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Introduction: This study aimed to determine the prevalence of Dupuytren's disease in men and its relationship with work exposure, particularly heavy manual work with and without significant use of vibrating tools, using data from a surveillance program for musculoskeletal disorders.Method: This cross-sectional study was conducted in France between 2002 and 2005. Dupuytren's disease was diagnosed clinically by one of 83 occupational physicians. Exposure in relation to work status and occupational risk factors was assessed with a self-administered questionnaire, and categorised according to vibration exposure (defined as use of vibrating tools for ≥2 h/day), heavy manual work without vibration exposure (defined as use of hand tools for ≥2 h/day (use of vibrating tools for ≥2 h/day excluded) and Borg scale ≥15/20) and no such exposure. Bivariate and multivariate associations using logistic models were recorded in men and in those with >10 years in the same job.Results: Of 2161 men, 1.3% (n=27) had Dupuytren's disease (mean age 47.1±6.7 years). Heavy manual work without vibration exposure was significantly associated with the condition (adjusted OR (aOR) 3.9; 95% CI 1.3 to 11.5) adjusted on age and diabetes), as was use of vibrating tools (aOR 5.1; 2.1 to 12.2). These associations remained significant among subjects with >10 years in the same job, with increases in aOR of 6.1 (1.5 to 25.0) and 10.7 (3.4 to 34.6), respectively.Conclusion: Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren's disease. [ABSTRACT FROM AUTHOR]

Background: This study aimed to estimate the annual burden of cardiovascular diseases and depression attributable to five psychosocial work exposures in 28 European Union countries (EU28) in 2015., Methods: Based on available attributable fraction estimates, the study covered five exposures, job strain, effort-reward imbalance, job insecurity, long working hours and workplace bullying; and five outcomes, coronary/ischemic heart diseases (CHD), stroke, atrial fibrillation, peripheral artery disease and depression. We estimated the burden attributable to each exposure separately and all exposures together. We calculated Disability-Adjusted Life Years (DALY) rate per 100 000 workers in each country for each outcome attributable to each exposure and tested the differences between countries and between genders using the Wald test., Results: The overall burden of CHD attributable to the five studied psychosocial work exposures together was estimated at 173 629 DALYs for men and 39 238 for women, 5092 deaths for men and 1098 for women in EU28 in 2015. The overall burden of depression was estimated at 528 549 DALYs for men and 344 151 for women (respectively 7862 and 1823 deaths). The three highest burdens in DALYs in EU28 in 2015 were found for depression attributable to job strain (546 502 DALYs), job insecurity (294 680 DALYs) and workplace bullying (276 337 DALYs). Significant differences between countries were observed for DALY rates per 100 000 workers., Conclusions: Such results are necessary as decision tools for decision-makers (governments, employers and trade unions) when defining public health priorities and work stress preventive strategies in Europe., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.)

Objectives The study aims to explore the prospective associations of the psychosocial work exposures of the job strain model with cardiovascular mortality, including mortality for ischemic heart diseases (IHD) and stroke, using various time-varying exposure measures in the French working population of employees. Methods The study was based on a cohort of 798 547 men and 697 785 women for which job history data from 1976 to 2002 were linked to mortality data and causes of death from the national death registry. Psychosocial work exposures from the validated job strain model questionnaire were assessed using a job-exposure matrix (JEM). Three time-varying measures of exposure were studied: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were used to examine the associations between psychosocial work exposures and cardiovascular mortality. Results Within the 1976-2002 period, there were 19 264 cardiovascular deaths among men and 6181 among women. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with cardiovascular mortality. Most of these associations were also observed for IHD and stroke mortality. The comparison between the different exposure measures suggested that current exposure may be more important than cumulative (or past) exposure. The population fractions of cardiovascular mortality attributable to job strain were 5.64% for men and 6.44% for women. Conclusions Psychosocial work exposures of the job strain model may play a role in cardiovascular mortality. The estimated burden of cardiovascular mortality associated with these exposures underlines the need for preventive policies oriented toward the psychosocial work environment.

Background: Our study aimed to explore the associations between psychosocial work exposures, as well as other occupational exposures, and suicide ideation in the French national working population. An additional objective was to study the cumulative role of occupational exposures in this outcome., Methods: The study was based on a nationally representative sample of the French working population of 20,430 employees, 8579 men and 11,851 women (2016 French national Working Conditions survey). Occupational exposures included 21 psychosocial work factors, 4 factors related to working time/hours and 4 factors related to the physical work environment. Suicide ideation within the last 12 months was the outcome. The associations between exposures and outcome were studied using weighted logistic regression models adjusted for covariates., Results: The 12-month prevalence of suicide ideation was 5.2% among men and 5.7% among women. Among the occupational exposures, psychosocial work factors were found to be associated with suicide ideation: quantitative and cognitive demands, low influence and possibilities for development, low meaning at work, low sense of community, role conflict, job insecurity, temporary employment, changes at work, and internal violence. Some rare differences in these associations were observed between genders. Linear associations were observed between the number of psychosocial work exposures and suicide ideation., Conclusions: Psychosocial work factors were found to play a major role in suicide ideation, and their effects were cumulative on this outcome. More research on multiple and cumulative exposures and suicide ideation and more prevention towards the psychosocial work environment are needed.

Introduction: Although evidence has been provided on the associations between psychosocial work exposures and morbidity outcomes in the literature, knowledge appears much more sparse on mortality outcomes. The objective of STRESSJEM is to explore the prospective associations between psychosocial work exposures and mortality outcomes among the national French working population. In this paper, we describe the study protocol, study population, data sources, method for exposure assessment, data analysis and future plans., Methods and Analysis: Data sources will include: the data from the national SUMER survey from DARES on the evaluation of psychosocial work exposures and the data from the COSMOP programme from Santé publique France linking job history (DADS data from INSEE) and mortality according to causes of death (data from the national death registry, INSERM-CépiDc). A sample of 1 511 456 individuals will form the studied prospective cohort for which data are available on both job history and mortality over the period 1976-2002. Psychosocial work exposures will be imputed via a job-exposure matrix using three job title variables that are available in both the SUMER and COSMOP data sets. Our objectives will be to study the associations between various psychosocial work exposures and mortality outcomes. Psychosocial work exposures will include the job strain model factors as well as other psychosocial work factors. Various measures of exposure over time will be used. All-cause and cause-specific mortality will be studied., Ethics and Dissemination: Both the SUMER survey and the COSMOP programme have been approved by French ethics committees. Dissemination of the study results will include a series of international peer-reviewed papers and at least one paper in French. The results will be presented in national and international conferences. This project will offer a unique opportunity to explore mortality outcomes in association with psychosocial work exposures in a large national representative sample of the working population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The literature remains seldom on the topic of self-rated health (SRH) among the national working populations of emerging countries. The objectives of the study were to examine the associations of occupational factors with SRH in a national representative sample of the working population in Brazil., Methods: This study relied on a cross-sectional sample of 36,442 workers, 16,992 women and 19,450 men. SRH was the studied health outcome. Sixteen occupational factors related to four topics were studied: employment characteristics, working time/hours, psychosocial work factors and physical and chemical work exposures. The associations between occupational factors and SRH were studied using logistic regression models with adjustment for sociodemographic characteristics (age, ethnicity and marital status). The analyses were performed for each gender separately and using weights., Results: The prevalence of poor SRH was 26.71%, this prevalence being higher among women (29.77%) than among men (24.23%). The following risk factors for poor SRH were found among men and women: working as a self-employed worker, clerk/service worker, manual worker, part-time (≤ 20 h/week), exposure to work stress, exposure to high physical activity and exposure to sun. The risk factors for poor SRH among women only were: working as a domestic worker and exposure to noise, and among men, working in the agriculture sector., Conclusions: Our study suggested that occupational factors related to both physical and psychosocial work environment may be associated with SRH in the working population in Brazil. Improving working conditions may be beneficial for health at work in Brazil.

Background: There has been little work into the relative effects of adolescent-onset, as compared to lifetime, mental illness on employment, income and occupational outcomes in adulthood., Methods: Using data from the Santé et Itinéraire Professionnel Survey, a nationally representative survey of 13 648 French working-age people to investigate prospective associations between self-reported mental illness and employment, income and occupational outcomes. We further investigated whether these outcomes would differ for those reporting an onset of mental illness prior to 18 years of age., Results: Adolescent-onset mental illness was associated with poorer employment outcomes, significantly increased risk of employment in low-skilled occupations, as well as reduced monthly wage earnings., Conclusions: Results extend understandings of the risks of adolescent-onset mental illness on employment and occupational outcomes and suggest that vocational recovery services should take these factors into account when designing support services for adolescents with mental health problems, particularly for males., (© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Social inequalities in work injury have been observed but explanations are still missing. The objectives of this study were to evaluate the contribution of working conditions in the explanation of social inequalities in work injury in a national representative sample of employees., Methods: The study was based on the cross-sectional sample of the national French survey SUMER 2010 including 46,962 employees, 26,883 men and 20,079 women. The number of work injuries within the last 12 months was studied as the outcome. Occupation was used as a marker of social position. Psychosocial work factors included various variables related to the classical job strain model, psychological demands, decision latitude, social support, and other understudied variables related to reward, job insecurity, job promotion, esteem, working time and hours and workplace violence. Occupational exposures of chemical, biological, physical and biomechanical nature were also studied. Weighted age-adjusted Poisson regression analyses were performed., Results: Occupational gradients were observed in the exposure of most psychosocial work factors and occupational exposures. Strong occupational differences in work injury were found, blue-collar workers being more likely to have work injury. Chemical, biological, physical and biomechanical exposures contributed to explain the occupational differences in work injury substantially. Noise, thermic constraints, manual materials handling, postural/articular constraints and vibrations had significant contributions. Psychosocial work factors also contributed to explain the differences especially among women., Conclusion: Prevention policies oriented toward chemical, biological, physical, biomechanical and psychosocial work exposures may contribute to reduce the magnitude of occupational differences in work injury.

Objectives This review aimed to quantify suicide risk among agricultural, forestry, and fishery workers and study potential variations of risk within this population. Methods We conducted a systematic literature review and meta-analysis from 1995 to 2016 using MEDLINE and following the PRISMA guidelines. A pooled effect size of suicide risk among the population of interest was calculated using meta-analysis. Subgroup analyses were conducted to investigate whether effect size differed according to population or study characteristics. Meta-regression was used to identify sources of heterogeneity. Results The systematic review identified 65 studies, of which 32 were included in the meta-analysis. Pooled effect size was 1.48 [95% confidence interval (CI) 1.30-1.68] representing an excess of suicide risk among the population of interest. Subgroup analysis showed that this effect size varied according to geographic area, with a higher effect size in Japan. The following study characteristics were found to contribute to the between-study variance: reference group, measure of effect size, and study design. Conclusions Our findings suggest an excess of suicide risk among agricultural, forestry, and fishery workers and demonstrated that this excess may be even higher for these groups in Japan. This review highlights the need for suicide prevention policies focusing on this specific population of workers. More research is also needed to better understand the underlying factors that may increase suicide risk in this population.

Background: Explanations of social inequalities in sickness absence are lacking in the literature. Our objectives were to evaluate the contribution of various occupational exposures in explaining these inequalities in a national representative sample of employees., Methods: The study was based on the cross-sectional sample of the SUMER 2010 survey that included 46 962 employees, 26 883 men and 20 079 women. Both sickness absence spells and days within the last 12 months, as health indicators, were studied. Occupation was used as a marker of social position. The study included both psychosocial work factors (variables related to the classical job strain model, psychological demands, decision latitude, social support and understudied variables related to reward, job insecurity, job promotion, esteem, working time/hours and workplace violence) and occupational exposures of chemical, biological, physical and biomechanical nature. Weighted age-adjusted Poisson and negative binomial regression analyses were performed., Results: Strong occupational differences were found for sickness absence spells and days and for exposure to most work factors. Psychosocial work factors contributed to explain occupational differences in sickness absence spells, and the contributing factors were: decision latitude, social support, reward, shift work and workplace violence. Physical exposure, particularly noise, and biomechanical exposure were also found to be contributing factors. Almost no work factor was found to contribute to occupational differences in sickness absence days., Conclusion: Preventive measures at the workplace oriented towards low-skilled occupational groups and both psychosocial work factors and other occupational exposures may be beneficial to reduce sickness absence spells and occupational differences in this outcome., (© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Introduction: A Job Exposure Matrix (JEM) for psychosocial job stressors allows assessment of these exposures at a population level. JEMs are particularly useful in situations when information on psychosocial job stressors were not collected individually and can help eliminate the biases that may be present in individual self-report accounts. This research paper describes the development of a JEM in the Australian context., Methods: The Household Income Labour Dynamics in Australia (HILDA) survey was used to construct a JEM for job control, job demands and complexity, job insecurity, and fairness of pay. Population median values of these variables for all employed people (n = 20,428) were used to define individual exposures across the period 2001 to 2012. The JEM was calculated for the Australian and New Zealand Standard Classification of Occupations (ANZSCO) at the four-digit level, which represents 358 occupations. Both continuous and binary exposures to job stressors were calculated at the 4-digit level. We assessed concordance between the JEM-assigned and individually-reported exposures using the Kappa statistic, sensitivity and specificity assessments. We conducted regression analysis using mental health as an outcome measure., Results: Kappa statistics indicate good agreement between individually-reported and JEM-assigned dichotomous measures for job demands and control, and moderate agreement for job insecurity and fairness of pay. Job control, job demands and security had the highest sensitivity, while specificity was relatively high for the four exposures. Regression analysis shows that most individually reported and JEM measures were significantly associated with mental health, and individually-reported exposures produced much stronger effects on mental health than the JEM-assigned exposures., Discussion: These JEM-based estimates of stressors exposure provide a conservative proxy for individual-level data, and can be applied to a range of health and organisational outcomes.

Background: Social inequalities in mental health have been demonstrated but understanding the mechanisms remains unclear. This study aims at exploring the role of psychosocial work factors in explaining occupational inequalities in mental health among European employees., Methods: The study sample covered 33,443 employees coming from the European Working Conditions Survey 2010. Mental health was measured by the WHO-5 well-being index and socioeconomic position by occupation. Twenty-five psychosocial work factors were constructed including job demands, job influence and development, role stressors, social support, quality of leadership, discrimination, violence at work, working hours, job promotion, job insecurity and work-life imbalance. Multilevel linear regressions and bootstrap analyses were performed., Results: Occupational differences were observed for poor mental health and almost all psychosocial work factors. Factors related to job demands, influence and development at work, social relationships and leadership, working hours and other factors contributed to explain the occupational inequalities in mental health. In particular, factors related to influence and development contributed substantially. Among men, workplace violences were found to contribute little whereas among women these factors did not play a role., Conclusions: Future prevention interventions should have a broad and comprehensive focus in order to reduce social inequalities in mental health., (© The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Little is known about associations between emergent psychosocial work factors and mental health., Aims: To explore associations between classical and emergent psychosocial work factors and depression and anxiety symptoms in employees in France., Methods: A national cross-sectional study (the SUrveillance Médicale des Expositions aux Risques professionnels (SUMER) survey) assessed psychosocial work factors including psychological demands, decision latitude, social support, reward and its sub-dimensions (esteem, job security and job promotion), bullying, verbal abuse, physical violence and sexual assault, long working hours, shift and night work, unsociable work days, predictability and demands for responsibility. We also measured depression and anxiety symptoms using the Hospital Anxiety and Depression scale. We used gender-stratified generalized linear models to adjust for age, occupation and economic activity., Results: A total of 26883 men and 20079 women participated (response rate 87%). Low decision latitude, high psychological demands, low social support, low reward, bullying and verbal abuse were associated with depression and anxiety in both genders (β coefficients from 0.14 to 1.40). In men, low predictability was associated with both depression and anxiety (β = 0.12 [95% confidence interval (CI) 0.01, 0.24] and 0.19 [95% CI 0.06, 0.32]) and long working hours were associated with anxiety (β = 0.48 [95% CI 0.27, 0.69]). The strongest associations were observed for bullying, reward (especially esteem) and psychological demands. Using a less conservative approach, we found more factors to be significantly associated with mental health symptoms., Conclusions: Most psychosocial work factors studied are associated with depression and/or anxiety symptoms. Comprehensive prevention policies may help to reduce exposure to psychosocial work factors, including emergent ones, and improve mental health at work., (© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: The literature has been extensive on the associations between psychosocial work factors and mental health. Nevertheless, the studies using prospective design, various concepts and more than one measurement point in time for these factors and diagnostic interview to assess mental disorders remain seldom in the literature. This study is an attempt to fill the gap in this topic., Methods: The study was based on a national representative sample of 4717 workers of the French working population (SIP survey), interviewed in 2006 and reinterviewed again in 2010 and free of mental disorders at baseline. Psychosocial work factors, measured in both 2006 and 2010, included: psychological demands, decision latitude, social support, reward, emotional demands, role conflict, ethical conflict, tensions with the public, job insecurity and work-life imbalance. Other occupational factors related to working time/hours and physical work environment were also studied. Major depressive (MDD) and generalized anxiety disorders (GAD) were measured using a standardised diagnostic interview (MINI). Covariates were age, occupation, marital status, having a child under 3 y, social support outside work and stressful life events. Multivariate analyses were performed using weighted logistic regression models., Results: Using models taking all occupational factors into account simultaneously, low reward and job insecurity predicted MDD. Psychological demands, low reward, emotional demands and job insecurity were predictive of GAD. The more frequent the exposure to job insecurity, the higher the risk of MDD and GAD, and the more frequent the exposure to psychological demands and low reward, the higher the risk of GAD. No effect was observed for repeated exposure to occupational factors., Conclusions: Classical and emergent psychosocial work factors were predictive factors of depression and anxiety with dose-response associations in terms of frequency of exposure. More attention may be needed on emergent psychosocial work factors and frequent exposure to these factors.

Background: The aim of this study was to explore the associations between socio-demographic, psychosocial, material and occupational factors and self-reported health (SRH) in the European working population. Another objective was to examine whether these associations varied according to occupation and country., Methods: This study was based on data from the European quality of life survey 2007 including 17,005 workers from 31 European countries. SRH was measured using a single item. Factors were classified into four different groups: socio-demographic, psychosocial, material and occupational factors. The associations between these factors and SRH were examined using multilevel logistic regression analyses including interaction tests., Results: When all four groups of factors were studied together, age, occupation, urbanization level, origin, trust level, social exclusion, material deprivation, financial and neighbourhood problems, access to medical services, quality of public services, psychological job demands, job reward, work-life imbalance and dangerous/unhealthy working conditions were associated with poor SRH. Almost no differences were found in these associations according to occupation and country., Conclusion: Various factors were associated with poor SRH. This study gave a first European overview of the associations between socio-demographic, psychosocial, material and occupational factors and SRH in Europe and could provide better advice to policy-makers at a European level., (© The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Studies exploring a wide range of psychosocial work factors separately and together in association with long sickness absence are still lacking., Objectives: The objective of this study was to explore the associations between psychosocial work factors measured following a comprehensive instrument (Copenhagen psychosocial questionnaire, COPSOQ) and long sickness absence (> 7 days/year) in European employees of 34 countries. An additional objective was to study the differences in these associations according to gender and countries., Methods: The study population consisted of 16 120 male and 16 588 female employees from the 2010 European working conditions survey. Twenty-five psychosocial work factors were explored. Statistical analysis was performed using multilevel logistic regression models and interaction testing., Results: When studied together in the same model, factors related to job demands (quantitative demands and demands for hiding emotions), possibilities for development, social relationships (role conflicts, quality of leadership, social support, and sense of community), workplace violence (physical violence, bullying, and discrimination), shift work, and job promotion were associated with long sickness absence. Almost no difference was observed according to gender and country., Conclusions: Comprehensive prevention policies oriented to psychosocial work factors may be useful to prevent long sickness absence at European level.

Background: Work stress has become a major occupational risk factor in industrialized countries and an important economic issue. The objective was to estimate the annual costs of coronary heart diseases (CHD) and mental disorders (MD) attributable to job strain exposure according to Karasek's model in France for the year 2003 from a societal perspective., Methods: We produced attributable fraction estimates which were applied to the number of cases (morbidity and mortality) and the costs of CHD and MD. Relative risk estimates came from a systematic literature review of prospective studies. We conducted meta-analyses based on this selection of studies. Prevalence of exposure to job strain came from the national SUMER survey conducted in France in 2003. Costs included direct medical costs and indirect costs: production losses due to sick leaves and premature deaths., Results: Between 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD was attributable to job strain for men, and between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910-1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The total number of sick leave days amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from 1.8 to 3 billion euros for the year 2003 (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113-133 million euros and the cost of MD was between 1.7 - 2.8 billion euros in 2003., Conclusion: This study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies.

Background: The studies on the associations between psychosocial work factors and sickness absence have rarely included a large number of factors and European data. The objective was to examine the associations between a large set of psychosocial work factors following well-known and emergent concepts and sickness absence in Europe., Methods: The study population consisted of 14,881 male and 14,799 female workers in 31 countries from the 2005 European Working Conditions Survey. Psychosocial work factors included the following: decision latitude, psychological demands, social support, physical violence, sexual harassment, discrimination, bullying, long working hours, shift and night work, job insecurity, job promotion and work-life imbalance. Covariates were as follows: age, occupation, economic activity, employee/self-employed status and physical, chemical, biological and biomechanical exposures. Statistical analysis was performed using multilevel negative binomial hurdle models to study the occurrence and duration of sickness absence., Results: In the models, including all psychosocial work factors together and adjustment for covariates, high psychological demands, discrimination, bullying, low-job promotion and work-life imbalance for both genders and physical violence for women were observed as risk factors of the occurrence of sickness absence. Bullying and shift work increased the duration of absence among women. Bullying had the strongest association with sickness absence., Conclusion: Various psychosocial work factors were found to be associated with sickness absence. A less conservative analysis exploring each factor separately provided a still higher number of risk factors. Preventive measures should take psychosocial work environment more comprehensively into account to reduce sickness absence and improve health at work at European level.

Objectives: To explore the associations between various material, psychosocial and behavioural factors and self-reported health (SRH), and to determine whether these associations varied according to educational level., Design: Representative national cross-sectional survey., Setting: Republic of Ireland., Participants: 4369 men and 5995 women aged 18 or more (Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007)., Methods: SRH was measured using one single item. Three groups of factors were studied: material, psychosocial and behavioural factors. Statistical analyses were performed using logistic regression analysis and interaction testing, the sample design being taken into account. All results were adjusted for age and educational level and stratified on gender., Results: When each group of factors was studied separately, non-working status, no private health insurance, inability to afford enough food, no car, being non-married, low social participation, serious neighbourhood problems, low social support, smoking, no alcohol consumption, illicit drug use, low physical activity and obesity were associated with poor SRH. When studied together, some material and psychosocial factors were no longer significant. Four significant interaction terms were found, suggesting that some factors might have a stronger association with SRH among low-educated people., Conclusions: Various types of factors were found to be associated with SRH, and most of these associations were similar according to educational level. Behavioural factors might be intermediate factors in the causal pathways from material and psychosocial factors to SRH. Prevention policies should integrate a large number of factors comprehensively to improve SRH.

Individuals with low socioeconomic position have high rates of depression; however, it is not clear whether this reflects higher incidence or longer persistence of disorder. Past research focused on high-risk samples, and risk factors of long-term depression in the population are less well known. Our aim was to test the hypothesis that socioeconomic position predicts depression trajectory over 13 years of follow-up in a community sample. We studied 12 650 individuals participating in the French GAZEL study. Depression was assessed by the Center for Epidemiological Studies-Depression scale in 1996, 1999, 2002, 2005 and 2008. These five assessments served to estimate longitudinal depression trajectories (no depression, decreasing depression, intermediate/increasing depression, persistent depression). Socioeconomic position was measured by occupational grade. Covariates included year of birth, marital status, tobacco smoking, alcohol consumption, body mass index, negative life events and preexisting psychological and non-psychological health problems. Data were analyzed using multinomial regression, separately in men and women. Overall, participants in intermediate and low occupational grades were significantly more likely than those in high grades to have an unfavorable depression trajectory and to experience persistent depression (age-adjusted ORs: respectively 1.40, 95% confidence interval (CI) 1.16-1.70 and 2.65, 95% CI 2.04-3.45 in men, 2.48, 95% CI 1.36-4.54 and 4.53, 95% CI 2.38-8.63 in women). In multivariate models, the socioeconomic gradient in long-term depression decreased by 21-59% in men and women. Long-term depression trajectories appear to follow a socioeconomic gradient; therefore, efforts aiming to reduce the burden of depression should address the needs of the whole population rather than exclusively focus on high-risk groups.

Objective: We aimed to assess whether the risk factors for severe shoulder pain, especially exposure to arm elevation, were still relevant after a 12-year follow-up, even following retirement., Methods: All men participating in the ARPEGE ancillary study of the GAZEL cohort (followed-up since 1989) and who answered the 1994 or 1995 general GAZEL self-administered questionnaire were included. Weight and self-reported exposure (arm elevation >90° with and without carrying loads) over the entire working life were collected at baseline (1994-1995). Shoulder pain and its intensity were recorded in 1994-1995 and again in 2006. Shoulder pain was measured on an intensity or discomfort 6-point scale in 1994-1995 and on an 8-point scale in 2006. Severe shoulder pain was defined as point-rated higher than the mid-points (>3/6 in 1994-1995 and >4/8 in 2006) while moderate pain was lower or equal to these thresholds., Results: At baseline, 1786 47-51-year-old men were included. In 1994-1995, moderate pain was observed among 8.5% (N=151) of men and severe shoulder pain among 14.6% (N=261). Exposure to arm elevation >90° while carrying loads was significantly associated with severe shoulder pain with >25 years of exposure [adjusted odds ratio (OR (adj)) 4.2, 95% confidence interval (95% CI) 1.7-10.5], taking into account age, sports, smoking habits, history of shoulder trauma, and body mass index. In 2006, when most of the subjects had retired, 1482 men (83.0%) answered the questionnaire, 17.3% of them with severe shoulder pain; the association between exposure to arm elevation >90° while carrying loads and severe shoulder pain was still significant (ORadj 3.3, 95% CI 1.3-8.0), and remained so when subjects with shoulder pain at baseline were excluded., Conclusions: Among men, the effect of high shoulder exposure (arm elevation >90° while carrying loads) during working life on severe shoulder pain remains even after retirement. Extended surveillance and prevention should be offered to these workers.

Background: Although psychosocial work factors are recognized as major occupational risk factors, little information is available regarding the prevalence of exposure to these factors and the differences in exposure between countries., Aims: To explore the differences in various psychosocial work exposures between 31 European countries., Methods: The study was based on a sample of 14,881 male and 14,799 female workers from the 2005 European Working Conditions Survey. Eighteen psychosocial work factors were studied: low decision latitude (skill discretion and decision authority), high psychological demands, job strain, low social support, iso-strain, physical violence, sexual harassment, bullying, discrimination, work-family imbalance, long working hours, high effort, job insecurity, low job promotion, low reward and effort-reward imbalance. Covariates were age, number of workers in household, occupation, economic activity, self-employed/employee, public/private sector and part/full time work. Statistical analysis was performed using multilevel logistic regression analysis., Results: Significant differences in all psychosocial work factors were observed between countries. The rank of the countries varied according to the exposure considered. However, some countries, especially Denmark, Netherlands and Norway, displayed a significantly lower prevalence of exposure to four factors or more, while some Southern and Eastern countries, especially Czech Republic, Greece, Lithuania and Turkey, had a higher prevalence., Conclusions: Differences in psychosocial work exposures were found between countries. This study is the first to compare a large set of psychosocial work exposures between 31 European countries. These findings may be useful to guide prevention policies at European level.

Food insecurity (which can be defined as inadequate access to sufficient, safe, and nutritious food that meets individuals' dietary needs) is concurrently associated with children's psychological difficulties. However, the predictive role of food insecurity with regard to specific types of children's mental health symptoms has not previously been studied. We used data from the Longitudinal Study of Child Development in Québec, LSCDQ, a representative birth cohort study of children born in the Québec region, in Canada, in 1997-1998 (n = 2120). Family food insecurity was ascertained when children were 1½ and 4½ years old. Children's mental health symptoms were assessed longitudinally using validated measures of behaviour at ages 4½, 5, 6 and 8 years. Symptom trajectory groups were estimated to identify children with persistently high levels of depression/anxiety (21.0%), aggression (26.2%), and hyperactivity/inattention (6.0%). The prevalence of food insecurity in the study was 5.9%. In sex-adjusted analyses, children from food-insecure families were disproportionately likely to experience persistent symptoms of depression/anxiety (OR: 1.79, 95% CI 1.15-2.79) and hyperactivity/inattention (OR: 3.06, 95% CI 1.68-5.55). After controlling for immigrant status, family structure, maternal age at child's birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting, only persistent hyperactivity/inattention remained associated with food insecurity (fully adjusted OR: 2.65, 95% CI 1.16-6.06). Family food insecurity predicts high levels of children's mental health symptoms, particularly hyperactivity/inattention. Addressing food insecurity and associated problems in families could help reduce the burden of mental health problems in children and reduce social inequalities in development.

Objective: Rotator cuff syndrome (RCS) is a major health problem among workers. The aim of the study was to examine the risk factors for RCS among workers exposed to various levels of shoulder constraints., Methods: From 3710 workers, representative of a French region`s working population, trained occupational physicians diagnosed a total of 142 cases of RCS among men and 132 among women between 2002-2005. Diagnoses were established by standardized physical examination while personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between RCS and personal and work-related factors were analyzed for each gender using logistic regression modeling., Results: The personal risk factors for RCS were age [odds ratio (OR) for 1-year increment 1.07, 95% confidence interval (95% CI) 1.05-1.09, among men and 1.08, 95% CI 1.06-1.10, among women] and diabetes mellitus (OR 2.9, 95% CI 1.0-8.6, among women). The work-related risk factors were (i) sustained or repeated arm abduction (≥ 2 hours/day) >90 degrees among men (OR 2.3, 95% CI 1.3-3.9) and >60 degrees among women (OR 1.8, 95% CI 1.0-3.2) or both conditions among men (OR 2.0, 95% CI 1.1-3.7) and women (OR 3.6, 95% CI 1.8-7.3); (ii) high repetitiveness of the task (≥ 4 hours/day) among men (OR 1.6, 95% CI 1.0-2.4) and women (OR 1.7, 95% CI 1.1-2.5); (iii) high perceived physical demand among men (OR 2.0, 95% CI 1.3-3.1); (iv) high psychological demand among men (OR 1.7, 95% CI 1.2-2.5); and (v) low decision authority among women (OR 1.5, 95% CI 1.0-2.3)., Conclusion: Personal (ie, age) and work-related physical (ie, arm abduction) and psychosocial factors were associated with RCS for both genders in this working population.

Background: In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure., Methods: Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP) after two rounds (valid control group, valid work exposure). A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC). Relevant associations between manual work, vibration exposure (at work) and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR)., Results: From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/population surveys) were included. Two different results could be extracted from five studies (based on different types of exposure), leading to 19 results, 12 for manual work (9 studies), and 7 for vibration exposure (5 studies). Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66]), and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88])., Conclusion: These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure) and Dupuytren's contracture in certain cases.

Background: Physical occupational exposure is a risk factor for low back pain in workers but the long term effects of exposure remain unclear. As several countries consider increasing the retirement age, further information on this topic is relevant. This study aimed to describe the prevalence of low back pain among middle aged and aging individuals in the general French population according to physical occupational exposure and retirement status., Methods: The study population originated from the French national survey 'Enquête décennale santé 2002'. Low back pain for more than 30 days within the previous twelve months (LBP) was assessed using a French version of the Nordic questionnaire. Occupational exposure was self assessed. Subjects were classified as "exposed" if they were currently or had previously been exposed to handling of heavy loads and/or to tiring postures. The weighted prevalence of LBP was computed separately for men and women, for active (aged 45-59) and retiree (aged 55-74), according to 5-year age group and past/present occupational exposure., Results: For active men, the prevalence of LBP was significantly higher in those currently or previously exposed (n = 1051) compared with those never exposed (n = 1183), respectively over 20% versus less than 11%. Among retired men, the prevalence of LBP tended towards equivalence with increasing age among those previously exposed (n = 748) and those unexposed (n = 599).Patterns were quite similar for women with a higher prevalence in exposed active women (n = 741) compared to unexposed (n = 1260): around 25% versus 15%. Similarly, differences between previously exposed (n = 430) and unexposed (n = 489) retired women tended to reduce with age., Conclusion: The prevalence of LBP in active workers was associated with occupational exposure. The link with past exposure among retirees decreased with age. These results should be considered for policies dealing with prevention at the workplace and retirement.

Prospective data on depressive symptoms and blood pressure are scarce, and the impact of age on this association is poorly understood. The present study examines longitudinal trajectories of depressive episodes and the probability of hypertension associated with these trajectories over time. Participants were 6889 men and 3413 women, London-based civil servants aged 35 to 55 years at baseline, followed for 24 years between 1985 and 2009. Depressive episode (defined as scoring≥4 on the General Health Questionnaire-Depression subscale or using prescribed antidepressant medication) and hypertension (systolic/diastolic blood pressure≥140/90 mm Hg or use of antihypertensive medication) were assessed concurrently at 5 medical examinations. In the fully adjusted longitudinal logistic regression analyses based on generalized estimating equations using age as the time scale, participants in the "increasing depression" group had a 24% (P<0.05) lower risk of hypertension at ages 35 to 39 years compared with those in the "low/transient depression" group. However, there was a faster age-related increase in hypertension in the increasing depression group, corresponding with a 7% (P<0.01) greater increase in the odds of hypertension for each 5-year increase in age. A higher risk of hypertension in the first group of participants was not evident before 55 years of age. A similar pattern of association was observed in men and women, although it was stronger in men. This study suggests that the risk of hypertension increases with repeated experience of depressive episodes over time and becomes evident in later adulthood.

Objective: Little is known about the long-term effect of occupational determinants on knee pain. We aimed to assess whether the risk factors for severe knee pain, observed with a cross-sectional approach, were still relevant after retirement, 12 years later., Methods: All men participating in the ARPEGE side study of the GAZEL cohort (employees of the French national utility for energy production and distribution, recruited in 1989) and who answered the 1994 or 1995 general GAZEL self-administered questionnaire, were included. Weight and self-reported exposures over the entire working life were collected at baseline. Knee pain and its intensity were recorded in 1994-1995 and again in 2006. Moderate and severe knee pain, defined from an intensity or discomfort scale (threshold 3 on a 6-level scale in 1994-1995, and 4 on an 8-level scale in 2006), were the main outcomes., Results: At baseline, 1786 men were included. In 1994-1995, moderate knee pain was observed among 10.3% and severe pain in 12.8% of men. In 2006, 1482 men (83%) answered the questionnaire. Moderate and severe knee pain were observed in 18.6% and 16.3% of respondents, respectively. Working in a kneeling or squatting position was significantly associated with severe knee pain at baseline, taking into account age, sports, smoking habits, and body mass index [adjusted odds ratio (OR (adj)) 1.4, 95% confidence interval (95% CI) 1.1-1.9 for "ever exposed" and OR (adj)2.0, 95% CI 1.3-3.1 for >25 years of exposure]. In 2006, when most subjects were retired, the association between working in a kneeling or squatting position and severe pain was weaker but still significant (OR (adj)1.4, 95% CI 1.04-1.85)., Conclusions: The effect of high knee exposure in the working life on severe knee pain remains even after retirement, although decreased. An extended surveillance and prevention program for these workers could be proposed.

Background: European comparative studies documented a clear North-South divide in socioeconomic inequalities with cancer being the most important contributor to inequalities in total mortality among middle aged men in Latin Europe (France, Spain, Portugal, Italy). The aim of this paper is to investigate educational inequalities in mortality by gender, age and causes of death in France, with a special emphasis on people aged 75 years and more., Methods: We used data from a longitudinal population sample that includes 1% of the French population. Risk of death (total and cause specific) in the period 1990-1999 according to education was analysed using Cox regression models by age group (45-59, 60-74, and 75+). Inequalities were quantified using both relative (ratio) and absolute (difference) measures., Results: Relative inequalities decreased with age but were still observed in the oldest age group. Absolute inequalities increased with age. This increase was particularly pronounced for cardiovascular diseases. The contribution of different causes of death to absolute inequalities in total mortality differed between age groups. In particular, the contribution of cancer deaths decreased substantially between the age groups 60-74 years and 75 years and more, both in men and in women., Conclusions: This study suggests that the large contribution of cancer deaths to the excess mortality among low educated people that was observed among middle aged men in Latin Europe is not observed among French people aged 75 years and more. This should be confirmed among other Latin Europe countries.

Objectives: To describe the frequency with which members of the French general population in the 30-to-69 age class sought care for lower back pain (LBP) from various healthcare professionals and to identify associated parameters., Material and Methods: Data were collected in the 2002-2003 Décennale Santé survey, which is representative of ordinary households in continental France. We assessed the frequency with which the 17,792 surveyed individuals sought care for LBP by considering consultations with healthcare professionals in general and consultations with general practitioners and physiotherapists in particular., Results: Among the survey subjects, 4.5% reported that they had sought treatment for LBP from a healthcare professional at least once during the 2-month survey period. The decision to seek care was correlated with the characteristics of the LBP. The duration of the pain was associated with the frequency of all types of consultation studied here. Sociodemographic, economic and occupational risk factors were also involved. Consultation with a physiotherapist was related to income., Conclusion: These results from a representative sample of the French general population show that the factors associated with seeking treatment for LBP differ according to the type of healthcare professional consulted., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Objective: To document one dimension of the impact of an epidemiological study through citations in scientific journals., Methods: Two sets of articles from studies performed in France were considered. They presented original results on occupational risk factors for low back pain and upper limb disorders. Citations of these articles were retrieved through the Web of Science and Google Scholar, and selected according to several criteria. Most citations present in the Web of Science were also retrieved from Google Scholar, except for the most recent articles. In the Web of Science, after exclusion of self-citations and duplicates, the total number of citations was 109 from 23 different countries for the low back pain articles, with 96 citations from 18 countries for upper limb disorders. A relatively large number of the citations belonged to clinical journals outside the fields of occupational health, ergonomics and public health., Conclusion: This study suggests that results dealing with occupational health disseminate into various fields of clinical research. However, this is only one dimension of the impact of a study.

Objective: To analyze the role that biomechanical strains and psychosocial work factors play in occupational class disparities in low-back pain in the GAZEL cohort., Methods: Recruited in 1989, the GAZEL cohort members were employees of the French national company in charge of energy who volunteered to enroll in an annual follow-up survey. The study population comprised 1487 men who completed questionnaires in 1996 (past occupational exposure to manual material handling, bending/twisting, and driving), 1997 (psychosocial work factors), and 2001 (low-back pain using a French version of the Nordic questionnaire for the assessment of low-back pain). Associations between low-back pain for >30 days in the preceding 12 months and social position at baseline (four categories) were described with a Cox model to determine prevalence ratios for each category. We compared adjusted and unadjusted ratios to quantify the contribution of occupational exposures., Results: The prevalence of low-back pain for >30 days was 13.6%. The prevalence of low-back pain adjusted for age was significantly higher for blue-collar workers and clerks than for managers. The number of socioeconomic disparities observed was significantly reduced when biomechanical strains were taken into account; adjusting for psychosocial factors had little impact., Conclusion: In this population, occupational exposures--especially biomechanical strains--played an important role in occupational class disparities for persistent or recurrent low-back pain.

Background: The aim of this study was to compare inequalities in mortality (all causes and by cause) by occupational group and educational level between men and women living in France in the 1990s., Methods: Data were analysed from a permanent demographic sample currently including about one million people. The French Institute of Statistics (INSEE) follows the subjects and collects demographic, social and occupational information from the census schedules and vital status forms. Causes of death were obtained from the national file of the French Institute of Health and Medical Research (INSERM). A relative index of inequality (RII) was calculated to quantify inequalities as a function of educational level and occupational group. Overall all-cause mortality, mortality due to cancer, mortality due to cardiovascular disease and mortality due to external causes (accident, suicide, violence) were considered., Results: Overall, social inequalities were found to be wider among men than among women, for all-cause mortality, cancer mortality and external-cause mortality. However, this trend was not observed for cardiovascular mortality, for which the social inequalities were greater for women than for men, particularly for mortality due to ischaemic cardiac diseases., Conclusions: This study provides evidence for persistent social inequalities in mortality in France, in both men and women. These findings highlight the need for greater attention to social determinants of health. The reduction of cardiovascular disease mortality in low educational level groups should be treated as a major public health priority.

Objective: To assess the effects of duration of exposure to biomechanical strains on various types of low back pain (LBP)., Methods: The population study was a random sample from the GAZEL cohort. Durations of exposure to selected biomechanical strains during subjects' working lifetime and potential confounders were assessed in 1996 by self-administered questionnaires. Data on LBP in the previous 12 months were collected in 2001. Relations between various dimensions of LBP and durations of exposure to the biomechanical strains were analysed with multivariate regression models. Polytomous models were built to determine whether some biomechanical strains were specifically associated with some types of LBP., Results: Analyses were performed separately for men (n = 2218) and women (n = 383). Significant associations were observed (ORs reported are those for 20 years of exposure) between LBP and durations of driving and bending/twisting for men (OR 1.24 and 1.37 respectively); LBP for more than 30 days and duration of exposure to bending/twisting for men and women (OR 2.20 and 2.00 respectively) and duration of driving for women (OR 3.15); LBP radiating to the leg and duration of driving for men (OR 1.43) and bending/twisting for women (OR 1.95); LBP radiating below the knee and duration of exposure to pulling/pushing/carrying for men (OR 1.88). Bending/twisting in both men and women, and driving for women appeared to be stronger risk factors for LBP for more than 30 days. Pulling/pushing/carrying heavy loads appeared to be a risk factor specific for LBP radiating below the knee for men., Conclusion: This study suggests that exposure to biomechanical strains has long-term effects and a dose-response relation with duration of exposure and specific effects for some types of LBP.

Objectives: Few prospective studies have evaluated outcomes of workers with self-reported symptoms of upper extremity musculoskeletal disorders (UEMSD). The objective was to study the three-year outcomes of workers with self-reported symptoms, with or without a positive physical examination., Methods: In 1993-4, 598 subjects highly exposed to repetitive work filled out a Nordic-style questionnaire. They underwent a standardised physical examination at that time and again in 1996-7 by the same occupational physician. The three-year outcomes (based on physical examination) of workers with a self-administered questionnaire positive at baseline for UEMSD, with or without a positive physical examination, were studied., Results: The three-year incidence rate was 44.1%; one third of these incident cases had self-reported symptoms in 1993-4. Workers with a positive questionnaire had a significantly higher risk of UEMSD at physical examination three years later (80.1% UEMSD cases with positive questionnaires n = 354, vs 44.2% cases without positive questionnaires n = 69, p<0.001). Moreover, workers with positive questionnaires but without UEMSD diagnosed in 1993-4 (n = 177) also had a significantly higher risk of UEMSD at physical examination three years later (60.5% cases with positive questionnaires n = 26, vs 38.8% cases without positive questionnaires n = 52, p = 0.01). Results were similar when gender and age were taken into account., Conclusion: Workers highly exposed to repetitive movements have a high risk of developing UEMSD and should be followed closely in surveillance programmes. Workers with self-reported symptoms without UEMSD diagnosed in physical examination represented only one third of new cases three years later. However, their risk of developing UEMSD was significantly increased, compared with those without symptoms.

Aim: To examine the associations between psychosocial work factors and general health outcomes, taking into account other occupational risk factors, within the national French working population., Methods: The study was based on a large national sample of 24 486 women and men of the French working population who filled in a self-administered questionnaire in 2003 (response rate: 96.5%). Psychosocial work exposures included psychological demands, decision latitude, social support, workplace bullying and violence from the public. The three health indicators studied were self-reported health, long sickness absence (>8 days of absence) and work injury. Adjustment was made for covariates: age, occupation, work status, working hours, time schedules, physical, ergonomic, biological and chemical exposures. Men and women were studied separately., Results: Low levels of decision latitude, and of social support, and high psychological demands were found to be risk factors for poor self-reported health and long sickness absence. High demands were also found to be associated with work injury. Workplace bullying and/or violence from the public also increased the risk of poor health, long sickness absence and work injury., Conclusion: Psychosocial work factors were found to be strong risk factors for health outcomes; the results were unchanged after adjustment for other occupational risk factors. Preventive efforts should be intensified towards reducing these psychosocial work exposures.

Objectives: We investigated changes in socioeconomic inequalities in cancer mortality rates among men in France between 1968 and 1996., Methods: We used a representative sample of 1% of the French population and studied 4 periods (1968-1974, 1975-1981, 1982-1988, and 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. The socioeconomic position of men aged 35 to 59 years was measured by using the occupational class reported at the time of the census at the beginning of each period. Analyses were conducted for all cancers and specifically for lung, upper aerodigestive tract, esophageal, colorectal, and other cancers., Results: In all analyses, we observed socioeconomic inequalities during the 4 periods considered; the inequalities increased between the first and the last period. Most of the total increase occurred between 1968 and 1981, and inequalities remained stable thereafter. Inequalities were larger when men out of the labor force were included in the analysis. The strongest increase in socioeconomic inequalities over time was observed for upper aerodigestive tract cancer., Conclusions: Although cancer mortality rates have decreased, substantial socioeconomic inequalities in cancer mortality among men remain.

Objectives: The study aimed at comparing results of standardized Nordic-style questionnaires with those of clinical examinations in two surveys on upper-limb work-related musculoskeletal disorders., Methods: The "repetitive task" survey (1757 workers in 1993-1994 and 598 workers in 1996-1997) studied risk factors of the disorders among those exposed to repetitive work. The "Pays de la Loire" survey (2685 workers in 2002-2003) was part of a population-wide surveillance system. In both surveys, each worker completed a Nordic-style questionnaire and underwent a standardized clinical examination. The presence of at least one upper-limb work-related musculoskeletal disorder was compared, with an evaluation of sensitivity, specificity, and kappa values, with a clinical examination as reference. In the second survey, a global score of a numerical scale for the severity of symptoms at the time of the examination was evaluated in the same way (plus ROC curves)., Results: Agreement between the questionnaire and the examination differed in the two surveys, from kappa 0.22 [95% confidence interval (95% CI) 0.19-0.23] in the "Pays de la Loire" survey to kappa 0.77 (95% CI 0.74-0.80) in the "repetitive task" survey in 1993-1994. Overall, sensitivity was excellent (82.3-100%). The specificity varied, from 51.1% in the "Pays de la Loire" survey to 82.4% for the >or=2 score based on the severity of symptoms in the survey., Conclusions: Nordic-style questionnaires exploring symptoms in the past year can be useful tools for monitoring upper-limb work-related musculoskeletal disorders, especially if they include numerical rating scales of symptom severity. Physical examination remains essential for a medical or clinical diagnosis.

Objective: To investigate the reasons for the excess risk of upper limb musculoskeletal disorders among manual workers compared with other workers in a random sample of 2656 French men and women (20-59 years old) participating in a study on the prevalence of work related upper limb disorders conducted by France's National Institute of Health Surveillance., Methods: Prevalence ratios (PR) of physician-diagnosed musculoskeletal disorders of the shoulder, elbow, wrist, and hand (any of six leading disorders, rotator cuff syndrome, carpal tunnel syndrome) in manual versus non-manual workers were calculated using Cox regression models with a constant time of follow up and robust variance., Results: 11.3% of men and 15.1% of women were diagnosed with an upper limb disorder. The risk was especially high in manual workers (PRs: 1.40 to 2.10). Physical work factors accounted for over 50% of occupational disparities overall, 62% (men) to 67% (women) for rotator cuff syndrome, and 96% (women) for carpal tunnel syndrome. The authors calculated that under lower levels of physical work exposures, up to 31% of cases among manual workers could have been prevented., Conclusions: In working men and women, upper limb musculoskeletal disorders are frequent. Physical work exposures, such as repetitive and forceful movements, are an important source of risk and in particular account for a large proportion of excess morbidity among manual workers.

We investigated the time trends in social inequalities in breast cancer mortality with an analysis by age at death and birth cohort using a representative 1% sample of the French population and four subcohorts (1968-1974, 1975-1981, 1982-1988 and 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in breast cancer mortality were studied among women aged 35-74 at the beginning of each period. In the 1970s, higher breast cancer mortality was found among higher educated women. This positive association progressively weakened and no association remained in the 1990s although it disappeared earlier among younger women. In an analysis by birth cohort, the same pattern was found among women born before 1925, whereas no association between education and mortality was observed among women born after 1925. Educational disparities in breast cancer mortality are currently changing and the previously observed positive gradient has disappeared. An important question is whether these relations are indirect, and due to changes in the prevalence of risk factors associated with education, but which we could not study.

Objective: to investigate social inequalities in cancer mortality from 1975 through 1990 among men and women in France., Methods: A sample, that included census data for approximately 1% of the French population, has been followed for mortality from 1975 to 1990. Causes of death were obtained through a record-linkage with the French national cause-of-death file. The analysis was restricted to those aged 35:59 in 1975 and included 61,876 men and 65,291 women. Occupational class, coded according to the social class scheme of Erikson, Goldthorpe and Portecarero in 7 categories, and educational level (in 4 categories) in 1975 have been studied. The analysis has been conducted for 15 cancer sites among men and 13 among women. Analysis used a Cox proportional hazards model., Results: For educational level, inequalities among men were more pronounced for cancers of the pharynx Relative Risk (RR) lowest versus highest educational level=9.2, 95% Confidence Interval (CI) 2.9-29.1, larynx (RR=6.2, CI=3.0:12.6), oral cavity (RR=2.7, CI=1.3-5.3), lung (RR=3.5, CI=2.5-4.8), esophagus (RR=3.1, CI=1.9-5.2), stomach (RR=2.5, CI=1.2-5.3) and rectum (RR=3.4, CI=1.2-9.6). No association between educational level and cancer mortality was observed for cancers of either the colon or lymphatic and hematopoietic tissue. Social inequalities were less pronounced among women but nevertheless observed for cancer of the uterus (RR=1.9, CI=1.0-3.6), stomach (RR=4.1, CI=1.0-17.1) and lung (RR=1.6, CI=0.7-3.7). No associations were found for mortality from breast or ovarian cancers. Results were similar when socioeconomic status was measured by occupational class., Conclusion: The analysis showed substantial inequalities in cancer mortality in France, with large differences according to cancer site.

The type A behavior pattern (TABP), characterized by impatience, time urgency, and hostility, was originally developed in relation to coronary heart disease. Since 1986, there has been a debate on whether the TABP is also associated with risky driving behaviors leading to increased risks in road traffic accidents (RTAs). The authors examined prospectively the relation among risky driving behaviors, serious RTAs, and the TABP in a cohort of 20,000 French employees of Electricité de France-Gaz de France who were aged 39-54 years in 1993. A total of 11,965 participants were included in this study. The TABP was assessed in 1993 using the French version of the Bortner Rating Scale. Driving behaviors and serious RTAs were recorded in 2001. Sociodemographic and alcohol consumption data were available from the cohort's annual follow-up. The impact of the TABP on the risk of serious RTAs was assessed using the Cox proportional hazards regression model with time-dependent covariates. After adjustment for potential confounders, the risk for serious RTAs increased proportionally with TABP scores: hazard ratios were 1.29 (95% confidence interval: 1.03, 1.63) for intermediate-level scores and 1.48 (95% confidence interval: 1.16, 1.90) for high-level scores relative to low TABP scores. The authors concluded that type A drivers had an increased risk of RTAs. Implications of this finding for traffic safety are discussed.

Background: Personal responses to stressful life events are suspected of increasing the risk of serious traffic accidents., Methods: We analyzed data from a French cohort study (the GAZEL cohort), including a retrospective driving behavior questionnaire, from 13,915 participants (10,542 men age 52-62 years and 3373 women age 47-62 years in 2001). Follow-up data covered 1993-2000. Hazard ratios for serious accidents (n = 713) were computed by Cox's proportional hazard regression with time-dependent covariates. Separate analyses were also performed to consider only at-fault accidents., Results: Marital separation or divorce was associated with an increased risk of a serious accident (all serious accidents: hazard ratio 2.9, 95% confidence interval = 1.7-5.0; at-fault accidents: 4.4, 2.3-8.3). The impact of separation and divorce did not differ according to alcohol consumption levels. Other life events associated with increased risk of serious accident were a child leaving home (all accidents: 1.2, 0.97-1.6; at-fault accidents: 1.5, 1.1-2.1), an important purchase (all accidents: 1.4, 1.1-1.7; at-fault accidents: 1.6, 1.2-2.1), and hospitalization of the partner (all accidents: 1.4, 1.1-2.0)., Conclusion: This study suggests that recent separation and divorce are associated with an increase in serious traffic accidents.

Objectives: Despite the high frequency of work-related musculoskeletal disorders, the relation between work conditions and ulnar nerve entrapment at the elbow has not been the object of much research. In the present study, the predictive factors for such ulnar nerve entrapment were determined in a 3-year prospective survey of upper-limb work-related musculoskeletal disorders in repetitive work., Methods: In 1993-1994 and 3 years later, 598 workers whose jobs involved repetitive work underwent an examination by their occupational health physicians and completed a self-administered questionnaire. Predictive factors associated with the onset of ulnar nerve entrapment at the elbow were studied with bivariate and multivariate analyses., Results: The annual incidence was estimated at 0.8% per person-year, on the basis of 15 new cases during the 3-year period. Holding a tool in position was the only predictive biomechanical factor [odds ratio (OR) 4.1, 95% confidence interval (95% CI) 1.4-12.0]. Obesity increased the risk of ulnar nerve entrapment at the elbow (OR 4.3, 95% CI 1.2-16.2), as did the presence of medial epicondylitis, carpal tunnel syndrome, radial tunnel syndrome, and cervicobrachial neuralgia. The associations with "holding a tool in position" and obesity were unchanged when the presence of other diagnoses was taken into account., Conclusions: Despite the limitations of the study, the results suggest that the incidence of ulnar nerve entrapment at the elbow is associated with one biomechanical risk factor (holding a tool in position, repetitively), overweight, and other upper-limb work-related musculoskeletal disorders, especially medial epicondylitis and other nerve entrapment disorders (cervicobrachial neuralgia and carpal and radial tunnel syndromes).

The authors investigated associations between social integration and all-cause and cause-specific mortality among French employees of Electricity of France-Gas of France. A total of 12,347 men aged 40-50 years in 1989 and 4,352 women aged 35-50 years in 1989 comprised the sample. In age-adjusted survival analyses for all causes of death, men who were least socially integrated were 4.42 times as likely to die during follow-up (1993-1999) as those with the highest level of integration (p < 0.0001). After adjustment for age, occupation, smoking, alcohol consumption, body mass index, self-reported health, depressive symptoms, and region of France, relative risks for men ranging from the least socially integrated to the most socially integrated were 2.70 (95% confidence interval (CI): 1.17, 6.23), 1.95 (95% CI: 1.25, 3.04), and 1.37 (95% CI: 0.92, 2.04) in comparison with the most integrated men. In multivariate cause-specific analyses, isolated men had elevated risks of dying from cancer (relative risk = 3.60) and from accidents and suicide (relative risk = 3.54). Among women, in multivariate analyses, the relative risk was 3.64 (95% CI: 0.72, 18.58). The small number of deaths among women (n = 29) limited statistical power and prohibited cause-specific analyses. These results suggest that in this employed cohort of middle-aged men and women, social integration is an important predictor of mortality.

Aims: To determine the predictiveness of personal and occupational factors for the onset of shoulder pain in occupations requiring repetitive work., Methods: A sample of 598 workers in five activity sectors completed a self administered questionnaire in 1993-94 and again three years later. Both questionnaires included questions about shoulder pain. The associations between various factors at baseline and subsequent shoulder pain were studied among subjects free from shoulder pain at baseline., Results: The incidence of shoulder pain was associated with several independent risk factors: depressive symptoms, low level of job control, and biomechanical constraints. After adjustment for other risk factors, the presence of depressive symptoms predicted occurrence of shoulder pain. A low level of job control was also associated with the onset of shoulder pain in both sexes. For men, repetitive use of a tool was a strong predictor, while the two most important biomechanical risk factors for women were use of vibrating tools and working with arms above shoulder level., Conclusion: This study used a longitudinal approach to examine different sets of risk factors for shoulder pain simultaneously. The results confirm the role of several biomechanical constraints. Psychological symptoms and a low level of job control also play a role.