Objectives-To evaluate the eVects of work related and individual factors as well as physical activity and sports on the incidence and persistence of shoulder pain among forestry workers. Methods-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 diVerent sports. The response rate in 1995 was 90%. The eVects of the predictors on 1 year incidence and persistence of shoulder pain were studied with multivariate logistic regression modelling. Results-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 diVerent 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. Conclusion-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 eVects on the shoulders. (Occup Environ Med 2001;58:528-534) Keywords: mental stress; physical work load; sportsThe prevalence of shoulder symptoms seems to be relatively high, varying from 6% to 25% in the general population.1 2 During the past decades, the knowledge of aetiological factors, and occupational exposures in particular, has increased and work related factors such as repetitive work, vibration, and awkward postures-for example, severe shoulder flexion or abduction-have been related to shoulder disorders.1 3 4 Other factors such as age, smoking, and stress have been significant risk factors in some studies. [5][6][7] This knowledge is, however, mainly based on studies with cross sectional or case-control design. In a recent systematic review of the available evidence on occupational risk factors for shoulder pain, no longitudinal studies fulfilled the quality criteria. As well as prospective studies, more studies of the eVects of leisure time activities were called for.

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.

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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.

The findings from this study suggest that mental stress and smoking are independent risk factors for incidental sciatic pain. Overall physical exercise and most of the sports activities, except jogging and walking, had no effect on sciatic pain. Physical workload factors seemed to be more involved in the onset of sciatic pain, whereas psychosocial factors were related to the persistence of symptoms.

Miranda H, Viikari-Juntura E, Punnett L, Riihimäki H. Occupational loading, health behavior and sleep disturbance as predictors of low-back pain. Scand J Work Environ Health 2008;34(6):411-419.Objectives Risk factors for low-back pain are known to co-occur, but their joint effect has not often been studied.Little is also known about the variation of the risk factors or their effects with age.Methods This prospective study assessed the 1-year incidence of low-back pain by age group in a Finnish industrial population. The effects of the baseline variables on the risk of low-back pain in the follow-up were estimated with a log-binomial regression.Results Among 2256 blue-and white-collar workers free of low-back pain 12 months preceding the baseline, 21% reported low-back pain after 1-year of follow-up. Physical work load (sum of heavy lifting, awkward postures, and whole-body vibration) predicted low-back pain among those younger than 50 years [highest relative risk (RR) 2.4, 95% confidence interval (95% CI) 1.4-4.2], whereas health behavior (sum of smoking, overweight, and lack of physical exercise) increased the risk only among those 50 years or older (RR up to 2.8, 95% CI 1.4-5.4). Mental stress, dissatisfaction with life, and sleep problems were significant predictors in the group of 40-to 49-year-old workers. Work-related psychosocial factors were not associated with the outcome. ConclusionsIn this study, workers of different ages were affected by slightly different risk factors. The results support the provision of health promotion and stress management as part of programs to prevent work-related low-back pain. In particular, aging workers may benefit from such an integrated approach. More prospective studies on the joint effects of age-specific risk factors of low-back pain are warranted.

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.

We studied the number of musculoskeletal pain sites as a predictor of sickness absence during a 7-year follow-up among a nationally representative sample (the Health 2000 survey) of occupationally active Finns 30 to 55years of age (3420 subjects who did not retire or die during the follow-up). Baseline data (questionnaire, interview, clinical examination by a physician) were gathered in 2000 to 2001 and linked with information from national registers on annual compensated sickness absence periods (⩾10workdays) covering the years 2002 to 2008. Pain during the preceding month in 18 body locations was inquired and combined into 4 sites (neck, upper limbs, low back, lower limbs). Demographic factors, BMI, smoking, leisure-time physical activity, sleep disorders, physical and psychosocial workload, and chronic diseases were assessed. Four distinct sickness absence trajectories emerged, labeled as Low (59% of the subjects), Ascending (21%), Mixed (11%), and High (9%). In multinomial logistic regression, the odds ratios (ORs) for belonging to the High vs. the Low trajectory increased with the number of pain sites, being 2.1 for single-site pain, 2.6 for 2 pain sites, 2.9 for 3 pain sites, and 4.1 for 4 pain sites, after adjustment for chronic diseases, demographic and lifestyle factors, and workload. The confidence intervals of the ORs did not include unity. The adjusted ORs for belonging to the Ascending trajectory were 1.1, 1.3, 1.7, and 1.7, respectively. As the number of pain sites was a strong independent predictor of work absenteeism, early screening of workers with multisite pain and interventions to support work ability seem warranted.