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Tage S. Kristensen Psychosocial Department National Institute of Occupational Health

L:PSA018. PERSONLIGE ARKIVERLNAForskereTage. 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.

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Tage S. Kristensen Psychosocial Department National Institute of Occupational Health

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  1. 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

  2. Cardiovascular mortality for Danish men. SMR Farmers Architects Military officers Professors Gardeners Doctors All employed men Journalists Sailors Bus drivers Cooks Waiters Salvage corps drivers Restaurant owners Taxi drivers 67 68 69 71 75 77 100 121 122 127 135 150 150 162 185

  3. 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

  4. The connection betweenwork and CVD

  5. General model for the relationship between work environment and cardiovascular diseases WORK ENVIRON- MENT CARDIO- VASCULAR DISEASES CVD risk factors: Diet obesity, blood pressure, smoking etc. 1 2 3 THE SIGNIFICANCE OF WORK: 1+3

  6. Work and deathHow many deaths are due to working conditions? Nurminen & Karjalainen. Scand J Work Environ Health 2001;27:161-213.

  7. The impact of work on cardiovascular diseases Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10 Nurminen & Karjalainen. Scand J Work Environ Helath 2001;27:161-213.

  8. Empirical evidence

  9. Etiological fractions of work environment for cardiovascular diseases in Denmark (Olsen & Kristensen. J Epidemiol Community Health 1991;45:4-10)

  10. Standardized Hospitalization Ratios (SHR’s) for IHD among Danish men aged 20-59 years SHR (Tüchsen. Int J Epidemiol 1993;22:215-21)

  11. Relative risk of IHD among shift workers15 years of follow-up RR 3 2.8 2.5 2.2 2 2 1.5 1.5 1 1 0.4 0.5 0 (Knutsson et al. Lancet 1986;II:89-92

  12. Work noise and AMI A case control study of 395 cases and 2,148 controls from Berlin. OR (adjusted) 3.8 4 3.5 3 2.5 2.0 2 1.4 1.5 1.0 1 0.5 0 Noise level: Ising et al. Soz Präventivmed 1997;42:216-22.

  13. The job strain model demands control support The effort reward imbalance model effort (extrinsic) rewards (money, esteem, career opportunities) personality (instrincis effort – overcommitment) The two main psychosocial models on work and CVD Good – but not excellent – empirical support for the two models

  14. Hospital admission for CVD in a group of unemployed men compared with a control group RR 1.60 1.6 1.4 1.2 1.04 1 0.80 0.8 0.6 0.4 0.2 0 Before factory closure (2 years) During factory closure (3 years) After factory closure (3 years) (Iversen et al. BMJ 1989;299:1073-6)

  15. Issues in researchand prevention

  16. The cardiovascular tradition from Framingham and onwards. Risk factors are individual. • Behavioral: • Smoking • Physical inactivity • Type A • Salt intake • Diet • Alcohol • Physiological: • Cholesterol • Fibrinogen • Triglycerides • Glucose • Blood pressure • Heart rate • Obesity

  17. 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) Prevention strategies: Interventions aiming at the individual: High risk intervention or mass intervention

  18. 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

  19. The basic dimensions of stressors at workThe ”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.

  20. Topics for future research Human service work: Emotional demands Burnout fatigue CVD ? ? New organisations: Work without limits Workaholism CVD ? ? Unstable labour markets: Downsizing, unemployment, temporary work Uncertainty, stress CVD ? ?

  21. Causal network for CVD Individual characteristics Precursors Physiology Social & Environmental Factors Behavior Job strain Physical activity Fitness Cholesterol Athero-sclerosis Tobacco Social isolation Obesity Blood pressure Throm-bosis SES & Occupation CVD Diet Type A Fibrinogen Arr-hythmia Unem-ployment Noise Alcohol Stress Glucose ECG- changes Upstream Downstream

  22. Integrated prevention at the workplace Health promotion Work environment improvements Workplace rehabilitation

  23. This presentation can be found at:www.ami.dk/presentations The End

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