tage s. kristensen psychosocial department national institute of occupational health
DESCRIPTION
L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage. 27th International Congress on Occupational Health Iguassu Falls, Brazil. ICOH-Symposium on Psychosocial Factors. Tage S. Kristensen Psychosocial Department National Institute of Occupational Health Copenhagen , Denmark. - PowerPoint PPT PresentationTRANSCRIPT
Tage S. Kristensen
Psychosocial DepartmentNational Institute of Occupational Health
Copenhagen, Denmark
27th International Congress on Occupational Health
Iguassu Falls, Brazil
L:\PSA01\8. PERSONLIGE ARKIVER\LNA\Forskere\Tage
ICOH-Symposium on Psychosocial Factors
Cardiovascular mortality for Danish men.
FarmersArchitectsMilitary officersProfessorsGardenersDoctors
All employed men
JournalistsSailorsBus driversCooksWaitersSalvage corps driversRestaurant ownersTaxi drivers
676869717577
100
121122127135150150162185
SMR
Heart disease and work
”Little is known about occupational risks
for coronary heart disease”
Kyle Steenland. NIOSH. Am J Ind Med 1996;30:495-9
The connection betweenwork and CVD
General model for the relationship between work environment and cardiovascular
diseases
WORKENVIRON-
MENT
CARDIO-VASCULAR DISEASES
CVD risk factors:Diet obesity,
blood pressure,smoking etc.
3
1 2
THE SIGNIFICANCE OF WORK: 1+3
Work and deathHow many deaths are due to working conditions?
Men Women Total
Death, all causes 10% 2% 7%
Heart disease 19% 9% 17%
Stroke 12% 8% 11%
Cancer 14% 2% 8%
Respiratory diseases 7% 1% 4%
Accidents, violence 4% 0.4% 3%
All proportions apply to Finland
Nurminen & Karjalainen. Scand J Work Environ Health 2001;27:161-213.
The impact of work on cardiovascular diseases
Etiologic fraction Men 16%
Women 22%
Etiologic fraction IHD 17%
Stroke 11%
Nurminen & Karjalainen. Scand J Work Environ Helath 2001;27:161-213.
Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10
Empirical evidence
Etiological fractions of work environment for cardiovascular diseases in Denmark
(Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10)
Proportion of CVD
Risk factor Men Women
”Sedentary” work 42% 42%
Job Stressors 6% 14%
Shift & night work 7% 7%
Noise 1% 1%
Chemical exposures 0-1% 0%
Passive smoking 2% 2%
All factors 51% 55%
All factors except sedentary work 16% 22%
100
193215
168 172
0
50
100
150
200
250
Day Night Lateevening
24 hourrosters
Otherirregular
(4 years of follow-up. N=407,000)
Standardized Hospitalization Ratios (SHR’s) for IHD among Danish men aged 20-59 years
(Tüchsen. Int J Epidemiol 1993;22:215-21)
SHR
Relative risk of IHD among shift workers15 years of follow-up
0
0,5
1
1,5
2
2,5
3
0 2-5 6-10 11-15 16-20 21+
Years of shift work
1
1.5
22.2
2.8
0.4
RR
(Knutsson et al. Lancet 1986;II:89-92
3
2.5
2
1.5
1
0.5
0
Work noise and AMI
0
0,5
1
1,5
2
2,5
3
3,5
4
Type writer El. lawn mower El. drill Road drillNoise level:
OR (adjusted)
A case control study of 395 cases and 2,148 controls from Berlin.
Ising et al. Soz Präventivmed 1997;42:216-22.
1.0
1.4
2.0
3.84
3.5
3
2.5
2
1.5
1
0.5
0
The two main psychosocial models on work and CVD
The job strain model
– demands– control– support
The effort reward imbalance model
– effort (extrinsic)
– rewards (money, esteem, career opportunities)– personality (instrincis effort – overcommitment)
Good – but not excellent – empirical support for the two models
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
Hospital admission for CVD in a group of unemployed men compared with a control group
0.80
1.04
1.60
(Iversen et al. BMJ 1989;299:1073-6)
1.6
1.4
1.2
1
0.8
0.6
0.4
0
RR
0.2
Beforefactory closure
(2 years)
Duringfactory closure
(3 years)
Afterfactory closure
(3 years)
Issues in research
and prevention
The cardiovascular tradition from Framingham and onwards.
Physiological:
• Cholesterol
• Fibrinogen
• Triglycerides
• Glucose
• Blood pressure
• Heart rate
• Obesity
Behavioral:
• Smoking
• Physical inactivity
• Type A
• Salt intake
• Diet
• Alcohol
Risk factors are individual.
The individualistic bias of cardiovascular epidemiology and prevention
Sampling: Representative samples of individuals
Variables: Physiological and behavioral factors
Risk factors: Individual characteristics (e.g. high cholesterol) or behaviors (e.g. smoking)
Preventionstrategies: Interventions aiming at the individual:
High risk intervention or mass intervention
The missing connection between cardiovascular and occupational medicine
Occupational medicine
focuses on:
Cancer Lung diseases Musculoskeletal disorders Reproductive disorders Allergies– but not CVD
Preventive cardiology
focuses on:
Tobacco Cholesterol Blood pressure Physical activity Diet– but not work environment
The basic dimensions of stressors at work
The ”Copenhagen Stress Model”
• Influence (with regard to the conditions of daily work)
• Meaning(purpose and connection to the overall production)
• Predictability(relevant information about future changes and events)
• Social support(from supervisors and colleagues)
• Rewards(salary, appreciation, and possibilities for a good and secure future)
• Demands(quantitative and qualitative)
Kristensen. Scand J Work Environ Health 1999;25:550-557.
Topics for future research
Human service work:
New organisations:
Unstable labour markets:
Emotional demands
Burnout fatigue
CVD
Work without limits
Workaholism
CVD
Downsizing, unemployment, temporary work
Uncertainty, stress
CVD
?
?
?
?
?
?
Causal network for CVD
Social &Environmental
FactorsBehavior Physiology Precursors
Individual
characteristics
Upstream
Downstream
Tobacco
Job strainPhysicalactivity
Fitness CholesterolAthero-sclerosis
Social isolation
ObesityBlood
pressureThrom-
bosis
Unem-ployment
Diet Type A FibrinogenArr-
hythmia
Noise Alcohol Stress GlucoseECG-
changes
SES&
OccupationCVD
Integrated prevention at the workplace
Healthpromotion
Workenvironment
improvementsWorkplace
rehabilitation
This presentation can be found at:www.ami.dk/presentations