Occupational burnout and their determinants among schoolteachers in Nepal: a cross-sectional study.

BACKGROUND: Burnout syndrome attributable to cumulative stressors is highly prevalent among teachers. Despite this, knowledge of burnout syndrome among schoolteachers in lower-middle-income countries are limited, therefore we aimed to investigate self-reported occupational burnout syndrome and associated factors among schoolteachers in Nepal. METHODS: A survey was conducted among randomly selected 37 community schools in Kathmandu, Nepal in 2022, with a total sample of 218 schoolteachers (70% male). Occupational burnout was assessed using the Nepali version of the validated Maslach Burnout Inventory (MBI-ES). MBI-ES consists of 22 items assessing occupational burnout, which were classified into emotional exhaustion (EE, 9 items, score range: 0-45), depersonalization (DP, 5 items, 0-23), and personal accomplishment (PA, 8 items; 3-48). The greater score in EE and DP and the lower score in PA indicate a higher level of burnout. Various socio-demographic, lifestyle, and work-related factors were examined as determinants of occupational burnout using ANOVA and multivariable linear regression models. RESULTS: The mean scores of EE, DP, and PA were 14.99 (Standard Deviation, SD = 9.79), 4.18 (SD = 4.57), and 42.11 (SD = 6.82) respectively. Poor/moderate work ability contributed to poorer ratings of all three dimensions. Teaching special needs students contributed to EE and DP, whereas low physical activity and alcohol intake were associated with PA only. Younger age, being married, language of teaching, having a disability, sub-optimal physical fitness, poor sleep quality, and ever smoking contributed to EE only. CONCLUSION: Occupational burnout among schoolteachers was relatively high. Marital status, lifestyle behavioral, and work-related factors were associated especially with EE and workability was a strong determinant of all three dimensions. CLINICAL TRIAL REGISTRATION NUMBER: NCT05626543.

Can workplace intervention prolong work life of older workers? A quasi-experimental study.

BACKGROUND: We aimed to evaluate the impact of a workplace senior program intervention on early exit from labor market and on the disability retirement among older employees and work-related physical factors associated with it. METHODS: A total of 259 individuals aged 55 + years participated in the study (107 in intervention and 152 were controls). A questionnaire survey was conducted among Finnish food industry employees between 2003 and 2009 and the intervention "senior program" was provided between 2004 and 2009. The type of pension for the respondents who had retired by 2019 was obtained and dichotomized as statutory vs. early labor market exit. Disability pension was investigated as a separate outcome. Information on work-related factors was obtained from the survey. Cox regression analysis was used to estimate hazard ratios (HR) with their 95% confidence intervals. RESULTS: Fifty-one employees had early labor market exit. Of them, 70% (n = 36) were control participants. Employees in the senior program worked for longer years (mean years 7.4, 95% CI 6.4-8.1) compared to the control (6.6, 95% CI 6.3-7.5). Sixty percent lower risk of early labor market exit (HR 0.40, 95% CI 0.19-0.84) and disability pension was found among employees in the senior program compared to the control group. Good work ability had a 94% lower risk (0.06, 95% CI 0.01-0.29) of early labor market exit and 85% lower risk (0.15, 95% CI 0.03-0.73) of disability pension compared to poor work ability. Employees with musculoskeletal pain had 4 times higher risk of disability pension compared to those without musculoskeletal pain. CONCLUSIONS: A workplace senior program intervention prolonged work life and had positive effect on reducing disability pension among older industrial workers.

Effectiveness of interventions on the stress management of schoolteachers: a systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to analyse the effectiveness of interventions on the stress management of schoolteachers. METHODS: We searched the Medline, PsycINFO, CINAHL and Education Research Complete until 30 November 2021, to identify relevant studies using relevant key words. Job or occupational stress was used as the outcome measure. Stress was defined as Perceived Stress Scale, Teacher Stress Inventory, Maslach Burnout Inventory, Teacher's Distress, Brief Symptoms Inventory or Global Severity Index. Study selection, data extraction, risk of bias assessment was performed by two independent reviewers. The pooled estimate of the effect by the type of outcome measurement tool and by type of interventions used was calculated using random effects meta-analysis. We used Grades of Recommendations, Assessment, Development and Evaluation to assess the overall quality of the evidence. RESULTS: We reviewed 26 studies, of which 24 were randomised trials and 2 pre-test/post-test studies. Based on meta-analysis, a positive effect of intervention (pooled estimate -1.13, 95% CI -1.52 to -0.73) with high heterogeneity among studies (χ2=426.88, p<0.001, I2=94%) was found by type of interventions used. Cognitive-behavioural therapy had the strongest positive effect, followed by meditation among the types of interventions studied. We identified evidence of a moderate quality for interventions aiming to manage the stress level of schoolteachers. CONCLUSIONS: The meta-analysis showed a positive effect of interventions, suggesting that interventions might reduce the stress level among teachers. The quality of the evidence was moderate. PROSPERO REGISTRATION NUMBER: CRD42021225098.

Musculoskeletal pain trajectories of employees working from home during the COVID-19 pandemic.

OBJECTIVES: In March 2020, the COVID-19 pandemic necessitated a rapid public health response which included mandatory working from home (WFH) for many employees. This study aimed to identify different trajectories of multisite musculoskeletal pain (MSP) amongst employees WFH during the COVID-19 pandemic and examined the influence of work and non-work factors. METHODS: Data from 488 participants (113 males, 372 females and 3 other) involved in the Employees Working from Home (EWFH) study, collected in October 2020, April and November 2021 were analysed. Age was categorised as 18-35 years (n = 121), 36-55 years (n = 289) and 56 years and over (n = 78). Growth Mixture Modelling (GMM) was used to identify latent classes with different growth trajectories of MSP. Age, gender, working hours, domestic living arrangements, workstation comfort and location, and psychosocial working conditions were considered predictors of MSP. Multivariate multinomial logistic regression was used to identify work and non-work variables associated with group membership. RESULTS: Four trajectories of MSP emerged: high stable (36.5%), mid-decrease (29.7%), low stable (22.3%) and rapid increase (11.5%). Decreased workstation comfort (OR 1.98, CI 1.02, 3.85), quantitative demands (OR 1.68, CI 1.09, 2.58), and influence over work (OR 0.78, CI 0.54, 0.98) was associated with being in the high stable trajectory group compared to low stable. Workstation location (OR 3.86, CI 1.19, 12.52) and quantitative work demands (OR 1.44, CI 1.01, 2.47) was associated with the rapid increase group. CONCLUSIONS: Findings from this study offer insights into considerations for reducing MSP in employees WFH. Key considerations include the need for a dedicated workstation, attention to workstation comfort, quantitative work demands, and ensuring employees have influence over their work.

Quality of work community and workers' intention to retire.

PURPOSE: To study the workers' perception of the quality of work community and its association with intention to retire early, separately among women and men working in Finnish postal service. METHODS: A questionnaire survey was sent to all Finnish postal services employees aged ≥ 50 years in 2016 and 44% (n = 2096) replied to the survey (mean age 56.3, 40% women). Employee's intention to retire before statutory retirement was measured on a scale of 1-5 and dichotomized. The quality of work community was defined by four composite variables: equality at work, flexibility at work, supportive work environment and health or other reason and trichotomized by their tercile values. Odds ratio (ORs) and their 95% confidence intervals (CIs) for associations of quality of work community with intention to retire were calculated separately for men and women using log binomial regression models adjusted for potential confounders. RESULTS: About one-third of respondents intended to retire early with no significant gender difference in retirement intention. Low equality at work (women OR 2.77, 95% CI 1.60-4.81; men 2.84, 1.80-4.48) and low flexibility at work (women 3.30, 1.94-5.60; men 2.91, 1.88-4.50) was associated with higher likelihood of intention to retire. Among women intention to retire was found less likely due to low supportive work environment (0.52, 0.31-0.89) and among men due to intermediate health or other reason (0.65, 043-0.98). CONCLUSION: The results highlight the importance of the quality of work community as well as the promotion of work-related health in order to encourage employees to remain at workforce for longer.

Trajectories of low back pain from midlife to retirement and functional ability at old age.

BACKGROUND: This study aimed to identify trajectories of low back pain (LBP) over a 16-year follow-up from midlife to retirement and investigate their association with mobility limitations and disability in activities of daily living (ADL-disability) in later life. METHODS: The study population consisted of 6257 baseline (1981) respondents aged 44-58 years from Finnish Longitudinal study on Aging Municipal Employees. Repeated measurements of LBP were collected in 1985, 1992 and 1997. We studied persons who had data on LBP at baseline and in at least one of the follow-ups and had information on mobility limitations (n = 2305) and ADL-disability (n = 2359) at a 28-year follow-up in 2009. Latent class growth analysis was used to identify LBP trajectories. Odds ratios (ORs) with 95% confidence intervals (CIs) for the associations of LBP trajectory and later life mobility limitations and ADL-disability were estimated and adjusted for confounders. RESULTS: Three LBP trajectories with parallel shapes were identified: high-decreasing (19%), intermediate-stable (60%) and low (21%). After adjustment for confounders, high-decreasing trajectory had 3.2 times the odds (95% CI 2.1-4.9) of mobility limitations and 2.9 times the odds (95% CI 2.0-4.2) of ADL-disability as compared to low trajectory. The respective ORs for intermediate-stable trajectory were 1.6 (95% CI 1.2-2.1) and 1.7 (95% CI 1.3-2.3). CONCLUSIONS: Among majority of respondents, LBP remained stable over the follow-up. The respondents belonging to intermediate-stable and high-decreasing trajectories of LBP had higher odds of mobility limitations and ADL-disability at old age. This highlights that LBP during midlife to retirement has far-reached consequences on functional ability at old age.

Trajectories of mobility limitations over 24 years and their characterization by shift work and leisure-time physical activity in midlife.

BACKGROUND: We aimed to investigate trajectories of mobility limitations (MLs) over a period of 24 years. In addition, we aimed to study how shift work and leisure-time physical activity (LTPA) in midlife predict assignment to MLs trajectories separately for those retired on statutory pensions (SPs) and on disability pensions (DPs). METHODS: Subjects who responded MLs questionnaires (1985-2009, N = 3048) in Finnish Longitudinal Study on Aging Municipal Employees were included in this prospective cohort study. LTPA and shift work were measured during baseline. International Classification of Functioning was used to code MLs. Growth mixture modeling was used to identify the trajectories of MLs. Odds ratio (OR) and their 95% Confidence interval (CI) were assessed by using multinomial logistic regression. RESULTS: We identified four trajectories of MLs, namely low persistent, low increasing, high decreasing and high persistent. Among the SP recipients, shift work with night shifts was associated with an increased risk (adjusted OR 1.49; 95% CI 1.03-2.14) of belonging to the high persistent MLs trajectory. The inactive LTPA (SP: OR 5.99, 95% CI 3.39-10.58, DP: OR 6.81, 95% CI 2.52-18.43) was similarly associated with high persistent MLs trajectory. CONCLUSION: Nearly two-thirds of the people retired due to disability belonged to high MLs trajectory. High persistent MLs trajectory was associated with physical inactivity in midlife among those retired on SP and on DP. Shift work with night shift predicted high persistent MLs in SP strata. Active involvement in LTPA during midlife could be beneficial to spend MLs free later life.

Multisite musculoskeletal pain trajectories from midlife to old age: a 28-year follow-up of municipal employees.

OBJECTIVES: We studied the developmental trajectories of multisite musculoskeletal pain (MSP) to learn whether pain in midlife persists to old age, and whether pain trajectories associate with midlife work or lifestyle exposures or retirement from work. METHODS: Municipal employees aged 44-58 years were studied in 1981 (n=6257) with follow-ups in 1985, 1992, 1997 and 2009. Pain in the neck, low back, and upper and lower limbs was assessed in each survey. Trajectories of the number (0-4) of pain sites were defined using growth mixture modelling (n=3093). Workload, lifestyle and morbidity were elicited by questionnaire and retirement from registries. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Cumulative hazard curves for retirement by trajectory group were calculated. RESULTS: Three trajectories of pain over 28 years emerged: low (25%), moderate (52%) and high-decreasing (23%). In the latter, the number of pain sites first decreased sharply, stabilising to a moderate level after most subjects had retired. The disability pension rate was highest in this trajectory, which associated with high baseline morbidity, particularly musculoskeletal disorder (OR 8.06; 95% CI 5.97 to 10.87). Also high biomechanical exposure (2.86;95% CI 2.16 to 3.78), high job demands (1.79; 95% CI 1.39 to 2.30), high job control (OR 0.70; 95% CI 0.54 to 0.90), body mass index (BMI) ≥25.0 kg/m2 (1.40; 95% CI 1.09 to 1.80) and low leisure-time physical activity (LTPA) (1.39; 95% CI 1.09 to 1.78) at baseline were associated with this trajectory. However, high LTPA and BMI in repeated surveys also associated with the high-decreasing trajectory. CONCLUSION: MSP in midlife often persists to old age. However, high widespreadness of pain may decrease with retirement from work.

Work-Related Biomechanical Exposure and Job Strain as Separate and Joint Predictors of Musculoskeletal Diseases: A 28-Year Prospective Follow-up Study.

We investigated how work-related biomechanical exposure and job strain in midlife separately and jointly predicted back and degenerative musculoskeletal diseases (MSDs). A total of 6,257 employees participated in the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 and were followed up for 28 years. Risk ratios and the relative excessive risk due to interaction and 95% confidence intervals were modeled for separate and joint prediction estimates, respectively. After adjustment for confounders, job strain predicted degenerative MSDs among women after 4 and 11 years of follow-up. After 11 years, both exposures predicted both types of MSDs among men. Joint exposure predicted both types of MSDs after 4 years among women (for back MSDs, risk ratio (RR) = 1.58, 95% confidence interval (CI): 1.15, 2.18; for degenerative MSDs, RR = 1.59, 95% CI: 1.21, 2.07) and men (for back MSDs, RR = 1.50, 95% CI: 1.05, 2.15; for degenerative MSDs, RR = 1.61, 95% CI: 1.16, 2.22) and both types of MSDs after 11 years (for back MSDs, RR = 1.72, 95% CI: 1.21, 2.43; for degenerative MSDs, RR = 1.68, 95% CI: 1.25, 2.46) among men only, but the relative excessive risk due to interaction was not significant throughout. However, after 28 years, the separate and joint exposures did not predict MSDs. Workplace interventions should be focused on reducing job strain along with biomechanical exposure for possible prevention of MSDs in working life and around the time of retirement, but there may be other pathways of onset of MSDs in old age.

Developmental pathways of multisite musculoskeletal pain: what is the influence of physical and psychosocial working conditions?

OBJECTIVE: To investigate the developmental pathways of multisite musculoskeletal pain (MSP) and the effect of physical and psychosocial working conditions on the development of MSP trajectories. METHODS: The study was conducted among food industry workers (N=868) using a longitudinal design. Surveys were conducted every 2 years from 2003 to 2009. The questionnaire covered MSP, physical and psychosocial working conditions (physical strain, environmental factors, repetitive movements, awkward postures; mental strain, team support, leadership, possibility to influence) and work ability. MSP as an outcome was defined as the number of painful areas of the body on a scale of 0-4. Latent class growth modelling and multinomial logistic regression were used to analyse the impact of working conditions on MSP pathways. RESULTS: Five MSP trajectories (no MSP 35.6%, persistent MSP 28.8%, developing MSP 8.8%, increasing MSP 15.3% and decreasing MSP 11.5%) were identified. In a multivariable model, the no MSP pathway was set as the reference group. High physical strain (OR 3.26, 95% CI 2.10 to 5.04), poor environmental factors (3.84, 2.48 to 5.94), high repetitive movements (3.68, 2.31 to 5.88) and high mental strain (3.87, 2.53 to 5.92) at baseline predicted the persistent MSP pathway, allowing for poor work ability (2.81, 1.84 to 4.28) and female gender (1.80, 1.14 to 2.83). High physical strain and female gender predicted the developing MSP pathway. High physical strain, poor environmental factors and high repetitive movements predicted the increasing and decreasing MSP pathways. CONCLUSIONS: A substantial proportion of individuals reported having persistent MSP, and one-third reported changing patterns of pain. Adverse physical working conditions and mental strain were strongly associated with having high but stable levels of MSP.

Effects of a nine-month occupational intervention on health-related quality of life.

The aim of this study was to evaluate the effectiveness of vocationally outpatient oriented rehabilitation on an intervention group, compared with a control group that did not take part in the intervention. The groups were compared for health-related quality of life (HRQoL) by the quantitative indicator RAND 36. Data were obtained by a self-report at baseline and at nine months follow-up. Differences between base-line and follow-up were analyzed within group and between the groups. The study population consisted of 751 municipal employees aged between 26 and 64 years; an intervention with 463 women and 115 men ( n = 578), and a control group with 138 women and 35 men ( n = 173). In this study we focused on those who had answered to all questions in RAND 36, thus 581 remained. Of these, 388 were in the intervention group (mean age 49.0 years) and 110 in the control group (mean age 48.4 years). Intervention was based on cognitive behavioral therapy. Participants in the 9-month outpatient intervention group showed statistically significant increase in all eight RAND 36 areas. Most improvement was seen in the psychosocial functioning index ( p = 0.002). Although there were no statistically significant changes in RAND 36 components in the control group, difference in changes between groups were seen in energy and fatigue ( p < 0.001), social functioning ( p = 0.032) and general health perceptions 0.027 in favor of the intervention group. The results suggest that a cognitive behavioral intervention as an early rehabilitation program is effective in increasing employees' quality of life, as measured by RAND 36.

Associations between perceived leadership and presenteeism in an industrial population.

Background: Presenteeism has received increasing attention in occupational health research but the evidence for its association with perceived leadership is scant. Aims: To assess the association of perceived leadership and presenteeism among industrial workers. Methods: Survey responses from employees on perceived leadership were linked to the personnel register of a food industry company. The Presenteeism Scale method was used to determine the presenteeism percentage. Perceived leadership was measured as a composite variable of six individual items on motivating and participating leadership. Generalized linear models were used to determine the association of perceived leadership with presenteeism. Results: There were 847 participants. The majority of office workers of both genders reported better perceived leadership than factory workers. We found that perceived poor leadership was associated with a higher likelihood of presenteeism (rate ratio (RR) 1.64, 95% confidence intervals (CIs) 1.51-1.78). However, there was variation amongst and within occupational groups and genders, with a higher risk of presenteeism amongst male factory workers (RR 2.28, 95% CI 2.02-2.52) than female office workers. Conclusions: Leadership was found to be significantly associated with presenteeism, with a greater risk of presenteeism in those reporting poor perceived leadership. The association between levels of perceived leadership and presenteeism was stronger in men than women. Organizations should focus on motivating leadership practices to reduce the risk of presenteeism, especially among men.

Does age matter in predicting musculoskeletal disorder risk? An analysis of workplace predictors over 4 years.

BACKGROUND: Musculoskeletal disorders (MSDs) are a major workplace issue. With increasing pressure to extend working lives, predictors of MSD risk across all age groups require accurate identification to inform risk reduction strategies. METHODS: In 2005 and 2009, a survey was conducted in a Finnish food processing company (N = 734). Data on workplace physical and psychosocial hazards, work ability, job satisfaction and lifestyle-related variables were collected, and MSD risk was measured through assessment of work-related strain in four body areas. Predictors of MSD risk across three age groups (20-35, 36-49, 50+) were assessed with linear regression analysis. RESULTS: Physical hazards and MSD risk were related differently for each age group. The relationship between psychosocial hazards and MSD risk was less clear. For younger workers, physical hazards were not associated with MSD risk. In contrast, for those aged 36-49, repetitive movements (B = 1.76, p < 0.001) and awkward postures (B = 1.30, p = 0.02) were associated with increased MSD risk. For older workers, environmental hazards were positively associated with MSD risk (B = 0.37, p = 0.04). Predictors of MSD risk changed differently for each age group during 4 years of follow-up. For younger workers, change in environment and repetitive movements, for middle age team support and for older workers change in awkward posture were significant predictors of MSD risk. CONCLUSIONS: These results support the need for workplace-specific hazard surveillance data. This will ensure that all contributing factors to MSD risk can be accurately identified and controlled independent of age.

Musculoskeletal pain and re-employment among unemployed job seekers: a three-year follow-up study.

BACKGROUND: Poor health is a potential risk factor for not finding employment among unemployed individuals. We investigated the associations between localized and multiple-site musculoskeletal pain and re-employment in a three-year follow-up of unemployed job seekers. METHODS: Unemployed people (n = 539) from six localities in southern Finland who participated in various active labour market policy measures at baseline in 2002/2003 were recruited into a three-year health service intervention trial. A questionnaire was used to collect data on musculoskeletal health and background characteristics at baseline and on employment status at the end of the follow-up. We conducted a complete case (n = 284) and multiple imputation analyses using logistic regression to investigate the association between baseline musculoskeletal pain and re-employment after three years. RESULTS: Participants with severe pain in the lower back were less likely to become re-employed. This was independent of potential confounding variables. Pain in the hands/upper extremities, neck/shoulders, lower extremities, as well as multiple site were not determinants of re-employment. CONCLUSIONS: Our findings lend some support to the hypothesis that poor health can potentially cause health selection into employment. There is the need to disentangle health problems in order to clearly appreciate their putative impact on employment. This will allow for more targeted interventions for the unemployed.

Midlife job profiles and disabilities in later life: a 28-year follow-up of municipal employees in Finland.

PURPOSE: Occupations during adult life may have long-term effects and subsequently increase the risk of disability in old age. We investigated the associations between job profile groups in midlife and disability in old age for women and men. METHODS: This prospective 28-year follow-up study (1981-2009) examined 2998 municipal employees (1892 women and 1106 men) aged 44-58 years at baseline. A detailed analysis of the demands of 88 occupations based on interviews and observations at the work places was made at baseline. Thirteen job profile clusters emerged. Questionnaire information on health, lifestyle and socio-demographic factors was collected at baseline. In 2009, five Activities of Daily Living and seven Instrumental Activities of Daily Living tasks were assessed. A sum score of '0-12' was calculated using 12 dichotomous tasks where '0' indicates no difficulties in any tasks and '1-12' indicates increasing disability. Negative binomial regression was used to calculate rate ratios (RR) and their 95 % confidence intervals (CIs) for disability due to midlife job profiles. RESULTS: After adjusting for age, socioeconomic, lifestyle and health-related characteristics, women in auxiliary (RR 2.1, 95 % CI 1.4-3.2), home care (2.1, 1.4-3.2), kitchen supervision (2.0, 1.1-3.6) and office (1.6, 1.1-2.4) job profiles had a higher risk of disability in later life than those in administrative jobs. Auxiliary (1.5, 1.1-2.9) and technical supervision (1.7, 1.1-2.7) job profiles carried an increased risk among men. CONCLUSION: Midlife job profiles mainly linked with physically heavy work were strong predictors of disability in later life. In women, office work also increased the risk of disability.

Midlife work ability and mobility limitation in old age among non-disability and disability retirees--a prospective study.

BACKGROUND: Little is known about the wellbeing and mobility limitation of older disability retirees. Personal and environmental factors, such as time spent in working life, may either exacerbate or mitigate the onset of mobility limitation in general population. We aimed to study perceived midlife work ability as a determinant of self-reported mobility limitation in old age among municipal employees who transitioned into non-disability and disability retirement. METHODS: 4329 participants of the Finnish Longitudinal Study of Municipal Employees (FLAME) had retired during January 1985 and July 2000. They had data on retirement, perceived work ability in 1985, and self-reported mobility limitation (non-disability retirement n = 2870, men 39%; and diagnose-specific disability retirement n = 1459, men 48%). Self-reported mobility was measured in 1985, 1992, 1997 and 2009. The latest score available was used to assess the number of mobility limitation. Work ability was measured by asking the respondents to evaluate their current work ability against their lifetime best in 1985. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for work ability predicting mobility limitation in non-disability and diagnose-specific disability retirement groups were calculated using Poisson regression models. RESULTS: The prevalence of mobility limitation for those who transitioned into non-disability retirement (Incidence Rate, IR = 0.45, 95% CI = 0.44-0.46) was lower compared to those who retired due to disability (IR = 0.65, CI = 0.63-0.66). A one-point increase in the work ability score decreased the risk for having one more mobility limitation among non-disability and all diagnose-specific retirement groups (musculoskeletal disease, cardiovascular disease, mental disorder, and other diseases). CONCLUSIONS: Better midlife work ability may protect from old age mobility limitation among those who retire due to non-disability and disability. Promoting work ability in midlife may lead to more independent, active aging, regardless of type of retirement.

Type of retirement as a determinant of pre- and post-retirement hospital in-patient care use: a prospective study.

BACKGROUND: We examined prospectively the use of all-cause hospital in-patient care among public sector employees by using a 3-year pre- and post-retirement study window. METHODS: A total of 5269 participants of the Finnish Longitudinal Study of Municipal Employees had retired during January 1984 and July 2000. They had register-based data on retirement (non-disability retirement n = 3411, men 40%, and diagnose-specific disability retirement n = 1858, men 50%) and all-cause hospital in-patient admissions and discharges. Analyses were conducted using Generalized Estimating Equation model. RESULTS: The prevalence of hospital care use for non-disability retirees remained stable during the 6-year study window. The rate ratio (RR) for hospital care use increased in the year prior to retirement for men and women who transitioned into disability retirement due to cardiovascular disease and for women with disability due to mental disease. The RRs for hospital care use in the post-retirement year decreased for men who retired due to cardiovascular disease or mental disorders and for women who retired due to cardiovascular or musculoskeletal diseases. CONCLUSIONS: An increase in hospital care preceding retirement in major diagnosis-specific disability retirement groups was followed by various patterns of decrease in the need of care indicated a beneficial health effect of retirement.

Does the association between musculoskeletal pain and sickness absence due to musculoskeletal diagnoses depend on biomechanical working conditions?

AIM: To investigate single-site and multi-site musculoskeletal pain as predictors of future sickness absence due to musculoskeletal disorders (MSD) among blue-collar employees in food industry, and to study to what extent this relationship depends on physical loading at work. METHODS: Survey responses of 901 employees on working conditions and musculoskeletal pain during the past week were linked to their future sickness absence records obtained from the personnel register of a food industry company. Negative binomial regression models were computed to determine associations of pain in one and in multi-site with the number of sickness absence days due to MSD during a four-year follow-up. Analyses were made in the whole cohort and stratified by the occurrence of repetitive movements and awkward postures (low/high). RESULTS: Multi-site pain occurred among 59 % in the total cohort and predicted sickness absence with a rate ratio of 1.48 [95 % confidence interval (CI) 1.21-1.80], adjusted for age, gender, biomechanical and psychosocial working conditions, body mass index and physical exercise. Similar associations were seen in the sub-cohorts with a low occurrence of repetitive movements (RR 2.18, CI 1.69-2.80) and awkward postures (RR 1.78, CI 1.39-2.28), but not in the sub-cohorts with a high occurrence of these exposure. Single-site pain was not predictive of sickness absence. CONCLUSIONS: A very high level of sickness absence in biomechanically strenuous work was found. Multi-site pain predicted sickness absence due to MSD among the employees with low exposure, but not among those with high exposure.

Job strain in the public sector and hospital in-patient care use in old age: a 28-year prospective follow-up.

BACKGROUND: high job strain increases the risk of health decline, but little is known about the specific consequences and long-term effects of job strain on old age health. OBJECTIVES: purpose was to investigate whether physical and mental job strain in midlife was associated with hospital care use in old age. METHODS: study population included 5,625 Finnish public sector employees aged 44-58 years who worked in blue- and white-collar professions in 1981. The number of in-patient hospital care days was collected from the Finnish Hospital Discharge Register for the 28-year follow-up period. RESULTS: rates of hospital care days per 1,000 person-years for men were 7.78 (95% confidence interval [CI] 7.71-7.84) for low, 9.68 (95% CI 9.50-9.74) for intermediate and 12.56 (95% CI 12.47-12.66) for high physical job strain in midlife. The corresponding rates for women were 6.63 (95% CI 6.57-6.68), 7.91 (95% CI 7.87-7.95) and 10.35 (95% CI 10.25-10.42), respectively. Rates were parallel but lower for mental job strain. Reporting high physical job strain in midlife increased the risk of hospital care in old age compared with those who reported low job strain, fully adjusted incidence rate ratio 1.17 (95% CI 1.00-1.38) for men and 1.42 (95% CI 1.25-1.61) for women. These associations were robust in analyses confined to hospital care that took place after the employees had turned 65 years. CONCLUSION: exposure to high mental and, particularly, high physical job strain in midlife may set employees on a higher healthcare use trajectory which persists into old age.