The hypothesis was rejected. In a dose-response manner, occupational physical activity increased the risk for LTSA, while leisure-time physical activity decreased the risk for LTSA. The findings indicate opposing effects of occupational and leisure-time physical activity on global health.

A cornerstone of epidemiologic research is to understand the causal pathways from an exposure to an outcome. Mediation analysis based on counterfactuals is an important tool when addressing such questions. However, none of the existing techniques for formal mediation analysis can be applied to survival data. This is a severe shortcoming, as many epidemiologic questions can be addressed only with censored survival data. A solution has been to use a number of Cox models (with and without the potential mediator), but this approach does not allow a causal interpretation and is not mathematically consistent. In this paper, we propose a simple measure of mediation in a survival setting. The measure is based on counterfactuals, and measures the natural direct and indirect effects. The method allows a causal interpretation of the mediated effect (in terms of additional cases per unit of time) and is mathematically consistent. The technique is illustrated by analyzing socioeconomic status, work environment, and long-term sickness absence. A detailed implementation guide is included in an online eAppendix (http://links.lww.com/EDE/A476).

Objective To investigate the association between SARS-CoV-2 vaccination and myocarditis or myopericarditis. Design Population based cohort study. Setting Denmark. Participants 4 931 775 individuals aged 12 years or older, followed from 1 October 2020 to 5 October 2021. Main outcome measures The primary outcome, myocarditis or myopericarditis, was defined as a combination of a hospital diagnosis of myocarditis or pericarditis, increased troponin levels, and a hospital stay lasting more than 24 hours. Follow-up time before vaccination was compared with follow-up time 0-28 days from the day of vaccination for both first and second doses, using Cox proportional hazards regression with age as an underlying timescale to estimate hazard ratios adjusted for sex, comorbidities, and other potential confounders. Results During follow-up, 269 participants developed myocarditis or myopericarditis, of whom 108 (40%) were 12-39 years old and 196 (73%) were male. Of 3 482 295 individuals vaccinated with BNT162b2 (Pfizer-BioNTech), 48 developed myocarditis or myopericarditis within 28 days from the vaccination date compared with unvaccinated individuals (adjusted hazard ratio 1.34 (95% confidence interval 0.90 to 2.00); absolute rate 1.4 per 100 000 vaccinated individuals within 28 days of vaccination (95% confidence interval 1.0 to 1.8)). Adjusted hazard ratios among female participants only and male participants only were 3.73 (1.82 to 7.65) and 0.82 (0.50 to 1.34), respectively, with corresponding absolute rates of 1.3 (0.8 to 1.9) and 1.5 (1.0 to 2.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 1.48 (0.74 to 2.98) and the absolute rate was 1.6 (1.0 to 2.6) per 100 000 vaccinated individuals within 28 days of vaccination. Among 498 814 individuals vaccinated with mRNA-1273 (Moderna), 21 developed myocarditis or myopericarditis within 28 days from vaccination date (adjusted hazard ratio 3.92 (2.30 to 6.68); absolute rate 4.2 per 100 000 vaccinated individuals within 28 days of vaccination (2.6 to 6.4)). Adjusted hazard ratios among women only and men only were 6.33 (2.11 to 18.96) and 3.22 (1.75 to 5.93), respectively, with corresponding absolute rates of 2.0 (0.7 to 4.8) and 6.3 (3.6 to 10.2) per 100 000 vaccinated individuals within 28 days of vaccination, respectively. The adjusted hazard ratio among 12-39 year olds was 5.24 (2.47 to 11.12) and the absolute rate was 5.7 (3.3 to 9.3) per 100 000 vaccinated individuals within 28 days of vaccination. Conclusions Vaccination with mRNA-1273 was associated with a significantly increased risk of myocarditis or myopericarditis in the Danish population, primarily driven by an increased risk among individuals aged 12-39 years, while BNT162b2 vaccination was only associated with a significantly increased risk among women. However, the absolute rate of myocarditis or myopericarditis after SARS-CoV-2 mRNA vaccination was low, even in younger age groups. The benefits of SARS-CoV-2 mRNA vaccination should be taken into account when interpreting these findings. Larger multinational studies are needed to further investigate the risks of myocarditis or myopericarditis after vaccination within smaller subgroups.

Key Points Question Is SARS-CoV-2 messenger RNA (mRNA) vaccination associated with risk of myocarditis? Findings In a cohort study of 23.1 million residents across 4 Nordic countries, risk of myocarditis after the first and second doses of SARS-CoV-2 mRNA vaccines was highest in young males aged 16 to 24 years after the second dose. For young males receiving 2 doses of the same vaccine, data were compatible with between 4 and 7 excess events in 28 days per 100 000 vaccinees after second-dose BNT162b2, and between 9 and 28 per 100 000 vaccinees after second-dose mRNA-1273. Meaning The risk of myocarditis in this large cohort study was highest in young males after the second SARS-CoV-2 vaccine dose, and this risk should be balanced against the benefits of protecting against severe COVID-19 disease.

Holtermann A, Hansen JV, Burr H, Søgaard K. Prognostic factors for long-term sickness absence among employees with neck-shoulder and low-back pain. Scand J Work Environ Health. 2010;36(1):34-41.Objective The aim of this study was to identify prognostic factors for long-term sickness absence among employees with neck-shoulder or low-back pain.Methods In 2000, a representative sample of Danish employees (N=5036) rated their average pain intensity in the neck-shoulder and low-back during the last three months on a 10-point scale; using a questionnaire, they also reported on physical and psychosocial work factors, health behavior, work ability and self-efficacy. Employees reporting pain intensity of ≥4 were considered to have musculoskeletal pain. As a result, we defined two populations to be included in our analyses: people with pain in the neck-shoulder (N=848) and low-back (N=676) regions. Data on long-term sickness absence of long-term sickness absence of of ≥3 weeks for the period 2001-2002 were attained from the Danish national register of social transfer payments.Results One fifth of employees with neck-shoulder and low-back pain experienced long-term sickness absence long-term sickness absence during the two-year follow-up. Among employees with neck-shoulder and low-back pain, respectively, the main significant risk factors were (i) pain intensity [hazard ratio (HR)=1.12, 95% confidence interval (95% CI) 1.02-1.24 and HR=1.13, 95% CI 1.01-1.26] and (ii) heavy physical work (HR=1.68, 95% CI 1.21-2.33 and HR=1.41 95% CI 1.00-2.01). ConclusionPreventive initiatives for long-term sickness absence should aim to reduce pain intensity and heavy long-term sickness absence should aim to reduce pain intensity and heavy should aim to reduce pain intensity and heavy physical work among employees with neck-shoulder and low-back pain.Key terms chronic pain; musculoskeletal disorder; ��D; musculoskeletal sy ��D; musculoskeletal sy musculoskeletal symptom; pain; sick leave. The large cost implications of long-term sickness absence constitute a major concern for the welfare state in western societies (1). In Denmark, for example, longterm sick absence has not decreased despite public effort (2). The public and individual importance of such sick leave is highlighted by its association with subsequent disability pension (3, 4) and mortality (5). The causes for sickness absence are multi-factorial and complex (6, 7), but musculoskeletal pain is clearly a dominating source (8, 9). Particularly, pain in the neck-shoulder and the low-back regions has been shown to be strongly associated with long-term sickness absence (10, 11). However, not all employees with musculoskeletal symptoms are absent from work (12), and it has been argued that preventive initiatives should focus on sickness absence resulting from musculoskeletal pain rather than the onset of musculoskeletal pain per se (13). �oreover, much is known about risk factors for musculoskeletal pain (14) and sickness absence (15,16), but information about the risk factors for s...

While hand/wrist pain and low back pain are general risk factors for LTSA, neck/shoulder pain is a specific risk factor among white-collar workers. This study suggests the potential for preventing future LTSA through interventions to manage or reduce musculoskeletal pain.

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BackgroundOnly a few workplace initiatives among cleaners have been reported, even though they constitute a job group in great need of health promotion. The purpose of this trial was to evaluate the effect of either physical coordination training or cognitive behavioural training on musculoskeletal pain, work ability and sickness absence among cleaners.MethodsA cluster-randomised controlled trial was conducted among 294 female cleaners allocated to either physical coordination training (PCT), cognitive behavioural training (CBTr) or a reference group (REF). Questionnaires about musculoskeletal pain and work ability were completed at baseline and after one year's intervention. Sickness absence data were obtained from the managers' records. Analyses were performed according to the intention-to-treat-principle (ITT).ResultsNo overall reduction in musculoskeletal pain, work ability or sickness absence from either PCT or CBTr compared with REF was found in conservative ITT analyses. However, explorative analyses revealed a treatment effect for musculoskeletal pain of the PCT. People with chronic neck/shoulder pain at baseline were more frequently non-chronic at follow-up after PCT compared with REF (p = 0.05).ConclusionsThe PCT intervention appeared effective for reducing chronic neck/shoulder pain among the female cleaners. It is recommended that future interventions among similar high-risk job groups focus on the implementation aspects of the interventions to maximise outcomes more distal from the intervention such as work ability and sickness absence.Trial registrationISRCTN: ISRCTN96241850