SP may be an important phenomenon to consider when evaluating measures aimed at decreasing sickness absenteeism because more SP may lead to future sickness absence.

Objectives-To examine the variation of symptoms from the neck, shoulders, and back over a three year period among female nursing personnel and the relation between job strain and musculoskeletal symptoms. Methods-At a county hospital the female nursing personnel answered a questionnaire at baseline and then once a year over a period of three years. There were 565, 553, 562, and 419 subjects who answered the questionnaire at the first, second, third, and fourth survey, respectively. Of the study group, 285 nursing personnel answered the questionnaire on four occasions. Ongoing symptoms of the neck, shoulders, and back were assessed by means of a 10 point (0-9) scale with the verbal end points "no symptoms" and "very intense symptoms." Cases were defined as nursing personnel reporting ongoing symptoms, score >6, from at least one of the body regions. For assessments of job strain, a Swedish version of Karasek and Theorell's model was used. Results-Of the 285 subjects, 13% were defined as cases at all four assessments, and 46% varied between cases and not cases during the study period. In the repeated cross sectional surveys the estimated rate ratio (RR) for being a case was between 1.1 and 1.5 when comparing the group with job strain and the group without job strain. For the combination of job strain and perceived high physical exertion the estimated RR was between 1.5 and 2.1. When the potential risk factors were assessed one, two, or three years before the assessment ofsymptoms the estimated RR for becoming a case was between 1.4 and 2.2 when comparing the group with job strain and the group without job strain. Conclusion-Almost half ofthe healthcare workers varied between being a case and not, over a three year period. The analysis indicated that job strain is a risk factor for musculoskeletal symptoms and that the risk is higher when it is combined with perceived high physical exertion. (Occup Environ Med 1997;54:681-685)

To the best of the authors' knowledge, this study is the first to show that sickness presenteeism appears to be an independent risk factor for future fair/poor general health.

Good agreement was found between self-reported and register information on sickness absence. Self-reported data on sickness absence may be useful in common epidemiological applications.

The present results underline the importance of improving working conditions and supporting sustainable health in order to prevent high turnover and prolonged sick leave among nurses. Resigning and moving to another institution can be interpreted as a way to actively cope with an unhealthy work environment.

This study suggests prevention of some work and lifestyle factors as general measures to reduce long-term sick-listing among women in the public sector.

The fact that nursing personnel leave because of unsatisfactory salary and lack of professional opportunities underpins the importance of making nursing more attractive in terms of financial and professional development. However, the sample size of this study was relatively small and larger studies are thus required to further investigate the importance of these factors in the decision to leave nursing care.

Objectives Low-back pain is common among nursing personnel, and its origin is multifactorial. The present study focused on physical and psychosocial work load. The objectives of the study were to estimate the relative risk for ~lursing personnel, cornpared with other occupational groups, to seek health care for low-back pain, and to identify risk factors. MethodsThis study is a part of a population-based case-referent study in thc municipality of Norrtalje, situated north of Stockholm. Altogether 333 women served as cases and 733 served as referents. Eightyone cases and 188 referents were employed ill nursing work. The cases had sought health care for lowback pain during the study period, November 1993 to November 1996. The referents were randomly selected from the same population. The subjects filled out 2 questionnaires and participated in interviews about physical exposures and psychosocial factors.