[The Berne Härz-As (Ace of Hearts) Project: goals, study plan and initial results]

The relation of self-reported back pain to psychosocial, behavioral, and health-related factors in a working population in Switzerland

Back pain causes a considerable loss of working days as well as health care costs and therefore represents a major public health problem in industrialized countries. Psychosocial factors have received increasing attention from researchers studying the causal factors of non-specific back pain. However, most studies focus on few dimensions, like individual or work-related factors. We studied the simultaneous association of various factors representing psychosocial, behavioral, and health-related dimensions to self-reported back pain. Data from the Berne Workplace Health Project on 850 employed men and women was analyzed. Back pain was operationalized by a dichotomized variable (having suffered moderately to severely from back pain in the preceding four weeks). The theoretical model guiding the underlying project was a general demand-resource model. Variables that--according to that model--were hypothesized to be related to back pain as well as more specific factors--like physical work load--were analyzed by stepwise logistic regression analysis. In men, there was a statistical trend (P < 0.1) for several work-related factors (low job discretion, high job demands, low job satisfaction). In women, dissatisfaction with salary was the only work-related factor associated with back pain. There was no significant association between private context factors, like poor social network or high demands/low control, and back pain. Only in men, the likelihood of back pain increased with age, while only in women, back pain was associated with emotional problems (individual factors). Among the behavioral factors, smoking was associated to back pain in men, while in women none of the behavioral factors was significant. In both men and women reporting more than two functional symptoms and a history of intestinal problems were associated to back pain. All of our findings were in the expected direction, i.e., it was invariably unfavorable categories of explanatory variables that were associated with higher prevalence of back pain. However, most associations seem to be quite unspecific. There is a need for theoretically guided research aiming at the development of a more complex process model of back pain.

[Occupational status and prevalence of cardiovascular risk indicators in employed men in German-speaking Switzerland]

Based on a sample of 623 employed men from the Berne Workplace Health Project ("Härz-As-Project") we studied the relationship between the occupational status and prevalence of cardiovascular risk indicators. Besides "biological" risk indicators, like high total cholesterol, low HDL-cholesterol, hypertension, and overweight, we also studied two behavioral risk indicators (current smoking, physical inactivity in leisure time) and a summary risk score. Odds ratios for several risk indicators controlled for age, were markedly different among different occupational status groups. High cholesterol/HDL-cholesterol ratios were more common in lower occupational status groups, while the likelihood for hypertension and high total cholesterol was highest among qualified workers. There was a strong association between occupational status and the behavioral risk indicators smoking and physical inactivity in leasure time. Similarly, 1 or more risk indicators, and more than 2 risk indicators, respectively, were also found to be strongly related to occupational status. Our results confirm former findings of unequal distribution of cardiovascular disease risk indicators among groups of different occupational status. Future studies will have to focus upon the underlying causes for these inequities.