Occup. Med. Vol. 48, No. 5, pp.

289-295, 1998
Copyright 1998 Lippincott-Raven Publishers for SOM
Printed in Great Britain. All rights reserved
0962-7480/98

Absence attributed to
incapacity and occupational
disease/accidents among female
and male workers in the
fish-processing industry
B. Palsson, U. Stromberg, K. Ohlsson and S. Skerfving
Department of Occupational and Environmental Medicine, University
Hospital, Lund, Sweden

Key words: Musculoskeletal disease; neck; occupational disease; occupational accident;

repetitive work; social insurance; sickness cash benefit; upper limbs; work environment.
Occup. Med. Vol. 48, 289-295, 1998
Received 14 April 199/'-.accepted in final form 4 December 1997.

INTRODUCTION
Work environment conditions are important risk
factors for musculoskeletal diseases and accidents.1"3
In particular, industrial work involving repetitive movements is associated with a considerable risk of
musculoskeletal disorders.4"6 Thus, among workers in
the fish-processing industry, disorders in the musculoskeletal system are prevalent. In particular, females
are affected.7"10 Although some data indicate that the
risk is similar in women and men, with identical work
tasks,11 gender-related health risk has seldom been
directly addressed.

Correspondence and reprint requests to: B. Palsson, Department of

Occupational and Environmental Medicine, University Hospital, S-221
85 Lund, Sweden.

Absence attributed to incapacity (in the following

referred to as 'sick-leave') places a heavy economic
burden on society and industry.1'12 Musculoskeletal
disorders are a major cause of sick-leave.13 In Sweden,
sick-leave is more prevalent among women than in
men.2-14'15 It is not known to what extent this is due
to differences in working conditions.
Some countries keep databases on occupational
diseases and accidents. Such statistics provide an
important tool for society to monitor occupational
hazards so as to set priorities for preventive work and
to follow the development over time. However, studies
have only rarely investigated whether such statistics
accurately reflect risk.
The aims of this study were to compare the
frequency of sick-leave among female workers and
male workers in the same industry, and to compare

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Sick-leave between 1984 and 1989 was higher among both female (n = 515) and
male (n = 304) fish-processing workers [observed/expected (O/E) 2.24 and 1.69,
respectively] than among non-exposed groups (0.62 and 0.89). Diagnoses in the
musculoskeletal system dominated {i.e., neck/upper limbs; females, exposed vs.
non-exposed workers: 30 vs. 12%; males: 11 vs. 5.8%). In subjects who left
employment, the O/E-ratio decreased (females: 3.02 vs. 1.55; males: 2.40 vs. 1.55).
Among those women hired before the start of the observation period, exposed
subjects had higher frequencies of sick-leave than non-exposed, for both total illness
and musculoskeletal diagnoses. In the men, there were corresponding differences,
though not fully statistically significant. Reported occupational diseases [O/E:
females: 4.5; (95% confidence interval) Cl = 3.2-6.1; males: 2.3; Cl = 1.3-3.9] and
accidents (females: 4.3; Cl = 3.0-5.9; males: 1.8; Cl = 1.2-2.7) were also higher in
female than in male fish-processing workers, and much higher than in non-exposed
workers. In conclusion, work in the fish-processing industry was associated with
increased frequencies of sick-leave, especially because of diagnoses of the
musculoskeletal system, and occupational disorders and accidents, in particular
among female workers.

290

Occup. Med. Vol. 48, 1998

the incidences of being affected by occupational diseases and accidents. Further, the aim was to investigate
whether databases give an adequate picture of those
risks. We investigated sick-leave and reported occupational diseases and accidents among female and male
fish-processing workers. These data were compared to
those for non-exposed groups and the general population.

MATERIALS AND METHODS

The study had a historical cohort design.
Study groups

Methods
All persons in this study, both the exposed workers
and the non-exposed, belong to the same health
insurance system. A medical certificate is required
from the eighth day of sick-leave. For periods of illness
lasting a week or less, no physician's certification is

Statistics

The ratio between the observed (O) and expected (E)

numbers of days with sickness cash benefit was
calculated; E was obtained by taking the sum of the
products of the observed person-time and regionalspecific average numbers of sickdays for each calendar
year, age group (16-29, 30-49, 50-59, 60-64) and
sex. The two-sided Mann-Whitney test was employed
to compare the person-specific numbers of sickdays
observed in the exposed and non-exposed cohorts,
respectively. A p-value of < 0.05 is referred to as
statistically significant. For reported occupational

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The exposed group consisted of the workers at all 13

fish-processing factories on the south-east coast of
Sweden. The plants were situated in four towns.
The group of exposed female workers consisted of
515 women who had worked for at least 3 months
during a 6-year period (1984-89) in the fish-processing industry (Table 1). Most of the workday was spent
at three tasks: trimming cod, packing fish and working
at the herring filleting machine.
The group of exposed male workers consisted of
304 men who had worked for at least 3 months during
a 6-year period (1984-89) (Table 1). Most of their
workday was spent at the following tasks: operating
trucks, handling materials including emptying boxes
with fish and working at the cod filleting machine.
The 'non-exposed group' consisted of workers at
municipal work places in the same towns as the
exposed group (Table 1). They were not without
exposure to physical and psychosocial work environment factors, but certainly to a much lesser extent
than the exposed group.
The non-exposed group of female workers was
composed of 178 women who had worked for at least
3 months during a 6-year period (1984-89). Their
work tasks were varied and allowed mobility. They
were employed at day nurseries, in offices with various
work tasks (no constant video terminal work or typing),
took care of elderly people and some were gardeners.
A group of non-exposed male workers was composed
of 117 men who had worked for at least 3 months
during a 6-year period (1984-89) at municipal work
places in the same towns as the exposed group (Table
1). Their work tasks were varied, were not repetitive
and did not require heavy lifting. They were employed
as caretakers, or worked in community parks and
gardens. Some performed maintenance tasks.

needed; the subject her/himself reports the reason for

her/his sick-leave. Those periods are excluded from
the present total number of days with sickness cash
benefit under certain diagnoses.
Information about sick-leave (number of days with
sickness cash benefit, including diagnoses) between
1984 and 1989 in the exposed and non-exposed groups
was collected at the local social insurance offices (SIO).
The figures on sickness cash benefit do not include
pregnancy benefits or parental leave insurance. The
lengths of the sick-leave periods within each calendar
year were recorded. The observation period for each
individual ended at the time when she/he no longer
was entided to sickness cash benefit, or on 31 December 1989, whichever occurred first.
From the National Social Insurance Board (NSIB),
we collected sex-, age-, calendar-year-, and countyspecific figures on the number of days with sickness
cash benefit for the general population.13
For each group of diagnoses we calculated the
number of days with sickness cash benefit. It was not
possible to obtain data-based figures for the general
population regarding days with sickness cash benefit
under given diagnoses.
Disability pensioning was recorded as described
previously.13
In Sweden, a work injury is defined as a disease or
an accident resulting from harmful influence at work.
From the Swedish Occupational Injury Information
System (SOUS), data on reports of occupational
diseases and accidents between 1984 and 1989 in the
exposed and non-exposed cohorts were obtained, as
well as sex-, age-, calendar-year- and county-specific
figures for the Swedish population. These reports are
forwarded from the subject via the SIO and the labour
inspectorate, to the SOUS. We have previously seen
that the proportion of reports reaching the SOUS
is high.16 Only diseases and accidents occurring
during employment are considered. Observation
time ended at the first registration of occupational
disease/accident.
There were more persons in the groups reporting
occupational diseases/accidents than in those who
requested sick-leave, since information from the SIO
could only be obtained on subjects who gave their
consent.

B. P&lsson e( a/.: Occupational disease in the fish-processing industry 291

Table 1. Studied populations of exposed workers in the fish-processing industry and non-exposed groups
Non-exposed

Exposed
Study of occupational
disease/accidents

Study of sick-leave

Study base n
Non-responders n (%)
Studied n
Age*
Mean
Range
Employment time* (mo.)
Mean
Range
Full-time workers %
Immigrants %

Females
581
113 (19)
468

Females
646
131 (20)
515

Males
352
85 (24)
267

Study of sick-leave and

occupational disease/accidents

Males
390
86 (22)
304

Females
181

40

34
16-65

34
17-65

34
16-65

34
17-65

61
3-516
71
9

77
3-586
80
11

58
3-516
66
9

71
3-586
71
10

Males
120
3(3)
117

3(2)
178

44
19-64

19-63
125

156
7-483
93
3

3-408
58
5

* At end of employment, or end of observation period (1984-89).

Cohort
Gender
Employment status

Time
since
hired
(mo)

Sick-leave
Persons Observation
time
under
Musculoskeletal diagnosis"
All diagnoses
(personrisk
Low back
All
Neck,
Obs (days) Exp (days) Obs/Exp
years)
pain
upper limb
(%)

Exposed (during employment)

Women
Total
0-60
>60
Total*

396
164
468

607
562
1,169

22,899
43,344
66,243

12,646
16,921
29,567

1.81
2.56
2.24

36
64
54

0-60

156

326

368

1.58
2.15
1.93

62
52

34

694

7,148
11,167
18,315

21

87
193

11,335
23,955
35,290

33

>60
Total*
0-60
>60
Total*

218
58
242

244
131
375

10,742
13,679
24,421

4,411
3,673
8,084

2.44
3.72
3.02

39
74
58

0-60
>60
Total*

215
106
267

346
398
744

9,060
16,946
26,006

5,916
9,429
15,345

1.53
1.80
1.69

39
50
46

Current workers

0-60
>60
Total*

75
59
105

158
283
441

2,699
9,710
12,409

3,112
7,074
10,186

0.88
1.37
1.22

29
48
44

Leavers

0-60
>60
Total*

125
39
144

172
88
260

5,672
4,424
10,096

2,465
1,738
4,203

2.30
2.55
2.40

48
60
53

Exposed (after employment)

Women
Men

242
144

664
353

24,131
9,535

15,599
6,150

1.55
1.55

45
41

Non-exposed (during employment)

Women
0-60
>60
Total*

94
119
178

212
599
811

3,621
9,498
13,119

4,790
16,508
21,298

0.76
0.58
0.62

54
89
117

138
448
586

1,167
10,440
11,607

2,628
10,357
12,985

0.44
1.01
0.89

Current workers

Leavers

Men
Total

Men

0-60
>60
Total*

7.1

30

16
13

7.8
12
11

13
17
16

34
28
29

11
12
12

23
4.6
9.6

31
36
35

10
5.4
5.8

3.3
10
9.6

Some persons belong to both the 0-60 group and the > 60 group, since during 1984-89 they worked more than five years during
the observation period. Thus, the total number of persons under risk is less than the sum of numbers of persons in each group.

** For different physicians' diagnoses.

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Table 2. Total number of days with sickness allowance benefit between 1984-89 among females and males in the fish-processing industry

292 Occup. Med. Vol. 48, 1998

Table 3. Occupational diseases (total and musculoskeletal) and accidents (reported to SONS) between 1984-89 among women and
men exposed in the fish-processing industry and in non-exposed groups
Outcome
Cohort
Gender
Employment status

Persons
under risk

Occupational diseases
Exposed
Women
Total
Current workers
Men
Total
Current workers
Non-exposed
Women
Current workers
Men
Current workers

Musculoskeletal

Total
Obs

Exp

Obs/Exp

Cl

Obs

Exp

Obs/Exp

Cla

515
193

1,873
619

67
40

24.1
8.9

2.8
4.5

(2.2-3.5)
(3.2-6.1)

66
40

19.2
7.1

3.4
5.6

(2.7-4.4)
(4.0-7.7)

304
105

1,175
423

27
15

13.8
6.4

2.0
2.3

(1.3-2.9)
(1.3-3.9)

24
14

8.5
3.6

2.8
3.9

(1.8-4.2)
(2.1-6.5)

178

827

13

11.7

1.1

(0.6-1.9)

9.6

0.9

(0.4-1.8)

117

576

8.4

1.1

(0.5-2.0)

4.8

1.4

(0.6-3.0)

513
193

1,829
617

69
37

25.6
8.6

2.7
4.3

(2.1-3.4)
(3.0-5.9)

11
6

7.9
2.8

1.4
2.1

(0.7-2.5)
(0.8-4.7)

303
105

1,037
369

54
25

43.4
13.6

1.2
1.8

(0.9-1.6)
(1.2-2.7)

4
3

7.2
2.6

0.6
1.2

(0.2-1.4)
(0.2-3.4)

178

827

10.7

0.7

(0.3-1.5)

3.2

1.9

(0.7-4.1)

117

513

24

18.2

1.3

(0.8-2.0)

3.5

1.1

(0.3-2.9)

Cl = 95% confidence interval.

diseases and accidents, the ratio O/E was also calculated; moreover, a confidence interval for the ratio O/E
was calculated by considering O as a Poisson variable.
Ethical considerations
In connection with a personal interview in either 1.990
or 1991, we asked the men and women in the exposed
and non-exposed groups for permission to access the
information collected by the social insurance offices.
Those who had left were contacted by phone or post.
All subjects in the study gave written consent. The
rate of non-response was 19% and 24% in the exposed
women and men, respectively. This was mainly due to
subjects who had left their employment. The study
design was approved by the Ethics Committee of Lund
University.

RESULTS
Sick-leave
During employment. The exposed women had a much
higher observed total number of days with sickness
cash benefit during employment than expected (O/E

= 2.24; Table 2). The exposed men also had considerably

increased figures (ratio = 1.69). In both women and men,
the ratio between observed and expected increased with
time of employment. In the non-exposed groups,
the sick-leave was lower than expected.
The total group of exposed women took 54% of
their sick-leave because of musculoskeletal diagnoses;
among the men, the corresponding figure was 46%
(Table 2). This fraction increased with length of
employment, for women as well for men. Among the
exposed females, about half of the sick-leave time
attributable to all kinds of musculoskeletal diagnoses
was due to neck/upper limb diagnoses (30%), while
in the exposed males, this fraction was lower (11%;
Table 2). Moreover, for both sexes, the fraction
increased with time after hiring. The fractions of
musculoskeletal diagnoses were lower in the nonexposed groups (29% and 35%, respectively), and
decreased in females with length of employment.
Further, the sick-days associated with diagnoses of
neck/upper limb disorders were also higher than for
the non-exposed, in both women and men, and
increased with time of employment, which was not
the case among the non-exposed (Table 2). Moreover,
in both sexes of exposed workers, the sick-leave time
due to low-back pain increased slightly, and rose with
time after hiring; among the non-exposed women, it

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Occupational accidents
Exposed
Women
Total
Current workers
Men
Total
Current workers
Non-exposed
Women
Current workers
Men
Current workers

Observation
time
(personyears)

B. Palsson ef a/.: Occupational disease in the fish-processing industry

decreased, while it increased in men.

The currently exposed workers were compared to
the currently non-exposed ones with respect to their
observed numbers of sickdays. Among those who
started their current employment before 1984 there
was a statistically significant difference between the
exposed and non-exposed women (p < 0.001 for total
numbers of sickdays, as well as for sick-leave days
under musculoskeletal diagnoses), and an almost
significant difference between the male groups (p =
0.06 for total sickdays, p = 0.08 for sickdays under
musculoskeletal diagnoses). Among those who started
their employment in 1984 or later, there was a significant difference for sickdays under musculoskeletal
diagnoses between exposed and non-exposed women
(p = 0.04); the other differences were not statistically
significant. There was no evidence of confounding by
age or duration of current employment in these
comparisons.

Disability pensioning
There was no elevated incidence of disability
pensioning among fish-processing workers as compared with the general population (females: O/E =
1.04, CI = 0.68-1.56; males: O/E = 0.94, CI = 0.501.61).
Occupational diseases
During the period between 1984 and 1989, women in
the exposed group had a higher incidence of reports
of occupational diseases than expected (ratio 2.8; Table
3). Among the exposed men, there was also an
increased incidence (ratio 2.0). Almost all occupational
diseases were ascribed to musculoskeletal strain (66/67
in women; 24/27 in men). Accordingly, the ratios for
such complaints were even higher (3.4 in women; 2.8
in males). In neither female nor male non-exposed
persons did the occupational diseases deviate from the
expected.
Occupational accidents
Women in the exposed group had a higher incidence
of reports of work-related accidents than expected

(ratio 2.7; Table 3). However, among the exposed men,

the incidence was close to the expected (ratio 1.2).
Many of the occupational accidents were cuts (30/69
in women; 18/54 in men), while relatively few affected
the musculoskeletal system. In the non-exposed group,
the work-related accidents did not deviate from the
expected. Out of the total of 32 accidents, only three
(all in males) were cuts.

DISCUSSION
The present results show that among workers in the
fish-processing industry, occupied mainly with repetitive industrial work, both women and men have far
more sick-leave days than expected; the increase was
higher in exposed women than in men. Further, for
both genders, the sick-leave frequency increased with
time after hiring, and decreased in those who left
employment. In women, the increase of sick-leave
because of musculoskeletal disease appears within just
a few years after employment. In particular, the proportion of absence because of musculoskeletal
diagnoses, and especially diagnoses of neck/upper limb
problems, was high. Moreover, among the fish-production workers, there were significant increases of
the incidences of both reported work-related diseases
and accidents (cuts in particular), especially in women.
In another study in the same period, female workers
doing assembly work involving repetitive movements
were studied. As with the present women, there was
a pattern of higher sick-leave in the exposed group
compared with a non-exposed one, as well as a dominance of musculoskeletal diagnoses, especially
diagnoses for neck/upper limbs.13 Also, similar workers
leaving the exposed work had increased sick-leave
before leaving, and a decrease in their new employment. Further, the incidence of reported occupational
diseases (occupational accidents not studied) was
much higher than expected in both exposed groups.16
In the present fish-processing factories, there was
no elevated incidence in regard to disability pensioning.
This is in contrast to an earlier study of female
assembly workers.13 The reason for this discrepancy
is not clear. One possibility is that there might be a
difference between the populations regarding the
tendency to approach the social welfare system.
Another possibility could be selective incompleteness
of the cohort, or a differential non-response rate.
The findings in regard to sick-leave and occupational
diseases are in accordance with the results of crosssectional studies of women in the same fish-processing
factories, which assessed musculoskeletal complaints
via questionnaire, as well as musculoskeletal diagnoses
based on a physical examination (i.e., prevalence odds
ratio of a diagnosis in the neck/shoulder and elbows/
hands, 3.2 and 3.1, respectively.7 In males, the corresponding figures were 1.9 and 1.8, respectively
(Nordander et al, to be published). Thus, both the
sick-leave and occupational-disease information seems

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After employment. Of the women in the exposed group,

242 left their work during the observation period to
work elsewhere, or in some cases faced unemployment
('leavers')- During exposed work, they had a higher
total sick-leave rate than after leaving the fish-processing industry (3.02 vs. 1.55; Table 2). A total of 144
males left their jobs in fish-processing. They also had
a higher rate of sick-leave during their employment
in the fish-processing industry than afterwards (2.40
vs. 1.55). Among the subjects who remained in the
exposed work throughout the observation period
('current workers'), the rates were lower than among
the 'leavers' (women = 1.93; men = 1.22).

293

294

Occup. Med. Vol. 48, 1998

groups. Thus, the deleterious effect of this workload

on the musculoskeletal system is probably the main
explanation for the higher than expected sick-leave
(and occupational disease) frequencies in the exposed
groups. In accordance with this, in another study, home
care service workers with demanding work had a higher
incidence of musculoskeletal injuries than did nursery
school workers due to physically stressful tasks.20 The
association with work-environment factors is strongly
supported by the decrease of risk found after leaving the
factories, which is in accordance with earlier findings.13
In the present study, we assessed exposure in both
women and men. In the general Swedish population,
women have a much higher frequency of sick-leave
than men,2'14'15'21 while occupational diseases do not
differ, and men have higher accident rates than
women.22'23 In the present exposed groups, women
had much higher rates of sick-leave, occupational
diseases and accidents than men. Interestingly, among
subjects who left for other employment, there was no
gender difference in sick-leave as compared with the
general population. The women had very short-cycled,
repetitive work.13 Further, they had the risks of cuts
and infection in association with the trimming of cod.
The men's work was less repetitive but required heavier
lifting and materials handling. Hence, the difference
in frequency of sick-leave is probably due to different
work conditions. Whether there is also a gender difference in vulnerability is not known. In the non-exposed
group, the women had lower sick-leave frequency as
well as lower occupational accident rates than the men,
while there were no gender differences in occupational
diseases.
The costs of the high sick-leave frequency for the
social welfare system and society are very high.12 For
this reason, and because of the suffering of individuals,
there is a strong need for primary preventive actions.
In contrast, rehabilitation of the individual worker with
a disorder would probably, for several reasons, have
only a limited chance of success.

ACKNOWLEDGEMENTS
Grants were obtained from the Swedish Work Environment Fund, the Swedish Council for Planning and
Co-ordination of Research and the Medical Faculty
of Lund University. Valuable assistance was also given
by Ms Monica Hansi, Ms Lothy Granquist, Mr Borje
Bengtsson, MSc, Ms Robyn G. Attewell, MSc and the
staffs of the local and regional social insurance offices,
the National Social Insurance Board and the Swedish
National Archives.

REFERENCES
1. Lidbom T, Nelander S. Fortidspensionering och arbetsmiljo
[Disability pensioning and work environment]. LO gmnskar
1994; 4.

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to give a fairly accurate picture of the risk.

Sick-leave policy is determined by, among other
things, the social insurance system. There have been
major changes in Sweden since the end of the observation period. For example, the short-time sick-leave
compensation has been reduced. This has been associated with a lowering of the sick-leave rates.17 Also,
the reporting of occupational diseases and accidents
has decreased, because the compensation system has
been changed. It is not known whether these trends
have also affected high-risk factories of the type
presented in this study.
The present study was made with a cohort methodology usually employed in cancer morbidity and in
mortality studies. The method is fully applicable in
the present study setting. One should note that formal
statistical testing of the observed/expected (O/E) ratios
with respect to sickdays is problematic because each
individual generates several sickdays. However, direct
comparisons between the exposed and non-exposed
groups were feasible. For the occupational disease/
accident data, the calculation of confidence interval
for the O/E ratio can be performed by conventional
methods if only the first registration of occupational
disease/accident for each individual is used. The picture
was unaltered if later registrations were included.
The exposed groups were somewhat younger than
the non-exposed. However, the observed numbers of
sickdays in each group were compared with agespecific regional general population numbers. In the
direct comparisons between exposed and non-exposed
groups, there was no evidence of confounding by age.
The diagnostic information in the SOUS database
on occupational diseases/accidents has limitations.
Thus, in an earlier study, we found that only about
half of the musculoskeletal disorders had been
recorded under this diagnosis.16 In order to minimize
this bias, we used all reports indicating musculoskeletal
strain as a proxy of musculoskeletal disease.
The sick-leave periods under musculoskeletal diagnoses were particularly prevalent. The figures were
only slightly lower than those we discovered earlier for
female assembly workers,13 but higher than for females
in monotonous, repetitive work in general,3 probably
indicating that the work tasks we studied here were
more extreme. The present ratio for observed/expected
occupational diseases for women is similar to that
observed earlier in women in assembly work.16
The greater sick-leave and suffering from occupational disorders for employees in fish-processing is
most probably due to the severity of the work environment. A series of associated work-environment
factors may influence the tendency to take sick-leave.
Thus, jobs with low decision latitude and high demands
are strongly associated with sick-leave.18'19 The repetitive work of the women in the present study,7 as well
as in similar work sites,6'7 is associated with bad
psychosocial work-environment conditions.
In addition, there was a large difference in physical
workload between the exposed7 and the non-exposed

B. Palsson ef al.: Occupational disease in the fish-processing industry

295

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tive industrial work. (Submitted).

2. Vogel J> Kindlund H, Diderichsen E Arbetsforhdllanden, oha'lsa
och sjukfr&nvaro 1975-1989 [Working conditions, health and sick- 13. Palsson B, Horstmann V, Attewell R G, Ohlsson K, Skerfving
ness absenteeism 1975-1989]. Living Conditions, Report No.
S. Sick-leave and disability pensions among female assembly
78. Stockholm: Statistics Sweden, 1992: 213.
workers. Eur J Publ Health 1997; 7: 162-168.
3. National Social Insurance Board. Langvarig sjukfrdnvaro under
14. Alexandersson K, Leijon M, Akerlind I, Rydh H, Bjurulf R
olika arbetsforhillanden [Long-term sick-leave under varying work
Epidemiology of sickness absence in a Swedish county in 1985,
environment conditions]. Riksfbrsakringsverket redovisar 1990:
1986 and 1987. Scand J Soc Med 1994; 22: 27-34.
14. Stockholm, Sweden: Riksforsakringsverket, 1990.
15. Marklund S. The decomposition of social policy in Sweden.
4. Hagberg M, Wegman DH. Prevalence rates and odds ratios of
Scand J Soc Welfare 1992; 1: 2-11.
shoulder-neck diseases in different occupational groups. Br J
16.
Palsson B, Horstmann V, Attewell RG, Ohlsson K, Skerfving
Ind Med 1987; 44: 602-610.
S. Work Diseases and Work Accidents among Female Assembly
5. Ohlsson K, Attewell RG, Skerfving S. Self-reported symptoms
Workers. Report: June 27, 1997. Lund, Sweden: Department
in the neck and upper limbs of female assembly workers. Scand
of
Occupational and Environmental Medicine.
J Work Environ Health 1989; 15: 75-80.
17. National Social Insurance Board. 4.2, D I. Fbrsakring vid sjuk6. Ohlsson K, Attewell RG, Palsson B, et al. Neck and upper limb
dom och handikapp. [Sickness and handicap insurance].
disorders in females with repetitive industrial work. Am J Ind
Stockholm, Sweden: Riksforsakringsverket, 1993.
Med 1995; 27: 731-747.
7. Ohlsson K, Hansson G-A, Balogh I, et al. Disorders of the
18. Karasek RA. Job demands, job decision latitude, and mental
neck and upper limbs in women in the fish processing industry.
strain: Implications for job redesign. Admin Set Quart 1979;
Occup Environ Med 1994; 51: 826-832
24: 285-309.
8. Chiang H-C, Ko Y-C, Chen S-S, Yu H-S, Wu T-N, Chang P-Y.
19. Kristensen TS. Sickness absence and work strain among Danish
Prevalence of shoulder and upper-limb disorders among workslaughterhouse workers: An analysis of absence from work
ers in the fish-processing industry. ScandJ Work Environ Health
regarded as coping behaviour. Soc Sci Med 1991; 32: 15-27.
1993; 19: 126-131.
20. Ono Y, Lagerstrom M, Hagberg M, Linden A, Malker B.
9. Moe S. Workload and musculoskeletal complaints among
Reports of work related musculoskeletal injury among home
women in the fish-processing industry. 40 Nordic conference on
care service workers compared with nursery school workers
work environment in Denmark 1991 [Abstract].Copenhagen,
and the general population of employed women in Sweden.
Denmark: National Institute of Occupational Health, 1991 [In
Occup Environ Med 1995; 52: 686-693.
Danish].
21. National Social Insurance Board. Vbtfdr okar sjuktalet? [Why
10. 6lafsd6ttir H, Steingrimsdottir OA, Rafnsson V Musculoskeledoes the rate ofsick-leave increase?]. Statistisk rapport Is-Rl 989:1.
tal complaints among workers in the fish-processing industry
Riksforsakringsverket informerar. Stockholm, Sweden:
in Iceland. 41 Nordic conference on work environment in Reykjavik
Riksforsakringsverket, 1989, 65.
1992 [Abstract]. Reykjavik, Iceland: Administration of Occu22. National Board of Occupational Safety and Health, Statistics
pational Safety and Health, 1992 [In Danish].
Sweden. Occupational Diseases and Occupational Accidents.
11. Mergler D, Brabant C, Vezina N, Messing K. The weaker sex?
Stockholm, Sweden: NBOSH, 1993.
Men in women's working conditions report similar health
23. National Board of Occupational Safety and Health, Statistics
symptoms. J Occup Med 1987; 5: 417-421.
Sweden. Occupational Diseases and Occupational Accidents.
12. Norlund A, Palsson B, Ohlsson K, Skerfving S. Economic
Stockholm, Sweden: NBOSH, 1995.
consequences of occupational disorders in women with repeti-