OBJECTIVES:Dental caries is a leading noncommunicable disease worldwide; however, its association with occupational factors, particularly long working hours, has not been elucidated. This study examined the longitudinal association between long working hours and dental caries in a large Korean working-age cohort. METHODS:Using data from the Kangbuk Samsung Health Study (2013-2024), we analyzed 1 136 767 person-visits of workers aged 20-64 years. Long working hours were defined as >52 hours per week. Dental caries was identified from clinical oral examinations performed by licensed dentists. Associations were estimated using generalized estimating equations adjusted for age, gender, and educational level. Subgroup and sensitivity analyses were also performed. RESULTS:Long working hours were significantly associated with dental caries (odds ratio 1.024, 95% confidence interval 1.007-1.041). In the subgroup analyses, compared with their respective counterparts, the association between long working hours and dental caries was significantly stronger among women, individuals with a college-level education or higher, and those with proactive oral health behaviors such as dental visits and toothbrushing before sleep. CONCLUSIONS:Long working hours were independently associated with the risk of dental caries; women and highly educated workers exhibited a stronger association with dental caries. These findings suggest the potential value of integrating oral health strategies into occupational health policies, particularly among more vulnerable subgroups.
OBJECTIVE:This review aimed to appraise the quality of existing guidelines on the management of occupational risks for employed women during pregnancy, identifying and describing their characteristics. METHODS:We systematically identified guidelines in MEDLINE, Embase, CINAHL, UpToDate, GIN International Guidelines Library, ECRI Guidelines Trust and websites of institutions and scientific societies. Four reviewers independently appraised each included document using the Appraisal of Guidelines for Research and Evaluation (AGREE II), generating domain scores of 0-100% (lowest to highest quality). An overall quality score for each guideline was assigned to each document by consensus among reviewers. RESULTS:The study included 31 documents: only 4 (12.9%) had good methodological quality for use in clinical practice; 27 (87.1%) scored poorly in domain III (rigor of development), failing to describe literature searches and formulation of recommendations methods, relationship between scientific evidence and recommendations or updating procedures. Domain IV (clarity of presentation) scores were higher as most documents presented their recommendations clearly, and 14 (45.1%) achieved scores of >60% for ease of identification and interpretation. Guidelines were generally clearer in defining their objectives, but none provided implementation tools. CONCLUSIONS:Guidelines for the management and prevention of occupational risks during pregnancy lacked sufficient rigor in their development. Despite generally clear objectives and presentation, critical gaps in methodology undermine their utility and applicability. There is a clear need to improve the development process of guidelines for the management and prevention of occupational risks during pregnancy.
OBJECTIVE:Circadian and sleep disruption may increase the risk and severity of SARS-CoV-2 infections, but the role of night shift work and disturbed sleep in the development of long-COVID remains inadequately investigated. We prospectively examined the association of night work and sleep disturbances with risk of long-COVID. METHODS:We followed participants of the COVICAT study, a population-based cohort of adults in Catalonia, Spain between 2021 and 2023. Night shift work and sleep characteristics were assessed in 2021. Long-COVID was defined as the report of persistent symptoms (>3 months) after a SARS-CoV-2 infection. Poisson regression analysis was performed to evaluate the independent and joint effects of night shift work and sleep disturbances including chronic insomnia with risk of long-COVID. Analyses were stratified by sex, body mass index and chronotype. RESULTS:During the two-year follow-up, 284 of the 1899 newly infected participants reported long-COVID symptoms. Compared to day workers, night shift workers had 88% higher risk of developing long-COVID [95% confidence interval (CI) 1.29-2.72], after adjusting for potential confounders. The risk further increased among night workers with obesity. Chronic insomnia in the general population was associated with 42% increased risk of long-COVID (95% CI 1.12-1.78). Night workers with chronic insomnia had a 2.7 fold higher long-COVID risk (95% CI 1.60-4.51) compared to day workers without chronic insomnia. Associations persisted in various sensitivity analyses. CONCLUSIONS:Our findings from a large prospective cohort indicate that night shift work and poor sleep are independently and jointly associated with a higher risk of long-COVID.
OBJECTIVES:This study aimed to quantify possible associations between exposure to workplace bullying and violence, or threats thereof, and working life expectancy (WLE) among older workers in Sweden. METHODS:We conducted a prospective cohort study using data on 12 920 individuals in analyses of workplace bullying and 12 903 individuals in analyses of violence. Participants, aged >50 at baseline, were obtained from the Swedish Longitudinal Occupational Survey of Health, using data from 2008 to 2020. We applied continuous-time multistate Markov models to estimate the average number of years that individuals could be expected to work beyond the age of 50, comparing those exposed to workplace bullying or workplace violence/threats of violence to those unexposed. RESULTS:In the unadjusted analysis, exposure to workplace bullying and workplace violence/threats of violence was associated with shorter WLE among older workers [bullying: -0.42 years, 95% confidence interval (CI) -1.23-0.01; violence: -0.42 years, 95% CI -1.06-0.01]. After controlling for sex and occupational level, WLE at age 50 was -0.56 years among those exposed to workplace violence (95% CI -1.02- -0.10) compared with the unexposed. The esti mate for workplace bullying was -0.63 years (95% CI -1.39-0.14). CONCLUSION:Exposure to workplace violence or threats of violence was associated with fewer average expected years in work from age 50. This suggests that prevention of workplace violence could contribute to extended working lives. The association between workplace bullying and WLE was of similar magnitude but not statistically significant.
We appreciate Lavigne-Robichaud et al`s critical remarks (1) to our systematic review addressing the epidemiological evidence for causal relations between job strain and the risk of ischemic heart disease (IHD) (2). Their main concern relates to the strength of the hypothesized association between job strain and IHD and, by extension, the magnitude of the population attributable fraction. They argue that our overall conclusion places too much emphasis on biases that inflate risk estimates and underrates biases that attenuate estimates towards the null. However, we believe it is premature to discuss in detail the strength of associations before a causal link is established with reasonable confidence. The main objective of our review was to evaluate the epidemiological evidence that observed associations are indeed causal. We concluded that the current evidence neither substantiates nor excludes a causal association for several reasons, including, but not limited to, the presence of inflating or deflating biases (2). That said, we appreciate the opportunity to discuss the sources of bias raised by Lavigne-Robichaud et al (1). First, it is argued that dichotomizing exposure into "high" and "no-high" job strain deflates risk estimates because a subgroup of the no-high job strain group (passive jobs with low demands and low control) might also be associated with increased risk. However, others have found that results are broadly similar when different non-strain groups are used as reference (3). Thus, at present, the evidence for effects of passive jobs is not strong enough to deviate from the parsimonious use of "all others" as reference. Second, the notion that the pooled risk estimate may be attenuated by sex because women develop IHD at older ages than men is supported by our review indicating slightly lower risk estimates among women. However, the confidence intervals substantially overlap [(2), table 4] and the small difference, if valid, may be due to several other factors and thus considered of minor importance. Third, the use of job-exposure matrices (JEM) is not associated with attenuated risk estimates if the average exposure in the job groups is close to the true average (4). This condition is probably violated in most instances and may lead to attenuated risk estimates if the exposure misclassification is non-differential. However, misclassification may depend on potential confounders (eg, sex, socioeconomic status and psychosocial and lifestyle factors) in ways that inflate or deflate risk estimates. Note also that the JEM studies do not provide the independent assessment of exposure that is needed for stronger conclusions to be drawn. This is because most studies are based on JEM established by population-based questionnaire studies. We consider the lack of independent exposure assessment a major obstacle for causal inference. Fourth, we agree that the prospective cohort study design in principle eliminates recall bias caused by later occurring manifest disease. But it is not obvious that subclinical or early stages of the disease cannot confound the association, potentially leading to inflated risk estimates even in prospective studies (3). Fifth, self-reported psychosocial work exposures are inherently vulnerable to respondents` individual interpretations, particularly when they are asked to rate the intensity or frequency of subjective experiences. We acknowledge the references provided by Lavigne-Robichaud et al, but these studies do not rule out potential confounding by personality (5, 6). The influence of social context, attitudes, life experiences and personality traits remains unresolved and likely constitute bias regardless of study design (7). We are aware that our review may be misused to discourage sound efforts to improve the psychosocial work environment. While this unfortunate risk is inherent to all critical appraisals of the literature, we believe it remains incumbent on researchers to provide the most evidence-based assessments possible so that we can collectively endeavor to improve science. References 1. Lavigne-Robichaud M, Landsbergis P, Brisson C, Sembajwe G, Gilbert-Ouimet M, Li J, Milot A, Trudel X. Job strain and ischemic heart disease: the balance of methodological bias and implications for prevention. Response to: Bonde JP et al. The demands-control-support work stress model and risk of ischemic heart disease: causal inference based on observational epidemiology. Scand J Work Environ Health. 2026;52(5):625-626. https://doi.org/10.5271/sjweh.4315. 2. Bonde JP, Skaaby S, Flachs EM, Dollard M, Keyes K, Rosengren A et al. The demands-control-support work stress model and risk of ischemic heart disease: causal inference based on observational epidemiology. Scand J Work Environ Health 2026 Jul;52(4):360-70. https://doi.org/10.5271/sjweh.4299. 3. Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L et al.; IPD-Work Consortium. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet 2012 Oct;380(9852):1491-7. https://doi.org/10.1016/S0140-6736(12)60994-5. 4. Armstrong BG. Effect of measurement error on epidemiological studies of environmental and occupational exposures. Occup Environ Med 1998 Oct;55(10):651-6. https://doi.org/10.1136/oem.55.10.651. 5. Spector PE, O'Connell BJ. The contribution of personality traits, negative affectivity, locus of control and Type A to the subsequent reports of job stressors and job strains. J Occup Organ Psychol 1994;67:1-2. https://doi.org/10.1111/j.2044-8325.1994.tb00545.x. 6. Shipley BA, Weiss A, Der G, Taylor MD, Deary IJ. Neuroticism, extraversion, and mortality in the UK Health and Lifestyle Survey: a 21-year prospective cohort study. Psychosom Med 2007 Dec;69(9):923-31. https://doi.org/10.1097/PSY.0b013e31815abf83. 7. Kasl SV. Measuring job stressors and studying the health impact of the work environment: an epidemiologic commentary. J Occup Health Psychol 1998 Oct;3(4):390-401. https://doi.org/10.1037/1076-8998.3.4.390.
OBJECTIVE:This study aimed to evaluate whether an employer-provided bicycle benefit changes commuting behavior and overall physical activity in a municipal workforce. METHODS:Surveys from the Finnish Public Sector study in 2022 (pre-intervention) and 2024 (post-intervention) were used. The preregistered primary analysis was an intention-to-treat analysis. Employees in a municipality offering a bicycle benefit were propensity score-matched 1:2 to controls from a municipality without the benefit. Additional analyses included a per-protocol analysis (ie, the adopters) and an analysis of non-adopters (ie, nudge impact). Changes (2024 versus 2022) in weekly commuting kilometers were analyzed with propensity score-adjusted Poisson generalized estimating equation models. RESULTS:In the intention-to-treat analysis, commuting by bicycle increased in the intervention group [rate ratio (RR) for 2024 compared with 2022=1.16, 95% confidence interval (CI) 1.04-1.30] compared with controls (RR 0.93, 95% CI 0.80-1.09; P for group × time interaction 0.02), corresponding to a 2.4 km weekly increase. Car commuting decreased (RR 0.89, 95% CI 0.83-0.96 versus RR 1.00, 95% CI 0.94-1.07; P=0.02), corresponding to a 7.7 km/week reduction (≈236 km/year) and ≈26 kg reduction in CO2e per person annually. No changes were observed in winter commuting or overall physical activity. Effects were larger among participants with optimal health and work ability. Among adopters, summer cycling increased by 14.4 km/week (RR 1.64, 95% CI 1.35-2.00). Non-adopters showed no changes. CONCLUSIONS:Availability of bicycle benefit increased bicycle commuting in summer weather and reduced car commuting, but effects were concentrated among healthier employees and adopters, suggesting that complementary measures may be needed to achieve broader health and climate impacts.
OBJECTIVE:Low-dose ionizing radiation (LDIR, ≤100 mGy) is a public health concern due to its extensive use in diagnostic and therapeutic imaging. This study examined somatic variants (SV) among Korean industrial radiographers exposed to LDIR using whole-genome sequencing (WGS). METHODS:WGS data from 65 workers (mean age 36.7 years) collected between 2016 and 2023 were analyzed. Participants had a mean employment duration of 12.7 years and an average cumulative radiation dose of 33.9 mSv from National Dose Registry records. SV were identified via the GATK Mutect2 single-sample workflow applied to peripheral blood-derived DNA and sequentially filtered using standard pipelines, including FilterMutectCalls, population frequency, recurrent artifacts, Funcotator annotation, and manual Integrative Genomics Viewer review. RESULTS:A total of 105 170 somatic variants were identified, with a median of 1744 variants per individual, approximately 98% of which were single nucleotide variants. Cumulative radiation dose showed a significant positive correlation with total SV burden (R=0.32, P=0.013), including both coding (R=0.34, P=0.008) and non-coding regions (R=0.31, P=0.015). Age, smoking, alcohol consumption, hypertension, and hyperlipidemia were not significantly associated with variant burden. CONCLUSIONS:These WGS-based findings provide preliminary insight into blood-derived SV patterns among occupationally exposed radiation workers. Given the small sample size, blood-only design, and absence of matched unexposed controls, the findings should be interpreted as hypothesis-generating and require validation in larger longitudinal studies with comprehensive exposure assessment.
Objectives Person-related work requires workers to interact with individuals who are not employed at the workplace, eg, clients or patients. Besides (i) the general demands of interpersonal contact, this can entail (ii) emotional demands and (iii) conflicts/quarrels. These three potential stressors may negatively affect workers' mental health. We examined the associations of these three dimensions of person-related work with the risk of mental health problems, including diagnoses of depressive, anxiety/stress-related and alcohol-/drug-use disorders, pharmacotherapy for such disorders, and suicidal behaviors, including deaths and suicide attempts. Methods Around 3.6 million workers aged 20-60 years in Sweden in 2006 were included in the study. Dimensions of person-related work were assessed respectively using a job exposure matrix. Mental health and suicide outcomes in 2007-2020 were determined based on patient, drug, and death registers. Multi-variable Cox regression models were used. Results Of the study participants, 1 481 900 individuals experienced at least one of the studied outcomes. Among women, high exposure to each dimension of person-related work was respectively associated with increased risks of the outcomes [hazard ratios (HR) of 1.04-1.27 for general contact with people, 1.16-1.41 for emotional demands, and 1.11-1.19 for conflicts/quarrels], after adjusting for potential confounders. Among men, a high exposure to each dimension was respectively associated with increased risks (HR of 1.11-1.16 for general contact with people, 1.10-1.23 for emotional demands, and 1.08-1.16 for conflicts/quarrels) of mental health diagnoses and pharmacotherapy. The associations with suicide deaths and attempts were not observed after adjusting for income and previous mental health problems and suicide attempts. Conclusions Person-related work is associated with a slightly increased risk of mental health problems and suicidal behaviors among women and with mental health problems among men. Estimates seem to be strongest for emotional demands.
Objectives Occupational exposures can increase the risk of preterm birth (PTB). We hypothesized that the risk varies significantly according to maternal work tasks and aimed to quantify relative risks and excess fractions of PTB related to occupation and industry during pregnancy. Methods This nationwide study of 644 349 singleton pregnancies (2004-2018), classified maternal employment the year of conception into 38 occupational and 39 industrial groups. To approximate the lowest risk and excess fraction of PTB, ie, live birth before 37 completed gestational weeks, we constructed simulation-based reference groups that accounted for within-group random variation. Adjusted risk ratios (RR) and 99% confidence intervals (CI) of PTB were estimated relative to the simulation-based lowest risk reference and the population average. Results Increased risks of PTB were observed for 22 occupational and 10 industrial groups, compared with the simulation-based lowest risks. The highest RR were found for assembly workers (1.42, 99% CI 1.12-1.79) and home care workers (1.35, 99% CI 1.24-1.47). For industries, the highest RR were found for agriculture, forestry and fishing (1.29, 99% CI 1.06-1.57) and manufacture of metals and machinery (1.22, 99% CI 1.07-1.40). Compared to the population average, risks were significantly higher for home care workers, nursing home workers, clerks (not elsewhere classified), shop assistants, and jobs with unstated job codes, and for the industrial groups of manufacture of metals and machinery and residential centers and home help. Conclusion Several maternal occupational and industrial groups in Denmark had elevated risks of PTB. The findings are exploratory and further research is needed to identify the potential for prevention in the occupational setting.
We read with interest Bonde et al's (1) recent review. We agree with their premise: strengthening causal inference is an important objective for occupational epidemiology. However, we believe the conclusion that "at most, any true effect [of job strain on ischemic heart disease (IHD)] appears to be small" is not supported by a valid appraisal of the available evidence. The pooled relative risk estimate (RRE) of 1.14 is most likely underestimated, as common limitations in the available literature tend to bias results toward the null. The authors acknowledge underestimation sources: nondifferential exposure misclassification, overadjustment for cardiometabolic risk factors, and healthy-worker survivor selection (1). Additional sources of underestimation are not discussed. Dichotomizing exposure by combining active and passive exposures into a single "non-high-strain" category may attenuate risk estimates by increasing heterogeneity in the reference group. Indeed, workers with passive exposure may also be at increased IHD risk (2). The pooled RRE may further be attenuated by sex: women develop IHD at older ages partly due to pre-menopausal estrogen cardioprotection, thus working-age follow-up captures fewer events, reducing pooled estimates and precision (3). Sources of overestimation raised also warrant closer scrutiny. For instance, lower estimates in job-exposure matrix (JEM) studies are interpreted as evidence of upward bias in self-reported studies. However, even when exposure values are imputed within subgroups defined by sex and age, JEM do not fully capture individual-level variability in exposure within occupational categories (4). The resulting non-differential misclassification likely attenuates estimates, a limitation the authors acknowledge but do not take into account in their conclusion. The supporting reference for overestimation relies on a 4-item measure of perceived stress (5), limiting its relevance to job strain. An additional source of overestimation is negative affectivity, in which adverse health perceptions inflate individual-level exposure reports. However, this mechanism is not supported in prospective studies with control for anger, hostility, and cynicism (6, 7). Finally, the authors raise concerns about a health-reporting bias: workers with prodromal IHD symptoms may over-report perceived job strain, inflating observed associations. In prospective studies excluding early incident IHD events, associations were not attenuated and, if anything, marginally strengthened (6, 8), providing no support for reverse causation as a source of overestimation. More broadly, methodological characteristics are presented as isolated binary indicators rather than as interdependent dimensions. This hinders the overall appraisal of study quality. These methodological considerations have implications for burden estimation. There has been considerable debate about whether the population attributable fraction (PAF) of 3.4% that the IPD-Work Consortium reported for job strain and IHD (8) was an underestimate when accounting for exposure misclassification, alternative referent group definitions, and other sources of attenuation identified in the literature (9, 10). A subsequent prospective cohort study designed to address several of the sources of underestimation discussed here estimated that 18.2% of incident IHD were attributable to job strain exposure (11). In sum, while we share Bonde et al's emphasis on causal inference, the balance of methodological bias in this literature is more plausibly downward than unpredictable. Given the substantial burden of IHD, debates about the precise magnitude should not delay the development and evaluation of workplace interventions to reduce job strain and improve cardiovascular health. References 1. Bonde JP, Skaaby S, Flachs EM, Dollard M, Keyes K, Rosengren A et al. The demands-control-support work stress model and risk of ischemic heart disease: causal inference based on observational epidemiology. Scand J Work Environ Health 2026 Apr. [Epub ahead of print]. https://doi.org/10.5271/sjweh.4299. 2. Xu S, Huang Y, Xiao J, Zhu W, Wang L, Tang H et al. The association between job strain and coronary heart disease: a meta-analysis of prospective cohort studies. Ann Med 2015;47(6):512-8. https://doi.org/10.3109/07853890.2015.1075658. 3. Zahiriharsini A, Gilbert-Ouimet M, Hervieux V, Trudel X, Matteau L, Jalbert L et al. Incorporating sex and gender considerations in research on psychosocial work exposures and cardiovascular diseases: A systematic review of 55 prospective studies. Neurosci Biobehav Rev 2024 Dec;167:105916. https://doi.org/10.1016/j.neubiorev.2024.105916. 4. Schwartz JE, Pieper CF, Karasek RA. A procedure for linking psychosocial job characteristics data to health surveys. Am J Public Health 1988 Aug;78(8):904-9. https://doi.org/10.2105/AJPH.78.8.904. 5. Metcalfe C, Davey Smith G, Macleod J, Heslop P, Hart C. Self-reported stress and subsequent hospital admissions as a result of hypertension, varicose veins and haemorrhoids. J Public Health Med 2003 Mar;25(1):62-8. https://doi.org/10.1093/pubmed/fdg013. 6. Lavigne-Robichaud M, Trudel X, Talbot D, Milot A, Gilbert-Ouimet M, Vézina M et al. Psychosocial stressors at work and coronary heart disease risk in men and women: 18-year prospective cohort study of combined exposures. Circ Cardiovasc Qual Outcomes 2023 Oct;16(10):e009700. https://doi.org/10.1161/CIRCOUTCOMES.122.009700. 7. Tiwa Diffo E, Lavigne-Robichaud M, Milot A, Brisson C, Gilbert-Ouimet M, Vézina M et al. Psychosocial stressors at work and atrial fibrillation incidence: An 18-year prospective study. J Am Heart Assoc 2024 Aug;13(16):e032414. https://doi.org/10.1161/JAHA.123.032414. 8. Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L et al.; IPD-Work Consortium. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet 2012 Oct;380(9852):1491-7. https://doi.org/10.1016/S0140-6736(12)60994-5. 9. Choi BK, Schnall P, Landsbergis P, Dobson M, Ko S, Gómez-Ortiz V et al. Recommendations for individual participant data meta-analyses on work stressors and health outcomes: comments on IPD-Work Consortium papers. Scand J Work Environ Health 2015 May;41(3):299-311. https://doi.org/10.5271/sjweh.3484. 10. Kivimäki M, Singh-Manoux A, Virtanen M, Ferrie JE, Batty GD, Rugulies R; IPD-Work consortium. IPD-Work consortium: pre-defined meta-analyses of individual-participant data strengthen evidence base for a link between psychosocial factors and health. Scand J Work Environ Health 2015 May;41(3):312-21. https://doi.org/10.5271/sjweh.3485. 11. Lavigne-Robichaud M, Trudel X, Talbot D, Milot A, Pena-Gralle AP, Mésidor M et al. Coronary heart disease attributable to psychosocial stressors at work. JACC Adv 2025 Oct;4(10 Pt 2):102160. https://doi.org/10.1016/j.jacadv.2025.102160.
OBJECTIVES:Systematic research on employment/working conditions as risk or protective factors for suicidal behaviors is limited. In this study, we systematically reviewed the literature on a range of employment or working conditions and the risk of suicidal behaviors (suicide and suicide attempt), focusing on longitudinal studies. METHODS:We searched Web of Science, Scopus, PsycInfo, and Embase during 1995-2024 for cohort and case-control studies and performed meta-analysis to pool data if there were ≥2 studies on the same type of conditions and outcome. RESULTS:A total of 27 studies met the eligibility criteria, of which 14 studies were used in meta-analyses. Meta-analyses showed statistically significant associations between part-time work [relative risk (RR) 1.21, 95% confidence interval (CI) 1.12-1.30], job loss (RR 2.27, 95% CI 1.12-4.61), job insecurity (RR 1.64, 95% CI 1.36-1.96), high job demands (RR 1.14, 95% CI 1.08-1.20), low job control (RR 1.11, 95% CI 1.05-1.17), job strain (RR 1.32, 95% CI 1.29-1.36), workplace bullying (RR 1.78, 95% CI 1.16-2.73), and suicide. In terms of the evidence, we found moderate and low certainty for job loss and job insecurity, respectively. For other working conditions, certainty of evidence was considered very low or could not be assessed because of too few studies. Studies investigating suicide attempts were limited, and we only found very low evidence for workplace bullying and suicide attempt (RR 1.33, 95% CI 1.09-1.62, in a previously published meta-analysis). For all other conditions, we could not assess certainty of evidence of associations with suicide attempt. CONCLUSIONS:Although some working conditions may be risk factors for suicide, the number of studies is still too limited to allow for certainty of evidence on associations between specific working conditions and suicide.
Objective The adoption of digital technologies has historically impacted the most precarious occupations and contributed to widening labor market inequities. Large language models (LLM) may reshape this relationship. This study examines the association between occupational exposure to LLM and occupational precarity. Methods Using Canada's Labour Force Survey, occupational exposure to LLM and four dimensions of precarity (contractual instability, earnings inadequacy, schedule unpredictability, working-time mismatch) were examined. A multidimensional index was developed to summarize an occupation's overall exposure to precarity. Four multivariate linear regression models with cluster-robust standard errors estimated the associations between LLM exposure and each dimension of precarity. A fifth multivariate model examined the relationship between LLM exposure and the multidimensional precarity index. Utilizing model coefficients, mean estimates of occupational LLM exposure were produced. Results Using the multidimensional precarity index, our analysis showed that occupations characterized by low exposure to precarity had a significantly higher mean LLM exposure [mean 0.386, 95% confidence interval (CI) 0.356-0.417] compared to occupations with medium (mean 0.258, 95% CI 0.221-0.295), high (mean 0.260, 95% CI 0.194-0.328) or very high precarity (mean 0.205, 95% CI 0.136-0.275). Apart from earning adequacy, LLM exposure was also lower among occupations using each separate dimension of precarity. Conclusion Occupations most likely to be exposed to LLM are those where precariousness is lowest. These occupations have previously been sheltered from technological change. There is a need of examine the impacts of LLM on workers in job where the technology is prominent.
We thank Guseva Canu and van der Molen for their thoughtful commentary (1) on our article advocating for the development of occupational exposure limits (OEL) for psychosocial hazards. We appreciate their careful consideration of both the conceptual and methodological challenges associated with transferring established approaches from the assessment of non-psychosocial (ie, chemical and physical) hazards to the psychosocial domain. We also welcome that the authors share the concerns raised in our original discussion paper (2) regarding uncertainties in existing operationalizations of psychosocial hazards. Nonetheless, psychosocial risk assessment has progressed substantially and is considerably more nuanced than suggested in the commentary. While our discussion paper was framed as a mapping of the current knowledge – explicitly titled around “what we know and what we do not know, yet” – we believe the commentary engages primarily with a narrowed reading of our argument, namely a proposal to immediately establish OEL, rather than the roadmap of conceptual and methodological requirements we presented. Considering recent methodological advances, we conclude that advancing toward OEL for psychosocial hazards is not a premature leap but a timely and necessary next step. From latent variable models to actionable items It is true that, for decades, influential work-stress theories have relied on latent variable models to operationalize psychological phenomena which, although not directly observable, have repeatedly been linked to employee health outcomes. Methodologically, manifestations of distinct individual aspects of the latent constructs are combined to operationalize the latent variable of interest. It should be noted, however, that eg, the latent variable job demands represents no more an observable hazard than generic categories like dust or metal represent identifiable hazardous substances. Accordingly, while the goal is to optimize job demands or job control, this can only be accomplished by addressing the distinct actionable items that constitute such latent constructs. Guseva Canu and van der Molen themselves use the example of bus drivers for whom efforts had been disentangled into 39 distinct actionable items. As an additional example, the Joint German Occupational Safety and Health Strategy (3) identifies more than 70 actionable items that constitute six latent domains of job stressors (work content, work organization, working time, social relations, work equipment, work environment) each representing a quantifiable presence or absence of hazards. The “fundamental paradigm shift […] toward more specific, measurable, and harmonized approaches”, as advocated by Guseva Canu and van der Molen, is thus already underway. Whether no-observed adverse effect level (NOAEL)/ lowest-observed-adverse effect level (LOAEL) are most usefully defined at the level of individual items, item composites, or aggregated constructs is itself an empirical question that future research should address. Subjective bias and social construction of hazards Guseva Canu and van der Molen argue that assessments of social support, decision authority, or emotional demands are inherently subjective or socially constructed. By referencing cultural norms and economic pressures, they highlight individual processes of perception, implying that actual exposure cannot be accurately quantified in terms of OEL. We believe that these phenomena can still serve as valid and meaningful decision aids for preventive action: Within occupational groups, employees show high within-group agreement in psychosocial risk assessments, and in addition, there is substantial agreement between employee evaluations and those conducted by occupational safety and health (OSH) committees for the same job activities (4). Moreover, methodological advances are improving our understanding of how subjective bias can be minimized. Stress measures frequently confounded exposure with appraisal as items often incorporate evaluations of job characteristics as stressful. To address this, it was recommended to operationalize job stress using condition-related, non-evaluative items (5, 6). Finally, advanced understanding of the psychometrics of psychosocial risk assessment, including activity-based rather than person-based item wordings combined with frequency rather than agreement response options, can further reduce subjective bias via personality traits on assessments (7). These developments demonstrate that, despite inherent subjectivity, psychosocial exposures can be reliably quantified when validated and carefully designed instruments are used. Concluding remarks As with chemical and physical hazards, decisions regarding psychosocial exposures should be guided as objectively as possible by evidence-based criteria, giving both employees and organizations the confidence that preventive measures – or the decision not to implement them – are justified rather than based on subjective judgments. We believe that, despite their construct-dependent ontological nature, OEL for psychosocial hazards can provide substantial support for preventive decision-making. We also share Guseva Canu’s and van der Molen’s emphasis on the political economy of the OEL setting, which our own call for institutionalized discussion forums (Essential 4) explicitly anticipates. With our proposal, we aimed to establish a framework for these decisions based on the current scientific state of the art. While its methodological foundations may not be perfect, we believe it represents a substantial improvement to harmonize research efforts and standardize reporting in a way that encourages researchers to tackle the remaining challenges. In other words, act on OEL where the evidence permits and continue to improve where gaps remain. References 1. Guseva Canu I, van der Molen HF. Occupational exposure limits for psychosocial hazards: A promising concept or a premature leap? Scand J Work Environ Health. 2026;52(4):462-465. https://doi.org/10.5271/sjweh.4280. 2. Pauli R, Lang J, Müller A, Taibi Y, Kraus T, Metzler Y. Requirements for occupational exposure limits in psychosocial risk assessment: what we know, what we don’t know and what we can learn from other disciplines. Scand J Work Environ Health 2025 Nov;51(6):559–68. https://doi.org/10.5271/sjweh.4247. 3. Gemeinsame Deutsche Arbeitsschutzstrategie: Berücksichtigung psychischer Belastung in der Gefährdungsbeurteilung – Empfehlungen zur Umsetzung in der betrieblichen Praxis [Joint German Occupational Safety and Health Strategy. Consideration of psychological stress in risk assessments: Recommendations for implementation in operational practice] (4th fully revised edition; as of 15 June 2022, updated January 6, 2026). Federal Ministry of Labour and Social Affairs. 4. Schneider I, Mädler M, Lang J. Comparability of self- and observer-ratings in occupational psychosocial risk assessments – Is there agreement? BioMed Res Int 2019 Jun;2019:8382160. https://doi.org/10.1155/2019/8382160. 5. Rau R. Questioning or observation or both together? Which instruments should be used when psychic work load and strain have to be analyzed? Zentralbl Arbeitsmed Arbeitsschutz Ergon 2010;60(9):294–301. https://doi.org/10.1007/BF03344299. 6. Semmer NK, Grebner S, Elfering A. (2004). Beyond self report: Using observational physiological and situation based measures in research on occupational stress. In P. L. Perrewe & D. C. Ganster (Eds.), Research in occupational stress and well being, volume 3. Emotional and physiological processes and positive intervention strategies (1st ed., pp. 205–263). JAI. 7. Pauli R, Lang J. Survey Design Moderates Negativity Bias but not Positivity Bias in Self-Reported Job Stress. Eur J Psychol Assess 2024;41(5):357–66. https://doi.org/10.1027/1015-5759/a000806.
OBJECTIVES: The association between night shift work and chronic kidney disease (CKD) risk remains uncertain. We investigated the associations of current/lifetime night shift work with incident CKD, assessed joint effects with genetic susceptibility, and explored the mediating roles of obesity and metabolomic alterations. METHODS: Utilizing UK Biobank data, current (N=242 721) and lifetime (N=63 659) night shift duration/frequency were assessed via questionnaires. The primary outcome was incident CKD. Polygenic risk scores (PRS) for cardiometabolic diseases (diabetes, hypertension, and cardiovascular disease) were calculated. Plasma metabolomics (249 measures, N=122 681) were analyzed. RESULTS: Over 13.7 years of follow-up, 5654 incident CKD cases were identified. Compared to day workers, those who usually or always worked night shifts had a 25% higher CKD risk [adjusted hazard ratio (HR_adj) 1.25, 95% confidence interval (CI) 1.10–1.41] and developed CKD 2.06 years earlier (95% CI 0.75–3.25). Lifetime night shift exposure showed consistent dose–response relationships, with 16–17% increased risks for either ≥5 cumulative years (HR_adj 1.17, 95% CI1.01–1.36) or ≥3 monthly night shifts (HR_adj 1.16, 95% CI1.01–1.33). Participants with both usual/always night shift exposure and high PRS for cardiometabolic diseases exhibited the greatest CKD risk. Obesity-related parameters (body mass index and waist circumference) mediated 14.7–14.8% of the observed night shift–CKD association. A novel 9-metabolite signature reflective of night shift mediated 5.47% of this association, primarily through disrupted fatty acid metabolism. CONCLUSIONS: Night shift work exhibits a dose-dependent association with CKD risk, exacerbated by cardiometabolic genetic predisposition and partially mediated through metabolic dysregulation and obesity. These findings underscore the need for workplace interventions targeting shift scheduling and metabolic health among high-risk workers.
OBJECTIVE: This study aimed to (i) investigate associations between different characteristics of exposure to shift work and breast cancer risk and (ii) identify effect modifiers. METHODS: Comprising 42 379 women from the Finnish Public Sector cohort, this longitudinal study included data from survey responses, payroll-based working hour records, and national breast cancer registry data. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HR), adjusting for age, marital status, socioeconomic status, living with a child, lifestyle, and occupational factors. Stratified analyses and interaction tests were performed to assess effect modification. RESULTS: Over an average follow-up of 9.8 years, 945 women were diagnosed with breast cancer. Among women aged ≥50 years, increased risk was associated with working >3 consecutive night shifts [hazard ratio (HR) 1.64, 95% confidence interval (CI) 1.22–2.21] and evening shifts (HR 1.28, 95% CI 1.03–1.59). Sleep problems and fatigue at work modified the association between night shift work and breast cancer risk, whereas psychological distress and diurnal preference did not. Permanent night shift workers reporting sleep problems (HR 1.76, 95% CI 1.01–3.09) or fatigue at work (HR 1.90, 95% CI 1.08–3.35) had a higher risk compared to day workers with similar symptoms. CONCLUSIONS: Women aged ≥50 years showed increased breast cancer risk for several shift work characteristics. Permanent night shift work was especially associated with increased risk among those reporting sleep problems or fatigue. These findings may help identify groups needing closer occupational health monitoring, though causal inference is limited by the observational design. Intervention studies are required to determine whether changes in work schedules or management of sleep problems and fatigue could reduce risk.
OBJECTIVES: Menopausal symptoms are common and can negatively affect women’s work functioning. Psychosocial work factors may play a role in how women experience these symptoms and their consequences on work. This study aims to examine the association between menopausal symptoms and work impairment, and whether psychosocial work factors moderate this association among peri- and postmenopausal women. METHODS: Data from 9490 peri- and postmenopausal women participating in the Dutch Lifelines cohort were used. Measures included self-reported menopausal symptoms, psychosocial work factors (job demands, work pace, influence at work, job insecurity, social support from colleagues, social support from supervisor, and job control), and work impairment. A two-part modeling approach was applied: logistic regression to estimate the likelihood of reporting any work impairment and a generalized linear model to assess the severity of impairment among those affected. Interaction terms tested whether psychosocial work factors moderated the association between menopausal symptoms and work impairment. RESULTS: Experiencing more severe menopausal symptoms was associated with both an increased likelihood [odds ratio (OR) 3.04, 95% confidence interval (CI) 2.84–3.26] and greater severity [Exp(β) 1.18, 95% CI 1.15–1.20] of work impairment. No moderating effects were found for most psychosocial work factors. Only job demands moderated the association between menopausal symptoms and the severity of impairment, with the association being stronger among women with high job demands than those with low demands. CONCLUSION: Menopausal symptoms contribute to both the presence and severity of work impairment. Although high job demands amplify this association, workplace strategies should support menopausal women across all work conditions.
OBJECTIVES: This study aimed to determine whether night shift work was associated with exposure to carcinogenic hazards, independent of occupation and industry. METHODS: We conducted a cross-sectional analysis of 16 250 job records reported by 7023 participants. Participants provided lifetime job histories, including shift schedules and exposures to hazardous agents. Carcinogenic agents included established carcinogens classified by the International Agency for Research on Cancer, as well as broader exposure categories that may potentially contain carcinogenic constituents. Jobs involving ≥1 and ≥7 night shifts/month were compared with day-shift jobs. Occupations and industries were coded using National Occupational Classification (2016) and North American Industry Classification System (2017) codes. Generalized linear mixed models with random intercepts for participant, occupation code (2-digit level), and industry code (2-digit level) were used to estimate odds ratios (OR) for exposures associated with night- versus day-shift work, adjusting for biological sex and job start year. RESULTS: Night shifts were associated with greater odds of any hazardous exposure [≥1 night shift/month: OR 3.1, 95% confidence interval (CI) 2.6–3.8; ≥7 night shifts/month: OR 3.1, 95% CI 2.5–3.8]. Significant associations were observed for multiple agents, including asbestos, degreasing agents, diesel engine exhaust, gasoline engine exhaust, ionizing radiation, mineral/cutting/lubricating oil, paints/stains/varnish, welding fume, and wood dust. CONCLUSIONS: Night-shift work was associated with an increased likelihood of self-reported exposure to multiple potentially carcinogenic agents, independent of broad occupational and industry groupings. Future research with more granular task-level information and quantitative exposure assessment will be important for clarifying the mechanisms underlying these differences.
Objectives This study aimed to characterize long-term labor market participation from five years before to five years after assessment at departments of occupational medicine among patients referred with low-back pain (LBP) and to compare these patterns with those in a matched general working population. Secondary objectives were to assess subgroup differences and time to return to work. Methods In this nationwide register-based cohort study, we included Danish residents aged 18-60 years referred for assessment (N=8256) and matched comparators (1:5 on sex, age, and calendar year; N=41 280). Using weekly register data, we calculated the prevalence of different labor market states before and after assessment as well as propensity score-weighted prevalence differences and ratios, and we performed stratified analyses. We estimated the five-year cumulative incidence of return to work among individuals on temporary public benefits using the Aalen-Johansen estimator. Results At assessment, 37% of patients were working versus 83% of comparators. Five years post-assessment, 40% of patients were working and 32% received permanent health-related public benefits. We observed substantial heterogeneity, with larger deficits in work participation in several subgroups. Among patients on temporary public benefits at assessment, the five-year cumulative incidence of return to work was 42%, with no increase in overall work prevalence. Conclusions LBP patients had persistently poorer labor market participation than matched comparators, with declines already evident one year before assessment. Prognosis was particularly poor among older patients, those with weaker labor market participation at assessment, and those with comorbidities. These findings highlight the need for early identification and timely intervention and referral.
Objectives The aim of the study was to examine whether exposure to workplace bullying and violence is associated with changes in health-related behaviors over time. Methods This multi-cohort study included four cohorts from Sweden, Denmark, Finland, and Norway, comprising 78 624 participants aged 18-65 years at baseline between 2004 and 2016. The data were analyzed using an emulated trial design. The main analysis ascertained both onset of workplace bullying and violence (exposures) and changes in health-related behaviors (outcome) using data from time TX and TX+1 (concurrent analysis). To clarify temporality, changes in health-related behaviors were further calculated at time TX+1 to TX+2 (longitudinal analysis). We applied logistic regression with generalized estimating equations. Subgroup differences by sex were examined. Results Among 125 854 participant-observations across 2-3 study phases of the 78 624 participants, 6-8% experienced onset of workplace bullying and 9-14% reported onset of workplace violence over 1-2 years. The strongest association was observed between onset of violence and becoming obese, with an odds ratio (OR) of 1.13 [95% confidence interval (CI) 1.00-1.27] in the concurrent and 1.31 (95% CI 1.05-1.64) in the longitudinal analysis. In addition, onset of bullying (OR 1.23, 95% CI 1.06-1.44) and violence (OR 1.11, 95% CI 0.99-1.24) were concurrently associated with initiation of excessive alcohol use, with weaker associations in the longitudinal analysis. Exposure-response relationships were observed for all aforementioned associations and findings were consistent across cohorts. Men were more likely to initiate excessive alcohol use than women after experiencing violence (P=0.008). Conclusion Exposure to workplace bullying and violence was associated with adverse changes in health-related behaviors.
Objective This study aimed to estimate the consequences of changes in employee exercise habits (starting and quitting) on work engagement and presenteeism. Methods Since January 2023, the Japan Institute for Labour Policy and Training has conducted the semi-annual JILLS-i longitudinal, web-based survey to represent Japan's middle-aged population structure (512 strata defined by gender, age, employment status, region, education). Of the 11 148 regular employees in the first wave, we analyzed the four-wave data of 6576 individuals (N=26 304 person-waves). We utilized work engagement and productivity (presenteeism) as our analytical outcomes. Binary indicators for relative time from changes in exercise habits were included as explanatory variables to estimate temporal associations with job-related outcomes using an event-study analysis, a quasi-experimental approach. Results Both starting and quitting exercise habits showed no significant association with presenteeism. However, starting exercise was positively associated with work engagement, whereas quitting was negatively associated with it. Starting exercise showed a significant association over longer follow-up waves than quitting exercise. Gender differences were observed in the association of quitting exercise with work engagement. Conclusions The acquisition of exercise habits may lead to a sustained improvement in work engagement, a crucial psychological resource for employees. Our results potentially suggest a divergence in the dynamics of effect between organizational support for starting versus preventing quitting exercise. Although exercise promotion may not lead to substantial improvements in productivity as measured by presenteeism, it may still yield meaningful psychological benefits.
