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        <title>SJWEH - Online-first articles</title>
        <description>List of Online-first articles on the SJWEH website</description>
        <link>https://www.sjweh.fi/rss/online-first/</link>
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        <language>en-US</language>
        <copyright>SJWEH</copyright>
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        <managingEditor>lodo@ttl.fi (Lisa O'Donoghue-Lindy)</managingEditor>
        <webMaster>risto@toivonen.biz (Risto Toivonen)</webMaster>
        <item>
            <title>Effectiveness of multifactorial and single interventions on safety climate and safe patient handling and movement practices: a cluster randomized controlled trial</title>
            <link>https://www.sjweh.fi/Effectiveness-of-multifactorial-and-single-interventions-on-safety-climate-and-safe,242518,0,2.html</link>
            <guid>https://www.sjweh.fi/Effectiveness-of-multifactorial-and-single-interventions-on-safety-climate-and-safe,242518,0,2.html</guid>
            <pubDate>Fri, 06 Nov 2026 15:37:46 +0100</pubDate>
            <category>Original Article</category>
            <description><![CDATA[Objective(s)
Evidence regarding the effectiveness of safe patient handling and movement (PHM) programs is limited. This study compared the effectiveness of a multifactorial and a single intervention for safe PHM in the Swedish healthcare sector.

Methods
This cluster randomized controlled trial included 46 healthcare units (HCU) from Swedish hospital care units and nursing homes, randomized to a multifactorial or single safe PHM intervention. Primary outcomes were changes in safety climate (NOSACQ-50) and PHM specific practices (SafePHM-14) over 12 months, analyzed using mixed models at aggregated HCU level, adjusting for organization type.

Results
Overall intervention-group differences were observed for management of safety justice [dimension 3, P=0.048] and workers’ safety commitment (dimension 4, P=0.026). However, no significant time × intervention group interactions were observed for any of the seven NOSACQ-50 dimensions or the 14 SafePHM-14 items. Significant time effects were observed in NOSACQ-50 management safety priority and ability (dimension 1, P=0.001), management safety empowerment (dimension 2, P=0.001), workers’ safety priority and risk non-acceptance (dimension 5, P=0.008), and peer safety communication, learning, and trust (dimension 6, P<0.001). SafePHM-14 practices improved over time in collaborative effort (item 1, P=0.005), equipment use (item 4, P=0.004), policy and guideline use (items 5–7, all P<0.001), risk assessment (item 8, P<0.001), patient mobility assessment (item 11, P=0.036), training (item 13, P<0.001), and injury prevention discussions (item 14, P<0.001).

Conclusion(s)
A multifactorial intervention was not more effective than a single intervention in improving safety climate related to PHM. However, safety climate and PHM practices improved over time in both groups. Given the minimal additional benefit observed, the value of implementing the more resource-intensive multifactorial intervention may be questioned.

<strong>by</strong> <i>Sebastian Buck, Jan Sandqvist, Emma Nilsing Strid, Nadine Karlsson, Paul Enthoven, Maria Andreassen, Charlotte Wåhlin</i>]]></description>
        </item>
        <item>
            <title>Re: Nielsen HB, Sejbaek CS, Dreyer LW, Madsen IEH, Flachs EM, Hougaard KS. Occupational history of psychosocial work environment exposures and risk of autoimmune rheumatic diseases – a Danish register-based cohort study. Scand J Work Environ Health. 2025;51(3):226-236.</title>
            <link>https://www.sjweh.fi/Re-Nielsen-HB-Sejbaek-CS-Dreyer-LW-Madsen-IEH-Flachs-EM-Hougaard-KS-Occupational,242583,0,2.html</link>
            <guid>https://www.sjweh.fi/Re-Nielsen-HB-Sejbaek-CS-Dreyer-LW-Madsen-IEH-Flachs-EM-Hougaard-KS-Occupational,242583,0,2.html</guid>
            <pubDate>Fri, 06 Nov 2026 14:17:11 +0100</pubDate>
            <category>Amendments &amp; Corrections</category>
            <description><![CDATA[After publication of this manuscript, the authors became aware of an error in the coding used to generate the analytic dataset. This erroneously excluded, from the cohort at baseline, all individuals who died at any time during follow-up. Consequently, the deceased did not contribute the risk-time they should have contributed up to their date of death, including risk-time before any diagnosis of autoimmune rheumatic diseases (RA, SS, SLE) occurring prior to death.  Once identified, the authors corrected the coding and reran all analyses. They then systematically re-checked all reported estimates throughout the manuscript and updated any values that changed accordingly. Overall, the rerun analyses are consistent with the published version. The direction of associations and their interpretations remain the same. The main conclusions of the article are unaffected. For a sensitivity analysis of full follow-up since 1979, the results of the reanalysis were similar to those of the main analyses, but for the estimates regarding accumulated work life exposure, where some estimates either became or lost statistical significance. The paper has been corrected and is provided here in full along with revised supplementary material.

<strong>by</strong> <i>Helena Nielsen, Camilla Sejbaek, Lene Dreyer, Ida Madsen, Esben Flachs, Karin Hougaard</i>]]></description>
        </item>
        <item>
            <title>Exposure sequence and recovery in a quantitative European job-exposure matrix (heat JEM): a comment</title>
            <link>https://www.sjweh.fi/Exposure-sequence-and-recovery-in-a-quantitative-European-job-exposure-matrix-heat,241892,0,2.html</link>
            <guid>https://www.sjweh.fi/Exposure-sequence-and-recovery-in-a-quantitative-European-job-exposure-matrix-heat,241892,0,2.html</guid>
            <pubDate>Tue, 03 Nov 2026 12:37:55 +0100</pubDate>
            <category>Letter to the Editor</category>
            <description><![CDATA[

<strong>by</strong> <i>Carlo Aresti</i>]]></description>
        </item>
        <item>
            <title>Occupational noise exposure and ischemic heart disease: a pooled analysis of six Nordic cohorts</title>
            <link>https://www.sjweh.fi/Occupational-noise-exposure-and-ischemic-heart-disease-a-pooled-analysis-of-six-Nordic,241888,0,2.html</link>
            <guid>https://www.sjweh.fi/Occupational-noise-exposure-and-ischemic-heart-disease-a-pooled-analysis-of-six-Nordic,241888,0,2.html</guid>
            <pubDate>Sun, 18 Oct 2026 00:00:00 +0200</pubDate>
            <category>Original Article</category>
            <description><![CDATA[Objective(s)
Objectives   This study aimed to investigate the impact of occupational noise exposure on incident ischemic heart disease (IHD), including acute myocardial infarction (AMI).

Methods
We conducted a pooled analysis of six Nordic cohorts with a total of 83 103 participants with individual and area-level confounder information. Occupational codes were matched to a job-exposure matrix developed from Swedish measurements in five categories (LAeq8h): <70, 70–74, 75–79, 80–84, and ≥85 dB(A). Residential address history was used to estimate baseline 1-year average residential road traffic noise exposure. Data on incident IHD and AMI were obtained from national patient registers. We calculated hazard ratios (HR) using Cox proportional hazard models adjusted for socioeconomic and lifestyle factors.

Results
After adjustment for baseline year, sex, marital status, area-level income, education, smoking, and physical activity, exposure to ≥85 dB(A) of occupational noise was associated with an 10% and 12% increased risk of IHD, excluding angina pectoris, and AMI, respectively. For these outcomes, suggestive exposure–response trends were observed, but risks were only statistically significant for those exposed to ≥85 dB(A) as well as men exposed to ≥75 dB(A). We did not find evidence that combined exposure to both occupational noise and road traffic noise was particularly harmful.

Conclusion(s)
We found increased risks of IHD and AMI among those exposed to occupational noise ≥85 dB(A). Further studies should investigate whether this association is confounded by other occupational exposures.

<strong>by</strong> <i>Claudia Lissåker, Mattias Sjöström, Andrei Pyko, Anja Olse, Annika Rosengren, Aslak Poulsen, Debora Rizzuto, Göran Pershagen, Jesse Thacher, Jørgen Brandt, Leo Stockfelt, Albin Albin, Pekka Jousilahti, Pekka Tiittanen, Steen Jensen, Timo Lanki, Mette Sørensen, Jenny Selander</i> doi:10.5271/sjweh.4333]]></description>
        </item>
        <item>
            <title>50 years of estimating exposures for different jobs: the past, present and future of developing and using job exposure matrices (JEM)</title>
            <link>https://www.sjweh.fi/50-years-of-estimating-exposures-for-different-jobs-the-past-present-and-future-of,241883,0,2.html</link>
            <guid>https://www.sjweh.fi/50-years-of-estimating-exposures-for-different-jobs-the-past-present-and-future-of,241883,0,2.html</guid>
            <pubDate>Thu, 15 Oct 2026 00:00:00 +0200</pubDate>
            <category>Original Article</category>
            <description><![CDATA[Objective(s)
Obtaining valid estimates of occupational exposures is an important objective of epidemiological studies involving the work exposome. Job-exposure matrices (JEM)  Job-exposure matrices (JEM) link coded job titles to estimates of workplace exposures. This paper reviews their development over the past 50 years and provides practical guidance on their construction, selection, and use.

Methods
We synthesized published literature and examples of existing JEM in a narrative overview of their historical development, construction, validation, and application. We organized practical considerations for developing and selecting JEM around exposure metrics, occupational classifications, temporal and geographical coverage, and validity.

Results
JEM frameworks include exposure components and metrics; timing or location; whether exposures are based on direct measurements, expert opinion, or both; differentiation of qualitative, semi-quantitative, and quantitative matrices; type of job classification used; incorporation of sex and other variables; and validity testing. Investigators seeking to use a JEM must assess several important features: existing JEM and their availability, compatibility of job coding systems (or existence of a correspondence table), relevant components and exposure metrics, and JEM limitations.

Conclusion(s)
Awareness of the strengths and limitations of JEM is important for their effective use. To date, JEM have been mostly used in large general population studies though future applications in research, exposome evaluation and for other public health and policy issues are likely.

<strong>by</strong> <i>Marc Fadel, Undem Karina, Marcel Goldberg, Annette Leclerc, Bradley Evanoff, Alexis Descatha</i> doi:10.5271/sjweh.4339]]></description>
        </item>
        <item>
            <title>Night work and differential effects on diurnal rhythms of cortisol, melatonin, and testosterone among permanent night-working men</title>
            <link>https://www.sjweh.fi/Night-work-and-differential-effects-on-diurnal-rhythms-of-cortisol-melatonin-and,241815,0,2.html</link>
            <guid>https://www.sjweh.fi/Night-work-and-differential-effects-on-diurnal-rhythms-of-cortisol-melatonin-and,241815,0,2.html</guid>
            <pubDate>Tue, 13 Oct 2026 00:00:00 +0200</pubDate>
            <category>Original Article</category>
            <description><![CDATA[Objective(s)
Night work-induced circadian misalignment is associated with an increased risk of adverse health effects. It has been suggested that permanent night workers can entrain to being awake at night and therefore do not experience substantial circadian disruption in relation to night work. The aim of this study was to investigate the effects of night work on diurnal rhythms of cortisol, melatonin, and testosterone among permanent night workers.

Methods
Twenty-three men with permanent night work participated in this observational field study. They collected saliva every 4 hours over a 24-hour period for assessment of diurnal rhythms (mesor, amplitude and acrophase) on three days: the 2nd and 4th consecutive night shifts, and a day off. Within-person regression analyses with repeated measures adjusted for age were used to evaluate differences between the 2nd and 4th night shifts and between night shifts taken together versus days off.

Results
There were no statistically significant differences between diurnal rhythms on the 2nd and 4th consecutive night shifts. We observed differences in levels (mesor and amplitude) of cortisol and melatonin on night shifts compared to days off with the highest levels during work days. The timing (acrophase) of testosterone, but not cortisol and melatonin, differed between night shifts and days off. Thus, observed differences between the various hormonal diurnal rhythms to night work indicate internal desynchronization.

Conclusion(s)
Studies of how diurnal rhythms of multiple biological systems are affected by night work and the link to health effects are warranted to further elucidate the mechanisms linking night work to adverse health effects.

<strong>by</strong> <i>Anne Helene Garde, Kirsten Nabe-Nielsen, Åse Marie Hansen, Anastasi Kosmadopoulos, Anders Aagaard, Heidi Lammers-van der Holst, Rasmus H Reeh, Ann Dyreborg Larsen</i> doi:10.5271/sjweh.4332]]></description>
        </item>
        <item>
            <title>Diverging trajectories of job demands, job resources, and psychological distress before long-term mental health-related sick leave among teachers</title>
            <link>https://www.sjweh.fi/Diverging-trajectories-of-job-demands-job-resources-and-psychological-distress-before,241814,0,2.html</link>
            <guid>https://www.sjweh.fi/Diverging-trajectories-of-job-demands-job-resources-and-psychological-distress-before,241814,0,2.html</guid>
            <pubDate>Mon, 12 Oct 2026 00:00:00 +0200</pubDate>
            <category>Original Article</category>
            <description><![CDATA[

<strong>by</strong> <i>Fumio Kobayashi, Akihiko Narisada</i> doi:10.5271/sjweh.4337]]></description>
        </item>
        <item>
            <title>Effect of occupation-related heat stress exposure on productivity among sugarcane workers in Thailand</title>
            <link>https://www.sjweh.fi/Effect-of-occupation-related-heat-stress-exposure-on-productivity-among-sugarcane,241644,0,2.html</link>
            <guid>https://www.sjweh.fi/Effect-of-occupation-related-heat-stress-exposure-on-productivity-among-sugarcane,241644,0,2.html</guid>
            <pubDate>Fri, 09 Oct 2026 00:00:00 +0200</pubDate>
            <category>Original Article</category>
            <description><![CDATA[Objective(s)
Climate change affects a wide range of issues, including work productivity due to elevated temperatures. This is particularly important for agricultural workers in tropical countries like Thailand. This cross-sectional study aims to investigate the effects of heat stress exposure on productivity among Thai sugarcane workers during harvesting seasons.

Methods
This study involved 287 sugarcane workers from Nakhon Sawan Province, Thailand, during the cooler or hotter 2023 harvesting periods. Information was collected on their demographic characteristics, health behaviors, working conditions, and work output (sugarcane stalks harvested). Wet bulb globe temperature (WBGT) was recorded in the fields during 14 cool and 11 hot season days. A full work shift time-weighted average effective WBGT (WBGTeff-FS-TWA), adjusted for clothing factors, was calculated to provide an estimate of heat stress exposure over a full work shift. Multiple linear regression determined the effects of heat stress exposure on the average number of sugarcane stalks harvested per hour adjusting for available confounders.

Results
Recorded WBGTeff-FS-TWA values averaged 31.3°C [standard deviation (SD) 2.8, range 22.9–35.4°C]. The mean number of stalks harvested per hour was 387, SD 185, with higher rates observed when harvesting burnt sugarcane and working solo. For every 1°C rise in WBGTeff-FS-TWA above the lowest observed baseline of 22.9°C, the average number of sugarcane stalks harvested decreased by 9 stalks per hour (β -8.59, 95% confidence interval -16.19– -0.99).

Conclusion(s)
Increased heat stress exposure decreases overall productivity. As global temperatures rise, heat stress increases, significantly impacting agricultural output alongside worker health.

<strong>by</strong> <i>Tadpong Tantipanjaporn, Andrew Povey, Holly A Shiels, Matthew Gittins, Martie van Tongeren</i> doi:10.5271/sjweh.4336]]></description>
        </item>
        <item>
            <title>Shift work and prescriptions of anxiolytic and antidepressant drugs among healthcare workers in Region Stockholm: a prospective cohort study</title>
            <link>https://www.sjweh.fi/Shift-work-and-prescriptions-of-anxiolytic-and-antidepressant-drugs-among-healthcare,241521,0,2.html</link>
            <guid>https://www.sjweh.fi/Shift-work-and-prescriptions-of-anxiolytic-and-antidepressant-drugs-among-healthcare,241521,0,2.html</guid>
            <pubDate>Tue, 08 Sep 2026 00:00:00 +0200</pubDate>
            <category>Original Article</category>
            <description><![CDATA[OBJECTIVE: The aim of this study was to investigate the associations between shift work (including night work) and multiple prescriptions of anxiolytic and antidepressant drugs (PAD) among nursing staff in Region Stockholm, Stockholm County’s healthcare authority. METHODS: Using register-based data, 32 375 nurses and nursing assistants employed at Region Stockholm for ≥1 year between 2008 and 2019 were included. Exposures were obtained from an employee register, while PAD were obtained from a national pharmaceutical register. With a one-year follow-up, discrete-time proportional hazards models were used to estimate hazard ratios (HR) after adjusting for covariates, in a final analytical sample of 17 834. RESULTS: Increased hazards of PAD were recorded among those who were on permanent night shifts [HR 1.39, 95% confidence interval (CI) 1.32–1.47] compared to those who worked days only. We observed a dose–response association between the number of night shifts and PAD. Among night workers, increased hazards were observed for those who worked ≥3 consecutive nights >21 times (HR 1.11, 95% CI 1.03–1.20) compared with those with none. Lastly, among non-night workers, decreased hazards were observed for quick returns from afternoon shifts (<11 hours) compared with those with no quick returns. CONCLUSION: Exclusive night work is associated with increased risks of multiple PAD compared to day work, implying an increase in risk of mental disorders among nurses and nurse assistants.

<strong>by</strong> <i>Seth Addo, Tove Nilsson, Per Gustavsson, Theo Bodin, Carolina Bigert, Abid Lashari, Mikko Härmä, Emma Brulin</i> doi:10.5271/sjweh.4327]]></description>
        </item>
        <item>
            <title>Job strain and cardiovascular mortality over long-term follow-up: a harmonized multicohort individual participant data meta-analysis</title>
            <link>https://www.sjweh.fi/Job-strain-and-cardiovascular-mortality-over-long-term-follow-up-a-harmonized-multicohort,241520,0,2.html</link>
            <guid>https://www.sjweh.fi/Job-strain-and-cardiovascular-mortality-over-long-term-follow-up-a-harmonized-multicohort,241520,0,2.html</guid>
            <pubDate>Mon, 07 Sep 2026 00:00:00 +0200</pubDate>
            <category>Original Article</category>
            <description><![CDATA[OBJECTIVE: We aimed to assess the long-term association between high job strain (JS) and cardiovascular disease (CVD) mortality in cohorts from Italy, Germany, and the United States. METHODS: We harmonized data from four cohort studies (MONICA Brianza, SEMM, MONICA/KORA, MIDUS), selecting employed participants aged 30–60 years and CVD-free at baseline. High JS was operationalized as high job demands and low job control. CVD mortality was ascertained over a median follow-up of >23 years. We estimated Cox models within each cohort; the main model was adjusted for sex, age, education, and occupational class. Additional analyses examined JS categories (low JS, active, passive, high JS), subgroups by sex and occupational classes, and person-time < and ≥65 years. Results were pooled using random-effects meta-analysis. Relevant published studies were identified for synthesis with our results. RESULTS: Over 444 767 person-years, 842 CVD deaths occurred. High JS was associated with CVD mortality [hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.01–1.27], with no evidence of heterogeneity. Results were consistent across JS categories, by sex (men: HR 1.15, 95% CI 1.07–1.23; women: HR 1.11, 95% CI 0.88–1.39), and across person-time <65 years (HR 1.24, 95% CI 0.91–1.67) and ≥65 years (HR 1.10, 95% CI 0.80–1.50). The association was stronger among manual workers (HR 1.25, 95% CI 0.84–1.86). Job demands appeared to contribute more than job control. Four published studies with comparable follow-up but heterogeneous study designs reported estimates consistent with our findings. CONCLUSIONS: High JS is a long-term predictor of CVD mortality, consistently across sexes and during both working age and after retirement. Workplace redesign to reduce job demands, particularly among manual workers, is warranted within a comprehensive prevention strategy.

<strong>by</strong> <i>Emanuele Giusti, Xiang Li, Giovanni Veronesi, Birgit Linkohr, Annette Peters, Melanie Waldenberger, Rossana Borchini, Giancarlo Cesana, Jian Li, Ina-Maria Rückert-Eheberg, Marco Ferrario</i> doi:10.5271/sjweh.4325]]></description>
        </item>
        <item>
            <title>Occupational heat stress and the role of wearable cooling interventions: A systematic review and meta-analysis of physiological and perceptual outcomes</title>
            <link>https://www.sjweh.fi/Occupational-heat-stress-and-the-role-of-wearable-cooling-interventions-A-systematic,241514,0,2.html</link>
            <guid>https://www.sjweh.fi/Occupational-heat-stress-and-the-role-of-wearable-cooling-interventions-A-systematic,241514,0,2.html</guid>
            <pubDate>Thu, 30 Apr 2026 00:00:00 +0200</pubDate>
            <category>Review</category>
            <description><![CDATA[OBJECTIVE: Occupational heat stress, driven by high ambient temperatures, humidity, and radiant heat impairs health, safety, and productivity. Among the interventions for mitigating heat strain, wearable cooling technologies [eg, water/ice, phase-change materials (PCM), ventilated/evaporative garments] is increasingly used, but their comparative effectiveness remains unclear. This systematic review aimed to evaluate the effectiveness of wearable cooling intervention on physiological and perceptual outcomes during heat exposure. METHODS: Adhering to PRISMA guidelines (PROSPERO: CRD42025631559), we searched PubMed, Embase, and Scopus (February 2026) for randomized or non-randomized intervention trials among workers or acclimatized adults. Data were extracted as mean/standard deviation (or transformed equivalents) and pooled using random-effects meta-analysis. Heterogeneity (I2), small-study effects (Egger’s test) and sensitivity/subgroup analyses of cooling modalities were performed. Risk of bias (RoB 2, ROBINS-I) and certainty (GRADE) were assessed. RESULTS: Sixty-nine studies were included in our review. Post-exposure, wearable cooling significantly reduced rectal temperature [mean difference (MD) -0.24°C; 95% confidence interval (CI) -0.37– -0.1; I=43.91%], gastrointestinal temperature (MD -0.26°C; -0.52– -0.001; I=98.13%), skin temperature (MD -1.14°C; -1.85– -0.42; I=96.56%), and heart rate (MD -7.69 bpm; -11.22– -4.15; I=73.19%). Egger’s tests suggested possible small-study effects for skin temperature and heart rate but not for core temperatures. Subgroup analyses indicated more consistent benefits with water/ice and PCM garments. Overall certainty ranged from low to very low due to risk of bias, inconsistency, and imprecision. CONCLUSIONS: Wearable cooling attenuates physiological heat strain and improves thermal comfort, particularly via water/ice and PCM systems. Given high heterogeneity and low certainty, adequately powered, standardized, head-to-head trials are needed.

<strong>by</strong> <i>Ankit Sheth, Ankit Viramgami, Mahendra Thakor, Bhavesh Modi, Bhavanishankara Bagepally, Ananya Kar, Ekta Ram, Anuj Dave, Rakesh Balachandar</i> doi:10.5271/sjweh.4294]]></description>
        </item>
        <item>
            <title>Cumulative years of biomechanical and psychosocial work exposures and long-term sickness absence: A register-based cohort study among early-career Norwegian employees</title>
            <link>https://www.sjweh.fi/Cumulative-years-of-biomechanical-and-psychosocial-work-exposures-and-long-term-sickness,242580,0,2.html</link>
            <guid>https://www.sjweh.fi/Cumulative-years-of-biomechanical-and-psychosocial-work-exposures-and-long-term-sickness,242580,0,2.html</guid>
            <pubDate></pubDate>
            <category>Original Article</category>
            <description><![CDATA[

<strong>by</strong> <i>Gunvor Kleven, Rachel Hasting, Anne Møller Fell, Julie Ulstein</i>]]></description>
        </item>
        <item>
            <title>Effects of workplace bullying on cardiovascular health: A prospective cohort study of the Gutenberg Health Study with a ten-year follow-up</title>
            <link>https://www.sjweh.fi/Effects-of-workplace-bullying-on-cardiovascular-health-A-prospective-cohort-study,242559,0,2.html</link>
            <guid>https://www.sjweh.fi/Effects-of-workplace-bullying-on-cardiovascular-health-A-prospective-cohort-study,242559,0,2.html</guid>
            <pubDate></pubDate>
            <category>Original Article</category>
            <description><![CDATA[Objective(s)
Evidence on long-term cardiovascular effects of workplace bullying is limited. We investigated prospectively the association between workplace bullying and the ten-year incidence of cardiovascular disease (CVD) and hypertension.

Methods
In a cohort of 4137 employees (< 65 years) from the Gutenberg Health Study (Mainz/Mainz-Bingen, Germany), workplace bullying at baseline (2007–2012) was assessed using a single-item and a five-item instrument. Incident CVD and hypertension at the ten-year follow-up (2017–2022) were clinically verified. Cox models were used for CVD, and robust Poisson regression for hypertension, adjusting for sex, age, and socioeconomic status (SES). Analyses were sex-stratified and considered exposure trajectories.

Results
Bullying prevalence was 15.3 % (single item) and 19.3 % (five items). For incident CVD, hazard ratios (HR) were 1.08 (95 % CI: 0.74–1.59) using the single-item, and 1.28 (95 % CI: 0.95–1.72) using the five-item instrument. Participants reporting bullying at baseline and five-year follow-up had the highest CVD risk (HR = 2.44; 95 % CI: 1.09–5.44). No association was observed with incident hypertension (single-item: RR = 1.04; 95 % CI: 0.84–1.28, five-item: RR = 0.94; 95 % CI: 0.78–1.13).

Conclusion(s)
Findings indicate an increased CVD risk when repeated experiences of workplace bullying were reported. No clear elevation of CVD risk was observed when workplace bullying was only considered once at baseline. No evidence was found for elevated hypertension risk. Workplace bullying may represent a relevant psychosocial factor in cardiovascular prevention, underscoring the need for further longitudinal and intervention studies.

<strong>by</strong> <i>Alice Freiberg, Matthias Nübling, Janice Hegewald, Karla Romero-Starke, Konstantin Kontohow-Beckers, Robin Martens, Hans-Joachim Lincke, Sylvia Jankowiak, Karin Rossnagel, Merle Riechmann-Wolf, Pavel Dietz, Manfred Beutel, Norbert Pfeiffer, Karl Lackner, Philipp Lurz, Emilio Gianicolo, Philipp Wild, Andreas Seidler</i>]]></description>
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