ALD is a good indication for liver transplantation, with similar results in the ALD patients. Structured management of the alcohol problem before and after transplantation is important in minimizing the risk of recidivism.

Objectives-To investigate associations between diVerent potential risk factors, related and not related to work, and disorders of the neck and upper extremities occurring up to 24 years later. Methods-The study comprised 252 women and 232 men, Swedish citizens, 42-59 years of age and in a broad range of occupations. Information about potential risk factors was available from a former study conducted in 1969. Data on disorders of the neck, shoulder, and hand-wrist disorders were obtained retrospectively for the period 1970-93. Results-Risk factors were found to diVer between the sexes. Among women overtime work, high mental workload, and unsatisfactory leisure time were associated with disorders in the neck-shoulder region. Interaction was found between high mental workload and unsatisfactory leisure time. Neck symptoms earlier in life were associated with recurrent disorders. Hand and wrist disorders were associated mainly with physical demands at work. Among men blue collar work and a simultaneous presence of high mental workload and additional domestic workload predicted disorders in the neck-shoulder region. Conclusions-Factors related and not related to work were associated with disorders of the neck, shoulders, and hands and wrists up to 24 years later in life. These included factors related to working hours which previously have not been noted in this context. Interactions between risk factors both related and not related to work were commonly found. (Occup Environ Med 1999;56:59-66)

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Objectives: To study associations between long term and short term exposure to different work environmental conditions and the incidence of neck or shoulder pain. The results were obtained as part of the MUSIC-Norrtälje study, which is a population based case-control study conducted in Sweden in 1993-7. Methods: The cases were people from the study base who sought medical care or treatment for neck or shoulder pain. Information on physical and psychosocial conditions in the work environment, currently and 5 years ago, and lifestyle factors, was obtained by self administered questionnaires from 310 cases and 1277 randomly selected referents. Results: Associations between both physical and psychosocial exposures in the work environment and seeking care for neck or shoulder pain were found. The risk patterns differed for the sexes, and risk ratios exceeding 1.5 were more often found among women than among men. Generally, subjects who had experienced a recent increase of exposure were more likely (relative risk (RR) 2.1-3.7) to seek care than those who had been exposed long term (RR 1.5-1.8). Among women, an increased amount of visual display terminal (VDT) work, work above shoulder level, and reduced opportunities to acquire new knowledge, and among men, an increased amount of seated work were associated with neck or shoulder pain. This might indicate short induction periods for neck or shoulder pain for these exposures. However, for repetitive work with the hands and hindrance at work among women, and possibly also local vibrations among men, the induction periods seem to be longer. Interactive effects between factors, both at work and in the family, were found, but only among women. Conclusions: Associations between some exposures in the work environment and seeking care for neck or shoulder pain were found. The high RRs for short term exposure might indicate that for many factors the induction period for neck or shoulder pain is short.

Both psychosocial factors and physical factors related to work have been found to be associated with low back pain (LBP) in many cross sectional and some longitudinal studies. [1][2][3][4] In analyses of potential risk factors for LBP related to work, often physical factors only, or psychosocial factors only, have been considered. Less often both types of factors have been studied and analysed simultaneously. 5 Even less often have conditions outside work been studied in parallel with work related conditions.6 Such a parallel approach is necessary for an understanding of the relative significance of diVerent risk factors. One argument for this approach is that, especially among women, a large part of the total daily physical and psychosocial load derives from tasks outside work, 7 as pointed out in a review by Frankenhauser. 8A second argument is that there mightbesides the interaction between work related psychosocial factors which has been demonstrated by Lindström 9 -be an interaction between factors related to work and conditions outside work, especially factors of a psychosocial nature. Such factors might influence each other, as mentioned by both Frankenhauser 8 and Friedman.10 Such reciprocal influence complicates analyses of associations between work related psychosocial risk factors and health outcomes, but increases the need for such analyses.In longitudinal studies psychosocial factors such as job satisfaction, work content, control in the work situation, social relations, and mental overstrain have been found to be associated with LBP. [11][12][13][14][15][16] Physical factors in these studies considered to contribute to LBP are physically heavy work and previous back problems.The aim of the present study was to investigate the relation between psychosocial and physical factors at work, as well as conditions during leisure time, and LBP over 24 years.