Does job stress mediate the risk of work disability due to common mental disorders among social workers compared with other health and social care, education, and non-human service professionals? A prospective cohort study of public sector employees in Finland.

OBJECTIVE: This study aimed to investigate (i) the risk of work disability (>10-day sickness absence spell or disability pension) due to common mental disorders (CMD) among social workers compared with other health and social care, education, and non-human service professionals and (ii) whether the risk was mediated by job stress. METHODS: A cohort of 16 306 public sector professionals in Finland was followed using survey data from baseline (2004 or if not available, 2008) on job stress [job strain or effort-reward imbalance (ERI)] and register data on work disability due to CMD from baseline through 2011. A Cox proportional hazards model was used to analyze the risk of work disability due to CMD between three occupation-pairs in a counterfactual setting, controlling for age, sex, job contract, body mass index, alcohol risk use, smoking, and physical inactivity. RESULTS: Social workers' job stress was at higher level only when compared to education professionals. Thus, the mediation hypothesis was analyzed comparing social workers to education professionals. Social workers had a higher risk of work disability due to CMD compared with education professionals [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.58-2.74]. This HR was partly mediated by job strain (24%) and ERI (12%). Social workers had a higher risk of work disability than non-human service professionals (HR 1.54, 95% CI 1.13-2.09), but not compared with other health and social care professionals. CONCLUSIONS: Job stress partly mediated the excess risk of work disability among social workers only in comparison with education professionals.

The effect of improving psychosocial stressors on psychological distress: a quasi-experiment of Finnish health and social care workers.

AIMS: To examine how a positive change in one to three psychosocial stressors (job demands, job rewards, and workplace social capital) influenced psychological distress. METHODS: The analysis included 3605 Finnish health and social services workers who completed surveys in 2019, 2020 and 2021. A logistic regression model was used to estimate the propensity score of experiencing a positive change in one to three psychosocial stressors between 2019 and 2020. We balanced the baseline characteristics with propensity scoring. A generalised linear model with a binomial distribution and a log link function was used to compare the quasi-intervention and quasi-control groups for the risk of psychological distress in 2021. RESULTS: Among the total sample, neither improving a single stressor nor two or three stressors affected psychological distress. However, among employees younger than 50 years, improving two or three psychosocial stressors in 2019-2020 decreased the risk of moderate to severe psychological distress in 2021 by 41% (risk ratio 0.59, 95% confidence interval 0.36-0.96). Among employees aged 50 years or older, improving job rewards lowered the risk of mild to severe psychological distress by 23% (risk ratio 0.77, 95% confidence interval 0.62-0.96). CONCLUSIONS: The results of this quasi-experiment suggest that the positive effect of improving psychosocial stressors is stronger among younger than older workers. Future interventions should be customised for different ages and aim to improve accumulated work stressors and individual stress-coping skills.

How does lowering psychosocial risks influence sickness absence? A prospective cohort study analyzed as a quasi-experiment.

BACKGROUND: We examined how reducing work-related psychosocial stressors affected long-term sickness absence of younger and older employees. METHODS: We used data from 43 843 public sector employees in Finland who participated in surveys in 2018 and 2020. We assessed psychosocial factors, such as job demands, job control, work effort, job rewards and worktime control. We obtained sickness absence data from registers for spells longer than 10 consecutive working days. We applied age-specific propensity score weighting and generalized linear models to estimate the effects of changes in psychosocial factors between 2018 and 2020 on sickness absence in 2020. RESULTS: Among employees under 50 years, increasing job rewards by 1 SD reduced the risk of sickness absence by 17% [risk ratio (RR) 0.83, 95% CI 0.72-0.96]. Among employees aged 50 years or older, decreasing job demands by 1 SD reduced the risk of sickness absence by 13% (RR 0.87, 95% CI 0.78-0.98), and increasing job control by 1 SD reduced the risk by 12% (RR 0.88, 95% CI 0.76-1.01). Changes in efforts and worktime control had no significant associations with sickness absence. CONCLUSIONS: Reducing psychosocial stressors can lower the occurrence of long-term sickness absence, but the associations differ by age group. Younger workers benefit more from enhancing job rewards, while older workers benefit more from lowering job demands and increasing job control. To establish the causal impact of psychosocial risk reduction on sickness absence across age groups, future research should employ randomized controlled trials as the methodological approach.

Changes in active commuting and changes in health: Within- and between-individual analyses among 16 881 Finnish public sector employees.

BACKGROUND: Active commuting, such as walking or cycling to work, can be beneficial for health. However, because within-individual studies on the association between change in active commuting and change in health are scarce, the previous results may have been biased due to unmeasured confounding. Additionally, prior studies have often lacked information about commuting distance. METHODS: We used two waves (2020, T1 and 2022, T2) of self-report data from the Finnish Public Sector study (N = 16,881; 80% female) to examine the within- and between associations (in a hybrid model) between active commuting and health. Exposure was measured by actively commuted kilometers per week, that is, by multiplying the number of walking or cycling days per week with the daily commuting distance. The primary outcome, self-rated health, was measured at T1 and T2. The secondary outcomes, psychological distress, and sleep problems were measured only at T2 and were therefore analyzed only in a between-individual design. RESULTS: After adjustment for potential time-varying confounders such as socioeconomic factors, body mass index, and health behaviors, an increase equivalent to 10 additional active commuting kilometers per week was associated with a small improvement in self-rated health (within-individual unstandardized beta = 0.01, 95% CI 0.01-0.02; between-individual unstandardized beta = 0.03, 95% CI 0.02-0.04). No associations were observed between changes in active commuting and psychological distress or sleep problems. CONCLUSIONS: An increase in active commuting may promote self-rated health. However, increase of tens of additional kilometers in commuting every day may be required to produce even a small effect on health.

Associations between accumulating job stressors, workplace social capital, and psychological distress on work-unit level: a cross-sectional study.

BACKGROUND: Psychosocial job stressor studies usually examine one exposure at a time and focus on individual workers. In this study we examined the accumulation of work stressors in work units and its association with psychological distress (PD) on work-unit level. We also investigated whether high workplace social capital modifies the effect. METHODS: We examined survey responses from 813 Finnish health and social services (HSS) work units, comprising 9 502 employees, in a cross-sectional study design. The survey was conducted in 2021. We calculated odds ratios for the association between accumulating job stressors and PD. We also analyzed the interaction between work stressors and the effect modification of high workplace social capital. RESULTS: We found that HSS work units with high percentage of employees having high job demands and low rewards (OR 7.2, 95% CI 3.7, 13.8) have an increased risk of higher PD in the work unit. We also found indication of high social capital possibly modifying the effect of job stressors on PD. The results suggest that accumulated job stressors are associated with PD on work unit level, with excess risk for PD compared to the stressors acting separately. CONCLUSIONS: The results indicate that the effect of accumulating job stressors should be further studied on work-unit level. Participatory organizational-level and work-unit level interventions to tackle job stressors and to improve workplace social capital are warranted.

Associations between commute mode use and self-rated health and work ability among Finnish public sector employees.

AIM: To determine the extent to which level of active commute mode use is associated with self-rated health and work ability. METHODS: The data were sourced from the Finnish Public Sector Study survey in 2020 (n = 38,223). The associations between active commuting - assessed with the frequency of using active commute modes - and self-rated health and work ability were examined with negative binomial regression analyses. Passive commuting and low-to-moderate levels of active commuting were compared with active commuting, and the models were adjusted for sociodemographic factors, working time mode, and lifestyle risk factors. We also assessed separate associations between walking and cycling as a mode of commuting by additionally considering the commuting distance and the outcomes. RESULTS: After adjustment, when using active commuters as a reference, passive commuters had a 1.23-fold (95% confidence intervals (CI) 1.19 to 1.29) risk of suboptimal self-rated health and a 1.18-fold (95% CI 1.13 to 1.22) risk of suboptimal work ability. More frequent and/or longer distance by foot and especially by bicycle, was positively associated with health and work ability. Never commuting by bicycle was associated with a 1.65-fold (95% CI 1.55 to 1.74) risk of suboptimal health and a 1.27-fold (95% CI 1.21 to 1.34) risk of suboptimal work ability when using high-dose bicycle commuting as a reference. CONCLUSIONS: Passive commuting was associated with suboptimal self-rated health and suboptimal work ability. Our results suggest that using active commute modes, particularly cycling, may be beneficial for employee health and work ability.

Long-term and recent trends in survival and life expectancy for people with type 1 diabetes in Finland.

AIMS: Type 1 diabetes has been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have been associated with improved survival. However, life expectancy for type 1 diabetes under contemporary care is not known. METHODS: Health care registers were used to obtain data on all people with type 1 diabetes in Finland in 1964-2017 and their mortality in 1972-2017. Survival analyses were used to study long-term trends in survival and abridged period life table methods to calculate life expectancy estimates. Causes of death were examined to consider development. RESULTS: Study data included 42,936 persons with type 1 diabetes and 6,771 deaths. Kaplan-Meier curves showed improved survival during the study period. In 2017, the remaining life expectancy at the age of 20 for a person diagnosed for type 1 diabetes was estimated to be 51.64 (95% CI: 51.51, 51.78) years which was 9.88 (9.74, 10.01) years lower than for the general Finnish population. CONCLUSIONS: We found improved survival among persons with type 1 diabetes during the last decades. However, their life expectancy remained significantly below that of the general Finnish population. Our results call for further innovations and improvements in diabetes care.

Changes in work-related stressors before and during the COVID-19 pandemic: differences by gender and parental status.

PURPOSE: The COVID-19 pandemic changed people's working conditions worldwide and research suggests increases in work stressors. However, it is not known to what extent these changes differ by gender or parental status. In the present study, we investigate trends in work stressors and whether these differ by gender and parental status. METHODS: We used cross-sectional time series data of the European Working Conditions Survey of 2015 and Living, Working and COVID-19 survey of spring 2020 to examine trends in work stressors by gender and parental status. Work stressors were working in leisure time, lack of psychological detachment and work-life conflict. We applied three-way multilevel regressions reporting prevalence ratios and reported predicted probabilities and average marginal effects to show trends and differences in changes in work stressors. RESULTS: Our multilevel regression results showed elevated prevalence ratios during the pandemic for working leisure time (PR: 1.43, 95% CI 1.34-1.53), psychological detachment (PR: 1.70, 95% CI 1.45-1.99) and work-life conflict (PR: 1.29, 95% CI 1.17-1.43) compared to before the pandemic. Except for working in leisure time, the increase was more significant among women and mothers. The proportion of work-life conflict in 2020 was 20.7% (95% CI 18.7-22.9) for men and 25.8% (95% CI 24.0-27.6) for women, equalling a difference of 5.1% (p < 0.001). CONCLUSIONS: There is evidence that work stressors increased disproportionately for women and mothers. This needs to be monitored and addressed to prevent widening gender inequalities in the quality of work.

Synergistic Interaction between Job Stressors and Psychological Distress during the COVID-19 Pandemic: A Cross-Sectional Study.

Psychosocial job stressors increase the risk of mental health problems for the workers in health and social services (HSS). Although previous studies suggest that the accumulation of two or more stressors is detrimental to mental health, few studies have examined the synergistic interaction of accumulating job stressors. We examined survey responses from 9855 Finnish HSS workers in a cross-sectional study design from 2021. We conducted an interaction analysis of high job demands, low rewards and low workplace social capital on psychological distress, focusing on the relative excess risk due to interaction (RERI). Additionally, we analysed the interaction of job demands, low rewards and COVID-19 burden (extra workload and emotional load). Our analysis showed that the total RERI for the job stressors on psychological distress was considerable (6.27, 95% CI 3.14, 9.39). The total excess risk was caused by two-way interactions, especially between high demands and low rewards and by the three-way interaction of all stressors. The total RERI for job demands, low reward and COVID-19 burden (3.93, 95% CI 1.15, 6.72), however, was caused entirely by two-way interaction between high demands and low rewards. Mental health interventions tackling high demands, low rewards and low social capital are jointly needed.

Hospital physicians´ working hour characteristics and sleep quality: a cross-sectional analysis of realized working hour and survey data.

BACKGROUND: Hospital physicians' work includes on-call duties to provide 24/7 health care. Previous studies using self-reported survey data have associated long working hours and on-call work with sleep difficulties. To reduce recall bias, we complemented survey data with payroll-based objective data to study whether hospital physicians' realized working hours are associated with sleep. METHODS: The study was nested within the Finnish Public Sector study. We used survey data on 728 hospital physicians (mean age 43.4 years, 62% females) from 2015 linked to realized daily working hour data from 3 months preceding the survey. The associations of working hour characteristics with sleep quantity and quality were studied with multinomial logistic regression analysis adjusted for demographics, overall stressfulness of life situation, control over scheduling of shifts, and hospital district. RESULTS: One fourth (26%) of the participants reported short (≤6.5 h) average sleep duration. Frequent night work (> 6 shifts/91 days) was associated with short sleep (OR 1.87 95%CI 1.23-2.83) compared to no night work. Approximately one third (32%) of the physicians reported insufficient sleep. Physicians with long weekly working hours (> 48 hours) had higher odds for insufficient sleep (OR 1.78 95%CI 1.15-2.76) than physicians with short weekly working hours (< 40 hours). Insufficient sleep was also associated with frequent on-call duties (> 12 shifts/3 months OR 2.00 95%CI 1.08-3.72), frequent night work (OR 1.60 95%CI 1.09-2.37), and frequent short shift intervals (≤11 hours; > 12 times/3 months OR 1.65 95%CI 1.01-2.69) compared to not having these working hour characteristics. Nearly half of the physicians (48%) reported at least one sleep difficulty at least two times a week and frequent night work increased odds for difficulties in initiating sleep (OR 2.43 95%CI 1.04-5.69). Otherwise sleep difficulties were not associated with the studied working hour characteristics. CONCLUSION: We used realized working hour data to strengthen the evidence on on-call work and sleep quality and our results advice to limit the frequency of night work, on-call shifts, short shift intervals and long weekly working hours to promote hospital physicians' sufficient sleep.

Psychosocial work environment as a dynamic network: a multi-wave cohort study.

While characteristics of psychosocial work environment have traditionally been studied separately, we propose an alternative approach that treats psychosocial factors as interacting elements in networks where they all potentially affect each other. In this network analysis, we used data from a prospective occupational cohort including 10,892 participants (85% women; mean age 47 years) and repeated measurements of seven psychosocial work characteristics (job demands, job control, job uncertainty, team climate, effort-reward imbalance, procedural justice and interactional justice) assessed in 2000, 2004, 2008 and 2012. Results from multilevel longitudinal vector autoregressive models indicated that job demands as well as interactional and procedural justice were most broadly associated with the subsequent perceptions of the work-related psychosocial factors (high out-Strength), suggesting these factors might be potentially efficient targets of workplace interventions. The results also suggest that modifying almost any of the studied psychosocial factors might be relevant to subsequent perceptions of effort-reward imbalance and interactional justice at the workplace.

Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank.

Background: Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use. Methods: In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines - non-drinking (never or former drinkers); moderate consumption (1-14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study. Findings: During 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9-30·8) years, women 29·8 (29·2-30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4-29·0) years, women 29·6 (29·4-29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9-26·0) years, women 24·0 (21·4-26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3-26·8), women 27·5 (26·4-28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less. Interpretation: Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller. Funding: Medical Research Council, National Institute on Aging, NordForsk, Academy of Finland, Finnish Work Environment Fund.

Return to work following anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Amongst people of working age, the return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is an important marker of success of surgery. We determined when patients are able to return to work after ACL reconstruction and identified factors that are associated with the timing of RTW. PATIENTS AND METHODS: We used logistic regression analyses to examine patient-related factors that may be associated with the length of RTW (above vs. below the median 59 days) after arthroscopic ACLR in a large cohort of patients working in the public sector in Finland (n = 803; n = 334 male, n = 469 female; mean age 41 years [SD 8.6]). RESULTS: The mean length of RTW was 65 days (SD 41). Higher odds ratios (OR) were observed for age groups 40-49 and ≥ 50 years compared with ≤ 30 years old (OR 2.0, 95% confidence interval 1.3-3.1 and 2.0, 1.2-3.4, respectively); for lower level non-manual and manual work compared with higher level non-manual work (3.0, 2.0-4.3 and 4.9, 3.4-7.0, respectively); and for those who had been on sick leave > 30 days in the preceding year (2.0, 1.4-2.9). Sex, comorbid conditions, preceding antidepressant treatment and concomitant procedures were not associated with the length of RTW. INTERPRETATION: Factors associated with prolonged sick leave beyond the median time of 59 days are higher age, lower occupational status, and preoperative sick leaves.

Interventions to reduce the risk of mental health problems in health and social care workplaces: A scoping review.

Work in the health and social care sector is stressful, and work-related stress increases the risk of depression, anxiety, burnout, and sleep disorders. Although interventions to reduce stress and burnout at workplaces have been developed and studied, most studies have lacked the effectiveness to improve the situation. Thus, more knowledge on interventions and analysis of their mechanisms is needed to reduce the risk of more adverse mental health problems (MHP). We conducted a scoping review to identify the relevant literature on individual and organizational interventions to improve mental health in health and social care workplaces. Data were gathered on target groups, intervention types and their effectiveness, and the outcomes of the interventions. We summarized this data thematically. The final review consisted of 76 studies. Mental health interventions primarily focused on health care workers rather than social care professionals. The interventions were mostly directed at individual workers, ignoring organizational-level interventions. They used a great variety of outcomes and questionnaires, and the questionnaires that measured the outcomes were used ambiguously. In most cases, the reported effectiveness of the studied interventions was incoherent, and many of the interventions had both statistically significant and non-significant effects. Evidence that interventions reduce the risk of work-related MHP is scarce. High-quality randomized controlled trials of interventions to promote mental health with more coherently formed outcomes are needed, especially on the organizational level. More interventions to improve social care professionals' mental health are also needed.

Working hours, on-call shifts, and risk of occupational injuries among hospital physicians: A case-crossover study.

OBJECTIVE: To investigate the association of hospital physicians' working hours and on-call shifts with the risk of occupational injuries. METHODS: In this nested cohort study of 556 Finnish hospital physicians, we linked electronic records from working-hour and on-call duty payroll data to occupational injury data obtained from the Finnish Workers' Compensation Center for the period 2005-2019. We used a case-crossover design with matched intervals for a 7-day 'case window' immediately prior to occupational injury and a 'control window' 7 days prior to the beginning of the case window, and analyzed their associations using conditional logistic regression models. RESULTS: We noted 556 occupational injuries, 281 at the workplace and 275 while commuting. Having three to four long (>12 h) work shifts on the preceding 7 days was associated with a higher probability of an occupational injury (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11, 4.09), and the OR for three to four on-call shifts was 3.54 (95%CI 2.11, 5.92) in comparison to having none of these work shift types. A higher number of several consecutive working days was associated with a higher probability of injury in a dose-response manner. Moreover, increasing weekly working hours was associated with an increased likelihood of injury (OR 1.03, 95%CI 1.01, 1.04), whereas the number of normal (≤12 h) work shifts reduced this likelihood (OR 0.79, 95%CI 0.64, 0.98). CONCLUSIONS: Our findings suggest that accumulated working-hour load, as opposed to single, very long (>24 h) work shifts, may increase the risk of occupational injury among hospital physicians.

The association between chronotype and sleep quality among female home care workers performing shift work.

There is a scarcity of evidence on the association between shift work, sleeping parameters, heart rate variability (HRV), and chronotype, i.e., morningness and eveningness. The aims of this study were to 1) compare participants with different chronotypes (morning (M), evening (E), or neither (N)) in terms of their total sleep time, sleep efficiency, and HRV parameters, taking their age into account, and 2) examine whether self-reported work-related stress, the length of the working career and years performing shift work affect this association. The participants of the study were home care workers working in two shifts in one municipality in Eastern Finland (N = 395). Of these, 52 females (mean age 42.78 y, SD 12.92 y) completed the study questionnaire and participated in physiological measurements. Several sleep-related parameters were assessed (total sleep time, sleep efficiency, number of awakenings, and length of awakening) and indices of autonomic nervous system based on HRV were calculated. The participants worked in two shifts: a morning shift (7:00-15:00 h) and an evening shift (14:00-21:30 h). All these parameters were assessed during the night before the first work shift (N1), the night before the second work shift (N2), the night before the final work shift (N3), and the night before the first day off work (N4). According to the results, 21.2% of the participants were M-types, 17.3% were E-types, and 61.5% were N-types. On average, the participants had been in working life for 18.8 years and performing shift work for 13.7 years. On night N3, E-types had a significantly shorter total sleep time and spent less time in bed compared to M- and N-types. The total sleep time of M-type and N-type participants was on average 66 minutes and 82 minutes longer, respectively, when compared to E-types on night N3. There were no statistically significant differences in actigraphy-based sleep quality parameters between M-, N-, and E-types on nights N1, N2, and N4. Our results together indicate that M- and N-type individuals may have better sleep quality than E-types, which was also reflected in HRV parameters. Further research with longitudinal study design and workplace interventions is needed to determine how the chronotype can be optimally and individually utilized to improve the health and well-being of morning-type and evening-type people. This is particularly important for both younger and older workers entering the workforce to support healthier and longer working lives.

Job demands and job control among occupational therapists in public sector in Finland.

BACKGROUND: Although health care professionals' increased job demands and strain have generated much public debate in recent years, the way in which occupational therapists' job strain has developed remains unknown. OBJECTIVE: To examine how Finnish occupational therapists working in municipalities experienced job demands and control in 2014-2018 compared with physiotherapists and registered nurses. MATERIAL AND METHODS: Occupational therapists (OT, n = 107), physiotherapists (PT, n = 331) and registered nurses (RN, n = 1389) responded to repeated surveys in the Finnish Public Sector Study in 2014-2018. We used the Job Content Questionnaire and analyzed the data using repeated measures analysis of variance and multiple linear regression with generalized estimating equations to identify the trends and differences. RESULTS: More OTs had lower job demands and higher job control than PTs and RNs in each year of study. These differences were statistically significant. Most OTs had low job strain. The changes in job control and job demands of participants in different years were not statistically significant. CONCLUSIONS: The OTs consistently experienced low job strain as compared to the PTs and RNs. Developing good practices in OT's work may be beneficial for improving employee health and well-being and high-quality client care.

Association of working hour characteristics and on-call work with risk of short sickness absence among hospital physicians: A longitudinal cohort study.

Physicians often work long hours and on-call shifts, which may expose them to circadian misalignment and negative health outcomes. However, few studies have examined whether these working hour characteristics, ascertained using objective working hour records, are associated with the physicians' risk of sickness absence. We investigated the associations of 14 characteristics of payroll-based working hours and on-call work with the risk of short sickness absence among hospital physicians. In this cohort study, 2845 physicians from six Finnish hospital districts were linked to electronic payroll-based records of daily working hours, on-call duty and short (1-3 days) sickness absence between 2005 and 2019. A case-crossover design was applied using conditional logistic regression with the 28 day case and control windows to estimate odds ratios (ORs) and 95% confidence intervals (CI) for short sickness absence. After controlling for weekly working hours and the number of normal (≤12 h) shifts, a higher number of long (>12 h) shifts (ORs for ≥5 versus none: 2.54, 95% CI 1.68-3.84), very long (>24 h) shifts (ORs for ≥5 versus none: 2.62, 95%CI 1.61-4.27), and on-call shifts (OR for ≥5 versus none: 2.15, 95% CI 1.44-3.21) and a higher number of short (<11 h) shift intervals (OR for ≥5 versus none: 12.61, 95% CI 8.88-17.90) were all associated with the increased risk of short sickness absence. These associations did not differ between male and female physicians or between age groups. To conclude, the findings from objective working hour records show that long work shifts, on-call shifts and short shift intervals are related to the risk of short (1-3 days) sickness absence among hospital physicians.

Association of changes in work due to COVID-19 pandemic with psychosocial work environment and employee health: a cohort study of 24 299 Finnish public sector employees.

OBJECTIVES: To examine the associations of COVID-19-related changes in work with perceptions of psychosocial work environment and employee health. METHODS: In a cohort of 24 299 Finnish public sector employees, psychosocial work environment and employee well-being were assessed twice before (2016 and 2018=reference period) and once during (2020) the COVID-19 pandemic. Those who reported a change (='Exposed') in work due to the pandemic (working from home, new tasks or team reorganisation) were compared with those who did not report such change (='Non-exposed'). RESULTS: After adjusting for sex, age, socioeconomic status and lifestyle risk score, working from home (44%) was associated with greater increase in worktime control (standardised mean difference (SMD)Exposed=0.078, 95% CI 0.066 to 0.090; SMDNon-exposed=0.025, 95% CI 0.014 to 0.036), procedural justice (SMDExposed=0.101, 95% CI 0.084 to 0.118; SMDNon-exposed=0.053, 95% CI 0.038 to 0.068), workplace social capital (SMDExposed=0.094, 95% CI 0.077 to 0.110; SMDNon-exposed=0.034, 95% CI 0.019 to 0.048), less decline in self-rated health (SMDExposed=-0.038, 95% CI -0.054 to -0.022; SMDNon-exposed=-0.081, 95% CI -0.095 to -0.067), perceived work ability (SMDExposed=-0.091, 95% CI -0.108 to -0.074; SMDNon-exposed=-0.151, 95% CI -0.167 to -0.136) and less increase in psychological distress (risk ratio (RR)Exposed=1.06, 95% CI 1.02 to 1.09; RRNon-exposed=1.16, 95% CI 1.13 to 1.20). New tasks (6%) were associated with greater increase in psychological distress (RRExposed=1.28, 95% CI 1.19 to 1.39; RRNon-exposed=1.10, 95% CI 1.07 to 1.12) and team reorganisation (5%) with slightly steeper decline in perceived work ability (SMDExposed=-0.151 95% CI -0.203 to -0.098; SMDNon-exposed=-0.124, 95% CI -0.136 to -0.112). CONCLUSION: Employees who worked from home during the pandemic had more favourable psychosocial work environment and health, whereas those who were exposed to work task changes and team reorganisations experienced more adverse changes.

Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries.

BACKGROUND: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints. METHODS: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers. FINDINGS: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality. INTERPRETATION: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality. FUNDING: NordForsk, the Medical Research Council, the National Institute on Aging, the Wellcome Trust, Academy of Finland, and Finnish Work Environment Fund.