Work environment and health determinants Longitudinal, controlled intervention and cross-sectional studies in public-service broadcasting companies

Sammanfattning: This thesis focuses on ongoing working life. The overall aim was to identify determinants for work health. Various occupational groups in two public service broadcasting companies in Sweden were included. Study persons: Participants were from all over the country (n=1961, participation rate 74%) divided in 11 occupational groups. Those on leave more than 6 months were excluded. Mean age was 48 yrs (21-67 yrs), 58% were males. Questionnaire and company register data were collected. Additional matched reference data from Statistics Sweden was captured. In a substudy the data collection comprised of repeated blood sampling, physical measures, and questionnaires at three occasions during 12 months (n=121, participation 95%). Another substudy was based on questionnaire responses and participants´ web-documentation of stress programme utilization (n=243, participation 96% and in follow-up 83%). Methods: A comparison was performed between persons with no sick-leave (well-listed) and with any sick-leave (<6 months, mean 25 days) with regard to work environment and organisation, health, sociodemography, life-style, and occupation. The same factors were compared to perceived work place aesthetics. Stress biomarkers´ relations to pain in neck-shoulder-back were analysed longitudinally during 12 months, and cross-sectionally. In a randomized controlled intervention follow-up during 12 months, the impact of a health promoting web-based stress-intervention programme on musculoskeletal pain and its relation to stress was analysed. Results: Individuals in working life with a high level of regenerative (anabolic) activity and a low level of degenerative (catabolic) activity were less likely to have pain than other subjects. Longitudinally, decreased anabolic activity was associated with increasing pain and vice versa (levels of NPY, albumin, GH and HDL). Low level of DHEA-S predicted pain 12 months later. A web-based health and stress-management programme did not decrease neck-shoulder-back pain and the perceived pain-relatedness to stress. Broader and multifactorial intervention methods might be needed. In the whole study population, 53% were well-listed (no sick day). The gender and age dependence was pronounced; more males and older persons being well-listed. As opposed to some earlier reports, sociodemographic conditions and life-style factors were weak or showed no difference between the welllisted and not well-listed participants. Neither did psychologically demanding work and stress outside work show any differences. Strong health determinants were on the one hand less: ill-health work presenteeism, work-related pain, negative work stress, sleep disturbances, need for ergonomic improvements, monotonous work, bent and twisted work positions, disturbing noise, and on the other hand more: perceived good health, support from superior, influence on work performance, and working irregular hours including evenings. Physical training showed a weak association to well-listing when weekly or more frequent. Differences between occupations were shown. As compared to the matched national reference sample, the study population reported more sleep disturbances, shoulder pain, anxiety, disturbing noise, demanding work positions and psychologically demanding work. Nevertheless, the sickabsenteeism was lower than the national average. The perceived need for aesthetic improvements was associated to negative work stress, problems at work, psychologically demanding work, neck-shoulder-back pain, sleep disturbances, and age (lower). Gender and physical training had no impact, whereas occupational status did. 20% reported no need and 46% reported a high need for improvements. The corresponding figures for ergonomic needs were 20% and 34% respectively. The response distributions of aesthetic versus ergonomic needs were significantly different. Conclusion: The results identify work-related health determinants and salutogenic predictors, from stress biomarkers to work environment and organisation. The findings may be employed in future studies and influence future work health promotion and intervention.