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Oral Session 18 – Psychosocial factors

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N. Chau, J. F. Ravaud, E. Bourgkard, J. Sanchez, M. Choquet, J. P. Meyer, C. Otero Sierra, J. P. Michaely, B. Legras, F. Guillemin, A. Bhattacherjee, S. Guillaume, A. Dazord, L. Méjean, N. Tubiana-Rufi, Y. Schléret, J. M. Mur.INRS, Département Epidémiologie en Entreprises, Vandoeuvre-lès-Nancy, France

Introduction: Continual social pressure and particularly demanding jobs can result in fatigue and psychosomatic disorders.

Objective: To assess the relationship of demanding work conditions with psychotropic drug use (fatigue, headache, sleeplessness, nervousness, and anguish) among employed people.

Methods: The sample included 2826 working subjects randomly selected from the Lorraine area in northeastern France. A postal questionnaire was filled in by the subjects. It included sociodemographic characteristics, living conditions, regular psychotropic drug use for fatigue, headache, sleeplessness, nervousness, and anguish, and highly demanding occupational hazards (use of hammer, screwdriver, hand tools with vibration, and machine tools; shocks; workplace with vibration; incorrect work posture; noise, heat, cold, artificial light, and heat radiation; standing about and walking; tasks at high level, work in adverse climates; handling objects; working on a production line; pace; and physical and mental workload). The data were analysed via adjusted odds ratios.

Results: The prevalence of regular psychotropic drug use was 3.8% for fatigue, 21.5% for headache, 4.3% for sleeplessness, 7.1% for nervousness and anguish, and 30.0% for all disorders combined. The workers subjected to at least one hazard (we only considered the hazards linked with at least one drug use with p<0.10) had increased drug use for fatigue (odds ratio adjusted on age, sex, and job of 1.66; 95% confidence interval 1.02 to 2.69), headache (1.39; 1.12 to 1.73), sleeplessness (2.46; 1.46 to 4.13), nervousness and anguish (2.00; 1.36 to 2.91), and for all disorders combined (1.60; 1.31 to 1.94). A relationship was found between the number of hazards (NH) and the use of at least one psychotropic drug. Specifically compared with the NH 0 group, the groups NH 1−2, NH 3–4, and NH ⩾5 had adjusted odds ratios of 1.44 (1.15 to 1.75), 1.66 (1.26 to 2.20), and 2.74 (1.83 to 4.09) respectively.

Conclusions: Demanding work conditions may cause fatigue and psychosomatic disorders. Prevention should be aimed at reducing occupational hazards, particularly when there is a large number of them.


K. Radon1, S. Huemmer1, H. Dressel1,2, D. Windstetter1,3, G. Weinmayr2, S. Weiland2, E. Riu1, C. Vogelberg4, W. Leupold4, E. von Mutius3, MarkGoldberg5, D. Nowak1.1Institute for Occupational & Environmental Medicine Munich, Germany; 2Department of Epidemiology, Ulm, Germany; 3Children’s Hospital, Munich, Germany; 4Children’s Hospital, Dresden, Germany; 5McGill University, Montréal, Canada

Introduction: Population based prospective studies on atopic diseases among teenagers entering the labour force are scarce. Nevertheless, existing guidelines advise asthmatic and allergic adolescents against high risk occupations.

Objective: To investigate the resulting healthy hire effect due to self selection in a prospective cohort study.

Methods: Participants of the ISAAC II study in Munich and Dresden (aged 9−11 years at baseline) were re-contacted after 7 years (response rate 77%). The questionnaire included validated items taken from the ISAAC and ECRHS questionnaires. Subjects were also asked about the type of job they would like to have in the future (preferred job choice). The jobs were double coded according to ISCO-88 and exposure to agents with high, low, or no asthma risk was evaluated using an asthma specific job exposure matrix. Nominal logistic regression was used to assess predictors for these exposure categories. Current asthma and allergic rhinitis as predictors were evaluated in separate models. As potential confounders we considered city, sex, nationality, student or vocational trainee, parental asthma, and SES.

Results: Of the 3782 adolescents, 57% specified a preferred job choice. Respondents were more likely to live in Dresden, to be in vocational training, and to have asthma. Jobs with high asthma risk were chosen by 28% of subjects, 16% selected jobs with low asthma risk, and the remaining adolescents indicated jobs without asthma risk (reference group). There was no association between having asthma and selecting jobs with asthma risk (odds ratio and 95% confidence interval: high risk jobs 1.1 (0.8 to 1.5); low risk jobs 1.2 (0.8 to 1.8)) nor allergic rhinitis (high risk jobs: 1.1 (0.8 to 1.5); low risk jobs: 1.2 (0.8 to 1.7)). Major predictors selecting a high risk occupation were being a vocational trainee (2.2; 1.8 to 2.8) and German nationality (1.6; 1.1 to 2.5). Boys were less likely to prefer high risk occupations (0.7; 0.6 to 0.9). The major predictor for low risk occupations was being in vocational training (2.6; 1.9 to 3.4) and male sex (3.3; 2.5 to 4.3).

Conclusions: We did not find any indication for a healthy hire effect in this cohort at the start of their professional career. This suggests that existing guidelines are not implemented by physicians and career counsellors.


P. Kristensen1, T. Bjerkedal2.1National Institute of Occupational Health, Oslo, Norway; 2Division of Military Medical Research and Development, Joint Norwegian Medical Services, Oslo, Norway

Introduction: Current health and work environment quality are often considered as determinants in the study of sickness absence. Life course studies indicate that social factors early in life may influence adult health.

Objective: To assess if this applies to sickness absence in young adults as well.

Methods: We established a cohort of all subjects in Norway born between 1967 and 1976 (n = 626 928). Information on index subjects and their parents were retrieved in national registers (Medical Birth Registry of Norway, National Insurance Administration, Statistics Norway, and Central Population Register). The main study determinant was an index variable constructed from parental characteristics during the index person’s childhood and adolescence: educational attainment, family pattern, marital history, disability pension, income, and maternal age. The study outcome was the first sickness absence spell during 2000–2003, defined as absence resulting in Insurance Administration compensation (spells usually lasting more than 2 weeks). We computed hazard ratios in Cox regression, adjusting for year of birth, parity, birthweight, childhood chronic disease, and geographical region. Analysis was restricted to 363 312 index subjects who had finished their education, did not receive disability pension, had income above the level entitling compensation, and did not have a sickness absence at 1 January 2000.

Results: In 2000–2003, 61.0% of the women and 25.0% of the men had at least one absence spell. The 4 year risk of absence in men was associated with early social disadvantage in a dose dependent fashion (increase from 11.8% to 48.6%). Among women, the absence risk increased from 54.8% to 70.6% according to social index level. Based on adjusted models, the percentage of total absence hazard that could be ascribed to parental social factors was 57% for men and 17% for women. Associations were strongest for musculoskeletal disorders.

Conclusions: Parental factors in childhood had an unexpectedly high impact on sickness absence among young adults, in particular men. This effect is likely to act through several mechanisms. Considering life course events may add to our understanding of sickness absence.


B. E. Moen, T. Riise.Section for Occupational Medicine, Institute of Public Health and Primary Health Care, University of Bergen, Norway

Introduction: Some people develop adverse reactions to polluted air, which we have difficulties in understanding. They experience various symptoms at very low levels of the putative causal exposure, and may be classified as having “multiple chemical sensitivity” (MCS).

Objective: To study the occurrence of symptoms related to the smell of substances in different occupations, and to describe lifestyle factors and health related quality of life among people with such symptoms.

Methods: A cross sectional study of a general population of 23 312 individuals aged 40–47 years in Hordaland County, Norway was performed. The participants answered questions concerning occupation, lifestyle factors, and symptoms related to the smell of environmental agents. Health related quality of life was estimated using the physical and mental summary scores of the SF-12 Health Survey.

Results: In this population, 20% of females and 13% of men experienced symptoms related to the smell of environmental agents. Such symptoms were most frequently experienced by painters (21%), restaurant workers (25%), mechanics (22%), drivers (23%), and assistants in industry (22%), while administrators had none of these symptoms. Comparing subjects with symptoms related to smell with those with no such symptoms within the five occupational groups with highest prevalence of these symptoms (n = 760) revealed no differences in smoking habits, alcohol consumption, physical exercise, or coffee and tea consumption. However, the subjects with symptoms related to smell had significantly lower levels of quality of life both to related physical and mental health (t test: p = 0.000 and 0.004, respectively).

Conclusion: Experiencing symptoms related to smell are associated with certain occupations with triggering chemical vapours. Such symptoms are related to a reduced health related quality of life.


I. S. Mehlum1,2, H. Kjuus1, K. B. Veiersted1, E. Wergeland2.1National Institute of Occupational Health, Oslo, Norway; 2Directorate of Labour Inspection, Oslo, Norway

Introduction: Norwegian authorities, trades and industries lack valid data on the prevalence and distribution of work related health problems. They are thus unable to assess the potential for prevention. Previous studies have demonstrated large geographical and socioeconomic differences in health in Oslo. Some of these differences may be related to occupational factors. The main objective of this study was to estimate the prevalence of self reported work related health problems among 30, 40, and 45 year old Oslo citizens.

Methods: The study is part of the Oslo Health Study, which was initiated to further examine the geographical and socioeconomic differences in health in Oslo. Almost 60 000 of Oslo’s approximately 500 000 citizens were invited to a comprehensive health examination, including questionnaires on a variety of potential risk and background factors. All 30, 40, and 45 year old subjects attending the study were asked about the occurrence of certain symptoms during the previous month, and whether they considered the symptoms to be work related. There were 26 074 subjects in these three age cohorts, of whom 8594 (33%) answered the questions.

Results: The highest prevalences were reported for musculoskeletal disorders. One half of the subjects reported neck or shoulder pain, and 27% reported pain in elbow, forearm or hand. For both groups, 75% considered their pain to be work related. Low back pain was reported by 46%, and half assessed it as work related. The prevalence of extraordinary tiredness, sleep disturbance, and eye symptoms were 39, 30, and 24%, respectively, about half of which were considered work related. The reported work related fractions for asthma, skin, and nose symptoms were all approximately 20%. There were some sex differences, but only small age differences in self reported health problems and their work relatedness. Occupational differences were large.

Conclusions: Our results indicate that a high proportion of common health problems in the population is related to working conditions. This implies a considerable potential for prevention by workplace intervention.

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