compared with the control group, but this was not statistically significant. Simple and inexpensive email-based encouragements to do daily stair-walks together with colleagues at work improves cardiovascular health among adults in sedentary occupations. There exists an enormous potential to prevent the hazardous health effects of a sedentary lifestyle through the use of email-based encouragements to do short bouts of physical activity at the workplace. Clinicaltrials.gov NCT01293253; http://clinicaltrials.gov/ct2/show/NCT01293253 (Archived by WebCite at http://www.webcitation.org/6HWG2jw68).

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51–5.10) for 1–4 transfers per day, OR 7.60 (5.14–11.22) for 5–8 transfers per day, and OR 8.03 (5.26–12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85–5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

High physical work demands increase the risk of musculoskeletal disorders and sickness absence. Supermarket work involves a high amount of manual material handling. Identifying specific ergonomic risk factors is an important part of occupational health and safety efforts in the supermarket sector. In this cross-sectional field study among 64 supermarket workers, we used electromyography during the workday to determine the influence of lifting height and load mass on muscular workload of the low-back and neck/shoulder muscles during un-restricted manual material handling (grocery stocking). We found a significant effect of load mass, i.e., higher loads associated with higher muscular workload in the low-back and neck/shoulder muscles. We demonstrated a significant interaction between start and end position, i.e., lifts performed from ‘Low’ start positions to ‘High’ end positions demonstrated the highest low-back muscular workload, whereas ‘High’ positions were associated with increased neck/shoulder workload. In conclusion, lifting higher loads and lifting goods from low to high positions (low-back) and at high positions (neck/shoulder) are associated with higher muscular workload. These results can be used to guide highly warranted preventive initiatives to reduce the physical workload during supermarket work.

Introduction Exercise programmes are used in the prevention and treatment of adductor-related groin injuries in soccer; however, there is a lack of knowledge concerning the intensity of frequently used exercises. Objective Primarily to investigate muscle activity of adductor longus during six traditional and two new hip adduction exercises. Additionally, to analyse muscle activation of gluteals and abdominals. Materials and methods 40 healthy male elite soccer players, training >5 h a week, participated in the study. Muscle activity using surface electromyography (sEMG) was measured bilaterally for the adductor longus during eight hip adduction strengthening exercises and peak EMG was normalised (nEMG) using an isometric maximal voluntary contraction (MVC) as reference. Furthermore, muscle activation of the gluteus medius, rectus abdominis and the external abdominal obliques was analysed during the exercises. Results There were large differences in peak nEMG of the adductor longus between the exercises, with values ranging from 14% to 108% nEMG (p<0.0001). There was a significant difference between legs in three of the eight exercises (35–48%, p<0.0001). The peak nEMG results for the gluteals and the abdominals showed relatively low values (5–48% nEMG, p<0.001). Conclusions Specific hip adduction exercises can be graded by exercise intensity providing athletes and therapists with the knowledge to select appropriate exercises during different phases of prevention and treatment of groin injuries. The Copenhagen Adduction and the hip adduction with an elastic band are dynamic high-intensity exercises, which can easily be performed at any training facility and could therefore be relevant to include in future prevention and treatment programmes.

OBJECTIVES: Sustained activity of the upper trapezius muscle during work has been linked to the development of neck pain. Women have higher occurrences of neck pain than men, even in the same occupations. This study aimed to investigate sex-specific associations between upper trapezius muscle activity time-related variables and neck pain using a meta-analysis of pooled data. METHODS: Seven Scandinavian research institutes provided surface electromyographic (EMG) data on the upper trapezius muscle activity during work and related questionnaire-based data on neck pain severity. EMG and questionnaire data were harmonized and pooled. Associations between upper trapezius muscle activity variables [median muscle activity, frequency of muscular rest periods, and periods with sustained muscle activity (SUMA)] and neck pain severity were investigated separately for women (N=293) and men (N=418) using linear regression analyses. RESULTS: In the cross-sectional analyses, women showed significant positive associations between the number of short SUMA periods and negative associations for long SUMA periods in regard to neck pain severity. In the longitudinal analyses, women showed no significant associations. In the cross-sectional analysis for men, one significant positive association was found between median upper trapezius muscle activity and neck pain severity. CONCLUSIONS: Compared to men, neck pain severity among women appears to be more dependent on upper trapezius muscle activity patterns at work. Therefore, ergonomic and organizational recommendations for work should be sex-specific or adjusted for women to reduce their prevalence of neck pain. Further research is needed to elucidate the underlying mechanisms of these sex differences.

Multiple studies have reported high prevalence of musculoskeletal disorders among supermarket workers. Technical field measurements can provide important knowledge about ergonomic risk factors for musculoskeletal disorders in the physical working environment, but these measurements are lacking in the supermarket sector. Therefore, using wearable electromyography and synchronous video recording in 75 supermarket workers, this cross-sectional study measured muscular workload during stocking activities in six different types of general store departments and during the thirteen most common work tasks across five different supermarket chains. Our results showed that muscular workload varies, especially for the low-back muscles, across (1) supermarket chains, (2) departments, and (3) specific stocking activities. Highest workloads of the low-back and neck/shoulders were seen in the fruit and vegetables department and during heavy, two-handed lifts of parcels (especially without using technical aids). In conclusion, physical work demands during supermarket stocking activities differ between chains, departments, and work tasks. These results can be used by company representatives and work environment professionals to specifically address and organize the stocking procedures to reduce the muscular workload during supermarket stocking.

Objective This study aimed to investigate the association between occupational lifting and day-to-day change in low-back pain (LBP) intensity. Methods Each day for three consecutive weeks, 95 full-time workers from 51 Danish supermarkets with frequent occupational lifting replied to daily text messages about LBP intensity (scale 0-10). Supervisors at the supermarkets provided information about daily working hours and load (number of different pallets handled) for each worker during the three weeks. Linear mixed models with repeated measures tested the association between variables controlled for LBP during the previous day and various confounders. Results Workers handled on average 1212 [standard deviation (SD) 861] kg and worked 8.5 (SD 1.8) hours per workday. LBP intensity was higher in the morning after work- compared with non-workdays [difference of 0.55, 95% confidence interval (95% CI) 0.39-0.71]. A cumulative effect of consecutive workdays existed, ie, pain intensity increased approximately 0.30 points per day for up to three days. For three consecutive work-compared with non-workdays, the difference was 0.92 (95% CI 0.50-1.34). Higher load resulted in higher pain intensity in the morning after workdays [0.16 (95% CI 0.02-0.31) per ton lifted], while no effect was found for number of daily working hours. Conclusion Among workers with frequent occupational lifting, workdays are associated, in a cumulative manner, with increased LBP intensity. Furthermore, an exposure-response association exists between workload and increased LBP intensity. However, the increase in pain intensity was small and future studies should assess whether long-term consequences exist.

Objectives: The capability of safety climate to predict accidents has been the target of widespread debate in occupational health and safety research. The objective of this prospective cohort study was to employ a shortened five-item safety climate survey to investigate whether safety climate reports in 2012 are predictive for accidents reported within the last 12 months in 2014. Methods: In both 2012 and 2014, 3864 blue-collar workers answered the Danish Working Environment and Health Cohort Study. Logistic regression was used to study the association [odds ratio (OR)] of reporting a work-related accident (yes/no) with more than one day of sickness absence (outcome) within the last 12 months in 2014 with the number of safety climate problems (predictor). The analyses were cumulatively adjusted for age, gender (model 1), socioeconomic class, occupational group, lifestyle (model 2), and previous accidents in 2012 (model 3). Results: Of the safety climate problems reported in 2012, 1017 (28%) participants reported one problem, 357 (10%) reported two and 614 (17%) reported three or more problems. Using the number of safety climate problems as a continuous variable, all models showed a dose-response relationship between number of safety climate problems in 2012 and at least one accident in 2014 (trend-test, P＜0.001). Compared to participants with no safety climate problems, participants reporting two safety climate problems in 2012 had a higher risk for reporting an accident in 2014 [OR 1.84, 95% confidence interval (CI) 1.22-2.77], and the risk was higher for participants reporting three or more safety problems (OR 2.22, 95% CI 1.60-3.09). Conclusions: A higher number of safety climate problems progressively increased the OR for reporting at least one accident within the last 12 months at the two-year follow-up. The five-item safety climate survey is a simple and important tool that can be used as part of risk assessment in blue-collar workplaces.

Chronic musculoskeletal pain is widespread in the working population and leads to muscular fatigue, reduced work capacity, and fear of movement. While ergonomic intervention is the traditional approach to the problem, physical exercise may be an alternative strategy. This secondary analysis of a randomized controlled trial investigates the effect of strength training on muscular fatigue resistance and self-rated health among workers with chronic pain. Sixty-six slaughterhouse workers with chronic upper limb pain and work disability were randomly allocated to 10 weeks of strength training or usual care ergonomic training (control). At baseline and follow-up, participants performed a handgrip muscular fatigue test (time above 50% of maximal voluntary contraction force) with simultaneous recording of electromyography. Additionally, participants replied to a questionnaire regarding self-rated health and pain. Time to fatigue, muscle strength, hand/wrist pain, and self-rated health improved significantly more following strength training than usual care (all P<0.05). Time to fatigue increased by 97% following strength training and this change was correlated to the reduction in fear avoidance (Spearman’s rho =-0.40; P=0.01). In conclusion, specific strength training improves muscular fatigue resistance and self-rated health and reduces pain of the hand/wrist in manual workers with chronic upper limb pain. This trial is registered with ClinicalTrials.gov NCT01671267.