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Papers by Helena Miranda

The Scientific World Journal, 2015

Background. Many worksite health promotion programs ignore the potential influence of working con... more Background. Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. Methods. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Results. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Conclusions. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.

Occupational and Environmental Medicine

To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absen... more To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absence days due to musculoskeletal disorders (MSD) among blue-collar employees, and to study what extent such a relationship might be confounded by physical loading at work.

International Archives of Occupational and Environmental Health

Aim To investigate single-site and multi-site musculoskeletal pain as predictors of future sickne... more Aim To investigate single-site and multi-site musculoskeletal pain as predictors of future sickness absence due to musculoskeletal disorders (MSD) among blue-collar employees in food industry, and to study to what extent this relationship depends on physical loading at work. Methods Survey responses of 901 employees on working conditions and musculoskeletal pain during the past week were linked to their future sickness absence records obtained from the personnel register of a food industry company. Negative binomial regression models were computed to determine associations of pain in one and in multi-site with the number of sickness absence days due to MSD during a four-year follow-up. Analyses were made in the whole cohort and stratified by the occurrence of repetitive movements and awkward postures (low/high). Results Multi-site pain occurred among 59 % in the total cohort and predicted sickness absence with a rate ratio of 1.48 [95 % confidence interval (CI) 1.21–1.80], adjusted ...

Occupational and environmental medicine, 2014

To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absen... more To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absence days due to musculoskeletal disorders (MSD) among blue-collar employees, and to study what extent such a relationship might be confounded by physical loading at work. Survey responses from 901 employees were linked to a food industry company's record of sickness absence due to MSD (≥ four days). Generalised Linear Models (GLM) with negative binomial distribution assumption was used in order to determine associations between the occurrence of multi-site pain (no pain, one-site and multi-site pain), individual variables, work related variables and sickness absence days due to MSD during a four-year follow-up. The high exposure group had about 92 and the low exposure about 72 all-cause sickness absence days yearly, and corresponding figures for absence due to MSD were 36 and 28. The share of MSD absence is about 40% irrespective of the exposure. Single site pain did not predict absen...

Occupational and Environmental Medicine, 2010

Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among he... more Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among health care workers, very few studies have examined the relationship between these two phenomena. We surveyed 920 clinical nursing home workers by questionnaire regarding musculoskeletal pain in the low back, shoulders, wrists or hands, and knees. Information was also collected on exposure to physical assaults at work during the preceding 3 months, other workplace safety features, physical workload and psychosocial work environment. Log-binomial regression was used to estimate the prevalence ratios (PR) with 95% CIs. Almost one-half of respondents reported being assaulted at least once during the preceding 3 months by a resident or resident's visitor. The prevalence of low back pain increased from 40% among non-assaulted workers to 70% among those assaulted three or more times. The highest risk was found for widespread pain (three or more areas), with an adjusted PR of 2.7 (95% CI 1.8 to 3.9) for workers assaulted three or more times. Good workplace safety buffered the effects, so that violence increased the risk of most pains considerably less in a work environment perceived to be safe. To our knowledge, this is the first study to show a dose-response association between physical assaults and musculoskeletal pain in a health care setting where violence is a frequent occurrence. This emphasises the need to address violence as a workplace hazard through practical measures for prevention as well as in future aetiological research on musculoskeletal disorders.

Scandinavian Journal of Work, Environment & Health, 2008

Scandinavian Journal of Medicine and Science in Sports, 2001

The study investigated the relations between physical exercise and musculoskeletal pain among for... more The study investigated the relations between physical exercise and musculoskeletal pain among forest industry workers. We studied a population of 3312 Finnish forest industry workers, who replied to a questionnaire survey in 1994 (response rate 77%). The outcome variables in this cross-sectional study were the number of days with pain in the low back, neck, shoulder and knee during the preceding 12 months. Multivariable logistic regression models were used in statistical analyses. Active walkers had more sciatic pain, active volleyball players had more shoulder pain and those who practiced trekking actively had more knee pain than those who practiced these activities less. The risk of shoulder pain was more than three times higher for those who played volleyball actively compared to those who played less. In addition, age, mental stress and work-related physical loading were strongly associated with musculoskeletal pain. When studying the relations between physical exercise and musculoskeletal pain in a working population, it is important to not only detect the general physical activity but also to specify the different modes of exercise. In addition, the other factors which are strongly related to pain (such as mental stress and work-related physical loading) should be taken into account.

Osteoarthritis and Cartilage, 2002

To evaluate the effects of work-related and individual factors as well as physical activity and s... more To evaluate the effects of work-related and individual factors as well as physical activity and sports on the incidence and persistence of knee pain among a working population. Employees of a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic Questionnaire) on musculoskeletal pain and its possible risk factors at the baseline of this study. A cohort of 2122 workers free of knee pain and another cohort of 333 workers with severe knee pain were followed up for one year. The effects of the risk factors on the incidence and persistence of knee pain were studied using multivariable logistic regression models. A total of 214 (10%) workers developed knee pain during the follow-up. Significant predictors of incident knee pain in the multivariable model were higher age, overweight, smoking, and previous knee injuries. Also, working with the trunk forward flexed in kneeling or standing position and physically strenuous work were non-significant predictors of incident knee pain. Of those 333 workers with severe knee pain at baseline, 220 (66%) still reported severe knee pain after one year. Higher age and job dissatisfaction increased the risk of persistent symptoms. General physical exercise and different sports activities did not predict the incidence or persistence of knee pain. In this large prospective study, the risk factors for self-reported knee pain seemed to be highly similar to the risk factors for knee osteoarthritis (OA) reported in other papers. Age, previous knee injuries, overweight, and knee-straining work were those risk factors, which contributed to the incidence of knee pain. Psychosocial elements of work were more involved in the persistence of the symptoms in the knee.

Occupational and Environmental Medicine, 2010

Occupational and Environmental Medicine, 2009

Occupational and Environmental Medicine, 2001

To evaluate the effects of work related and individual factors as well as physical activity and s... more To evaluate the effects of work related and individual factors as well as physical activity and sports on the incidence and persistence of shoulder pain among forestry workers. Workers in a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic questionnaire) on musculoskeletal pain and its possible risk factors for 4 consecutive years 1992-5. This 1 year follow up study covers the time 1994-5. Year 1994 was chosen as baseline because in that year the questionnaire contained for the first time more detailed questions about different sports. The response rate in 1995 was 90%. The effects of the predictors on 1 year incidence and persistence of shoulder pain were studied with multivariate logistic regression modelling. At baseline, 2094 subjects had been free of shoulder pain during the preceding 12 months. After 1 year, 14% (n=285) reported having mild or severe shoulder pain. Higher age, obesity, and mental stress as well as physically strenuous work and working with trunk forward flexed or with a hand above shoulder level increased the risk of incident shoulder pain. Of the different sports activities, dancing increased the risk of incident pain whereas jogging decreased the risk significantly. Of those 419 workers who had severe shoulder pain at baseline, 55% (n=230) still had severe pain 1 year later. Higher age, overload at work, and working with a hand above shoulder level increased the risk of persistent severe shoulder pain whereas cross country skiing and general sports activity decreased the risk. Our results support the current view that shoulder pain is the result of many factors, including occupational and individual factors. In this longitudinal study, physical work with a heavy load, awkward work postures, mental stress, and obesity were the risk factors at which preventive measures could be aimed. As a new finding, physical exercise had more protective than impairing effects on the shoulders.

Occupational and Environmental Medicine, 2009

Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. Studies on selected oc... more Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. Studies on selected occupational populations suggest an association of CTS with forceful repetitive work and vibration. Only few population-based studies have addressed the role of physical load factors in CTS. The aim of this study was to investigate the relations between exposures to a single or a combination of physical work load factors and CTS. The target population consisted of people aged 30 years or older residing in Finland during 2000-2001. Of the 7977 eligible subjects, 6254 (78.4%) were included in the study. Occupational physical load factors were assessed by interview and CTS by physical examination. The prevalence of possible or probable CTS was 2.1% in men and 5.3% in women. Work tasks with vibrating tools (adjusted odds ratio (OR) 1.9, 95% CI 1.2 to 2.9) and handgrip with high forces (OR 1.7, 95% CI 1.2 to 2.5) were related to an increased prevalence of CTS. There were joint effects between work tasks requiring handgrip with high forces and the use of vibrating tools (adjusted OR 3.3, 95% CI 2.0 to 5.4), between forceful activities (handgrip with high forces or handling of loads) and repetitive movements of the hands (OR 2.1, 95% CI 1.5 to 2.9), and between repetitive movements of the hands and the use of vibrating tools (OR 2.8, 95% CI 1.6 to 4.8). Only exposure in the most recent job was associated with CTS. Work tasks demanding handgrip with high forces or the use of vibrating tools are associated with CTS. The association is stronger if these work tasks are accompanied by repetitive movements of the hand or wrist.

Journal of Affective Disorders, 2014

The contribution of common mental disorders (CMD) co-occurring with chronic musculoskeletal disor... more The contribution of common mental disorders (CMD) co-occurring with chronic musculoskeletal disorders (MSD) to disability retirement is not known. A nationally representative sample (the Health 2000 survey) comprised 3943 occupationally active Finns aged 30-63. MSD and other chronic disorders were assessed by a physician in a standardized clinical examination, and CMD using the Composite International Diagnostic Interview. Disability pension data for 2000-2011 was retrieved from national pension records. Cox regression was used with censoring for death and pension other than that for disability. Covariate information was based on an interview. The baseline prevalence of CMD was 9.4% and of MSD 31.1%. CMD co-occurred with MSD in 3.3% of participants. The risks inflicted by CMD and MSD were additive. Thirty-eight per cent of the co-morbid subjects, 18% of those with CMD and 19% of those with MSD retired prematurely during the average follow-up of 8.6 years. Compared with those with neither type of disorder, the hazard ratio (HR) for disability pension was 2.4 (95% CI 1.7-2.7) for CMD only, 2.2 (1.8-2.7) for MSD only, and 4.1 (2.9-5.7) for the occurrence of both, allowing for age, gender, other chronic disorders, working conditions, and socio-economic and lifestyle factors. No synergistic or antagonistic interactive effects were observed. The determinants were measured only once and we had no information on incident disorders during the follow-up. It is important to identify subjects with both mental and musculoskeletal complaints in order to efficiently support their work ability.

International Archives of Occupational and Environmental Health, 2011

BMC Musculoskeletal Disorders, 2008

Annals of the Rheumatic Diseases, 2008

A study of whether occupational physical load predicted subsequent chronic shoulder disorders. A ... more A study of whether occupational physical load predicted subsequent chronic shoulder disorders. A comprehensive national survey was carried out among a representative sample (n = 7217) of the Finnish adult population in 1977-80. Twenty years later, 1286 participants from the previous survey were invited to be re-examined, and 909 (71%) participated. After excluding those with diagnosed shoulder disorders at baseline, 883 subjects were available for the analyses. At follow-up, a physician diagnosed chronic shoulder disorders in 63 subjects (7%) using a standardised protocol. Work exposure to repetitive movements and vibration at baseline increased the risk of shoulder disorder: adjusted ORs 2.3 (95% CI 1.3 to 4.1) and 2.5 (1.2 to 5.2), respectively. Exposure to several physical factors increased the risk further, the adjusted OR was nearly 4 for at least three exposures. The adverse effects of physical work were seen even among those older than 75 years at follow-up. The statistically significant risk factors differed between genders: for men vibration and repetitive movements, and for women lifting heavy loads and working in awkward postures. Age and body mass index modified the effects of the physical exposures. The results remained similar after excluding those with any shoulder pain at baseline. This is the first prospective study in a general population showing that occupational physical loading increases the risk of a subsequent clinical shoulder disorder and the effects seem to be long-term. Early preventive measures at the workplace may have long-lasting health benefits for the shoulder.

American Journal of Epidemiology, 2005

Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be d... more Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.

Scandinavian Journal of Work, Environment & Health, 2012

The Scientific World Journal, 2015

Background. Many worksite health promotion programs ignore the potential influence of working con... more Background. Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. Methods. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Results. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Conclusions. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.

Occupational and Environmental Medicine

To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absen... more To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absence days due to musculoskeletal disorders (MSD) among blue-collar employees, and to study what extent such a relationship might be confounded by physical loading at work.

International Archives of Occupational and Environmental Health

Aim To investigate single-site and multi-site musculoskeletal pain as predictors of future sickne... more Aim To investigate single-site and multi-site musculoskeletal pain as predictors of future sickness absence due to musculoskeletal disorders (MSD) among blue-collar employees in food industry, and to study to what extent this relationship depends on physical loading at work. Methods Survey responses of 901 employees on working conditions and musculoskeletal pain during the past week were linked to their future sickness absence records obtained from the personnel register of a food industry company. Negative binomial regression models were computed to determine associations of pain in one and in multi-site with the number of sickness absence days due to MSD during a four-year follow-up. Analyses were made in the whole cohort and stratified by the occurrence of repetitive movements and awkward postures (low/high). Results Multi-site pain occurred among 59 % in the total cohort and predicted sickness absence with a rate ratio of 1.48 [95 % confidence interval (CI) 1.21–1.80], adjusted ...

Occupational and environmental medicine, 2014

To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absen... more To investigate the importance of multi-site musculoskeletal pain as a predictor of sickness absence days due to musculoskeletal disorders (MSD) among blue-collar employees, and to study what extent such a relationship might be confounded by physical loading at work. Survey responses from 901 employees were linked to a food industry company's record of sickness absence due to MSD (≥ four days). Generalised Linear Models (GLM) with negative binomial distribution assumption was used in order to determine associations between the occurrence of multi-site pain (no pain, one-site and multi-site pain), individual variables, work related variables and sickness absence days due to MSD during a four-year follow-up. The high exposure group had about 92 and the low exposure about 72 all-cause sickness absence days yearly, and corresponding figures for absence due to MSD were 36 and 28. The share of MSD absence is about 40% irrespective of the exposure. Single site pain did not predict absen...

Occupational and Environmental Medicine, 2010

Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among he... more Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among health care workers, very few studies have examined the relationship between these two phenomena. We surveyed 920 clinical nursing home workers by questionnaire regarding musculoskeletal pain in the low back, shoulders, wrists or hands, and knees. Information was also collected on exposure to physical assaults at work during the preceding 3 months, other workplace safety features, physical workload and psychosocial work environment. Log-binomial regression was used to estimate the prevalence ratios (PR) with 95% CIs. Almost one-half of respondents reported being assaulted at least once during the preceding 3 months by a resident or resident's visitor. The prevalence of low back pain increased from 40% among non-assaulted workers to 70% among those assaulted three or more times. The highest risk was found for widespread pain (three or more areas), with an adjusted PR of 2.7 (95% CI 1.8 to 3.9) for workers assaulted three or more times. Good workplace safety buffered the effects, so that violence increased the risk of most pains considerably less in a work environment perceived to be safe. To our knowledge, this is the first study to show a dose-response association between physical assaults and musculoskeletal pain in a health care setting where violence is a frequent occurrence. This emphasises the need to address violence as a workplace hazard through practical measures for prevention as well as in future aetiological research on musculoskeletal disorders.

Scandinavian Journal of Work, Environment & Health, 2008

Scandinavian Journal of Medicine and Science in Sports, 2001

The study investigated the relations between physical exercise and musculoskeletal pain among for... more The study investigated the relations between physical exercise and musculoskeletal pain among forest industry workers. We studied a population of 3312 Finnish forest industry workers, who replied to a questionnaire survey in 1994 (response rate 77%). The outcome variables in this cross-sectional study were the number of days with pain in the low back, neck, shoulder and knee during the preceding 12 months. Multivariable logistic regression models were used in statistical analyses. Active walkers had more sciatic pain, active volleyball players had more shoulder pain and those who practiced trekking actively had more knee pain than those who practiced these activities less. The risk of shoulder pain was more than three times higher for those who played volleyball actively compared to those who played less. In addition, age, mental stress and work-related physical loading were strongly associated with musculoskeletal pain. When studying the relations between physical exercise and musculoskeletal pain in a working population, it is important to not only detect the general physical activity but also to specify the different modes of exercise. In addition, the other factors which are strongly related to pain (such as mental stress and work-related physical loading) should be taken into account.

Osteoarthritis and Cartilage, 2002

To evaluate the effects of work-related and individual factors as well as physical activity and s... more To evaluate the effects of work-related and individual factors as well as physical activity and sports on the incidence and persistence of knee pain among a working population. Employees of a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic Questionnaire) on musculoskeletal pain and its possible risk factors at the baseline of this study. A cohort of 2122 workers free of knee pain and another cohort of 333 workers with severe knee pain were followed up for one year. The effects of the risk factors on the incidence and persistence of knee pain were studied using multivariable logistic regression models. A total of 214 (10%) workers developed knee pain during the follow-up. Significant predictors of incident knee pain in the multivariable model were higher age, overweight, smoking, and previous knee injuries. Also, working with the trunk forward flexed in kneeling or standing position and physically strenuous work were non-significant predictors of incident knee pain. Of those 333 workers with severe knee pain at baseline, 220 (66%) still reported severe knee pain after one year. Higher age and job dissatisfaction increased the risk of persistent symptoms. General physical exercise and different sports activities did not predict the incidence or persistence of knee pain. In this large prospective study, the risk factors for self-reported knee pain seemed to be highly similar to the risk factors for knee osteoarthritis (OA) reported in other papers. Age, previous knee injuries, overweight, and knee-straining work were those risk factors, which contributed to the incidence of knee pain. Psychosocial elements of work were more involved in the persistence of the symptoms in the knee.

Occupational and Environmental Medicine, 2010

Occupational and Environmental Medicine, 2009

Occupational and Environmental Medicine, 2001

To evaluate the effects of work related and individual factors as well as physical activity and s... more To evaluate the effects of work related and individual factors as well as physical activity and sports on the incidence and persistence of shoulder pain among forestry workers. Workers in a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic questionnaire) on musculoskeletal pain and its possible risk factors for 4 consecutive years 1992-5. This 1 year follow up study covers the time 1994-5. Year 1994 was chosen as baseline because in that year the questionnaire contained for the first time more detailed questions about different sports. The response rate in 1995 was 90%. The effects of the predictors on 1 year incidence and persistence of shoulder pain were studied with multivariate logistic regression modelling. At baseline, 2094 subjects had been free of shoulder pain during the preceding 12 months. After 1 year, 14% (n=285) reported having mild or severe shoulder pain. Higher age, obesity, and mental stress as well as physically strenuous work and working with trunk forward flexed or with a hand above shoulder level increased the risk of incident shoulder pain. Of the different sports activities, dancing increased the risk of incident pain whereas jogging decreased the risk significantly. Of those 419 workers who had severe shoulder pain at baseline, 55% (n=230) still had severe pain 1 year later. Higher age, overload at work, and working with a hand above shoulder level increased the risk of persistent severe shoulder pain whereas cross country skiing and general sports activity decreased the risk. Our results support the current view that shoulder pain is the result of many factors, including occupational and individual factors. In this longitudinal study, physical work with a heavy load, awkward work postures, mental stress, and obesity were the risk factors at which preventive measures could be aimed. As a new finding, physical exercise had more protective than impairing effects on the shoulders.

Occupational and Environmental Medicine, 2009

Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. Studies on selected oc... more Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. Studies on selected occupational populations suggest an association of CTS with forceful repetitive work and vibration. Only few population-based studies have addressed the role of physical load factors in CTS. The aim of this study was to investigate the relations between exposures to a single or a combination of physical work load factors and CTS. The target population consisted of people aged 30 years or older residing in Finland during 2000-2001. Of the 7977 eligible subjects, 6254 (78.4%) were included in the study. Occupational physical load factors were assessed by interview and CTS by physical examination. The prevalence of possible or probable CTS was 2.1% in men and 5.3% in women. Work tasks with vibrating tools (adjusted odds ratio (OR) 1.9, 95% CI 1.2 to 2.9) and handgrip with high forces (OR 1.7, 95% CI 1.2 to 2.5) were related to an increased prevalence of CTS. There were joint effects between work tasks requiring handgrip with high forces and the use of vibrating tools (adjusted OR 3.3, 95% CI 2.0 to 5.4), between forceful activities (handgrip with high forces or handling of loads) and repetitive movements of the hands (OR 2.1, 95% CI 1.5 to 2.9), and between repetitive movements of the hands and the use of vibrating tools (OR 2.8, 95% CI 1.6 to 4.8). Only exposure in the most recent job was associated with CTS. Work tasks demanding handgrip with high forces or the use of vibrating tools are associated with CTS. The association is stronger if these work tasks are accompanied by repetitive movements of the hand or wrist.

Journal of Affective Disorders, 2014

The contribution of common mental disorders (CMD) co-occurring with chronic musculoskeletal disor... more The contribution of common mental disorders (CMD) co-occurring with chronic musculoskeletal disorders (MSD) to disability retirement is not known. A nationally representative sample (the Health 2000 survey) comprised 3943 occupationally active Finns aged 30-63. MSD and other chronic disorders were assessed by a physician in a standardized clinical examination, and CMD using the Composite International Diagnostic Interview. Disability pension data for 2000-2011 was retrieved from national pension records. Cox regression was used with censoring for death and pension other than that for disability. Covariate information was based on an interview. The baseline prevalence of CMD was 9.4% and of MSD 31.1%. CMD co-occurred with MSD in 3.3% of participants. The risks inflicted by CMD and MSD were additive. Thirty-eight per cent of the co-morbid subjects, 18% of those with CMD and 19% of those with MSD retired prematurely during the average follow-up of 8.6 years. Compared with those with neither type of disorder, the hazard ratio (HR) for disability pension was 2.4 (95% CI 1.7-2.7) for CMD only, 2.2 (1.8-2.7) for MSD only, and 4.1 (2.9-5.7) for the occurrence of both, allowing for age, gender, other chronic disorders, working conditions, and socio-economic and lifestyle factors. No synergistic or antagonistic interactive effects were observed. The determinants were measured only once and we had no information on incident disorders during the follow-up. It is important to identify subjects with both mental and musculoskeletal complaints in order to efficiently support their work ability.

International Archives of Occupational and Environmental Health, 2011

BMC Musculoskeletal Disorders, 2008

Annals of the Rheumatic Diseases, 2008

A study of whether occupational physical load predicted subsequent chronic shoulder disorders. A ... more A study of whether occupational physical load predicted subsequent chronic shoulder disorders. A comprehensive national survey was carried out among a representative sample (n = 7217) of the Finnish adult population in 1977-80. Twenty years later, 1286 participants from the previous survey were invited to be re-examined, and 909 (71%) participated. After excluding those with diagnosed shoulder disorders at baseline, 883 subjects were available for the analyses. At follow-up, a physician diagnosed chronic shoulder disorders in 63 subjects (7%) using a standardised protocol. Work exposure to repetitive movements and vibration at baseline increased the risk of shoulder disorder: adjusted ORs 2.3 (95% CI 1.3 to 4.1) and 2.5 (1.2 to 5.2), respectively. Exposure to several physical factors increased the risk further, the adjusted OR was nearly 4 for at least three exposures. The adverse effects of physical work were seen even among those older than 75 years at follow-up. The statistically significant risk factors differed between genders: for men vibration and repetitive movements, and for women lifting heavy loads and working in awkward postures. Age and body mass index modified the effects of the physical exposures. The results remained similar after excluding those with any shoulder pain at baseline. This is the first prospective study in a general population showing that occupational physical loading increases the risk of a subsequent clinical shoulder disorder and the effects seem to be long-term. Early preventive measures at the workplace may have long-lasting health benefits for the shoulder.

American Journal of Epidemiology, 2005

Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be d... more Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.

Scandinavian Journal of Work, Environment & Health, 2012