Psychotherapy duration and work disability: A prospective Finnish register study.

INTRODUCTION: The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD-related work disability and the change in psychotropic drug purchases is scarce. METHODS: We used a register-based cohort representing 33% of the Finnish population. The participants included working-age individuals (N = 12,047, 76% women, mean age = 36) who initiated long-term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration-dependent changes in CMD-related work disability (primary outcome, operationalized as depression or anxiety-related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes). RESULTS: There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the <1-year duration group (88% decline for SA and 43%-44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases). CONCLUSION: Work disability outcomes and duration varied among individuals, even with similar initial mental health-related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements.

The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study.

PURPOSE: This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups. METHODS: Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18-55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence. RESULTS: Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group. CONCLUSIONS: Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

Detecting mining impacts on freshwater ecosystems using replicated sampling before and after the impact.

Detecting human impact on freshwater ecosystems is problematic without rigorous assessment of temporal changes. Assessments of mining impacts are further complicated by the strong influence of local catchment geology on surface waters even in unmined environments. Such influence cannot be effectively considered by using broad-scale reference frameworks based on regionalization and stream types. Using the BACI (Before-After Control-Impact) design, we examined the impact of mining discharges on freshwater algae and macroinvertebrate communities resulting from the rerouting of treated wastewaters through a pipeline to larger water bodies in Northern and North-Eastern Finland. Impacted sites and control sites were sampled 1 to 2 years before and 1 to 3 years after the pipelines became operational. Stream diatom communities recovered from past loadings upstream of the pipeline (which was no longer impacted by wastewaters) after rerouting of the wastewaters, while no changes downstream from the pipeline were detected. Upstream from the pipeline, diatom species richness increased and changes in relative abundances of the most common diatom taxa as well as in the overall community composition were observed. The effects of the pipeline were less evident for stream macroinvertebrate communities. There was an indication that regional reference conditions used in national biomonitoring may not represent diatom communities in areas with a strong geochemical background influence. Lake profundal macroinvertebrate communities were impacted by past loadings before the construction of the pipeline, and the influence of the pipeline was observed only as changes in the abundances of a few individual species such as phantom midges (which increased in abundance in response to discharges directed through the pipeline). Our results highlight the variable influence of mining discharges on aquatic communities. Statistically strong monitoring programmes, such as BACI designs, are clearly needed to detect these influences.

Sociodemographic Factors as Predictors of the Duration of Long-term Psychotherapy: Evidence from a Finnish Nationwide Register Study.

OBJECTIVE: The role of sociodemographic factors in determining psychotherapy duration has been largely unexplored despite their known association with treatment use. We examined the association between sociodemographic factors and rehabilitative psychotherapy treatment duration, as well as any changes in duration over time. METHOD: We used three register-based nationally representative cohorts. Participants included employed Finnish individuals (n = 5572, 77% women, mean age = 37) who started psychotherapy treatment in 2011, 2013 or 2016 and were followed until 2019. We used negative binomial regression to examine the association between sociodemographic factors (age, gender, education, occupational status, income, geographical area of residence, and onset year of treatment) with treatment duration. RESULTS: The mean treatment duration was 27 months (with a standard deviation of 12 months). Several sociodemographic factors were associated with treatment duration. Gender and education were found to have the largest impact on treatment duration, with females having a longer duration (IRR 1.08, 95% CI 1.04-1.11) and those with low education having a shorter duration (IRR 0.91, 95% CI 0.85-0.97), resulting in a difference of 2-3 months. Treatment duration also increased in later years, which suggests potentially increasing differences in treatment implementation. At largest, the combined effect of all factors corresponded to a 10-month difference in treatment duration. CONCLUSIONS: The duration of long-term psychotherapy varied across the sociodemographic groups and increased in all studied groups in the 2010s.

Participatory Ergonomics Intervention to Prevent Work Disability Among Workers with Low Back Pain: A Randomized Clinical Trial in Workplace Setting.

Purpose In order to support people with low back pain (LBP) to stay at work, work arrangements are regarded important. This study aimed to evaluate the effectiveness of a workplace intervention using a participatory approach on work disability of workers with ongoing or recurrent LBP. Methods A total of 107 workers with LBP, with duration of pain for at least two consecutive weeks or recurrent pain of any duration during the last year, were randomized either to the intervention (n = 51) or control group (n = 56). The intervention included arrangements at the workplace, along with individual guidance provided by an occupational physiotherapist (OPT). The randomized intervention study used standard counselling and guidance by an OPT without workplace intervention as a comparison. Surveys were completed at baseline, and 6 and 12 months after baseline. Results There were no statistically significant differences between the intervention and control groups on the primary outcome measure, i.e. self-assessed work ability. We found no between-group differences in perceived health, self-assessed work productivity, number of sickness absence days and severity of back pain. However, there were significant positive within-group changes in the intervention group in the intensity of LBP, perceived health and the number of sickness absence days due to LBP. Conclusion Workplace arrangements are feasible using participatory ergonomics, but more quantitative and qualitative research is needed on its utilization and effectiveness among workers with LBP.

Assessing mining impacts: The influence of background geochemical conditions on diatom and macroinvertebrate communities in subarctic streams.

Mining has changed landscapes locally in northern Fennoscandia and there is an increasing pressure for exploitation of the remaining mineral deposits of the region. Mineral deposits, even if unmined, can strongly influence stream water chemistry, stream biological communities and the ability of organisms to tolerate stressors. Using data sampled from six mining areas with three active (gold and chrome), two closed (gold) and one planned mine (phosphate), we examined how mineral deposits and mining influence water chemistry and diatom and macroinvertebrate communities in subarctic streams in Finnish Lapland. We supplemented the data by additional samples compiled from databases and further assessed how variation in background geological conditions influences bioassessments of the impacts arising from mining. We found that water specific conductivity was elevated in our study streams draining through catchments with a high mineral potential. Mining effects were mainly seen as increased concentration of nitrogen. Influence of mineral deposits was detected in composition of diatom and macroinvertebrate communities, but communities in streams in areas with a high mineral potential were as diverse as those in streams in areas with a low mineral potential. Mining impacts were better detected for diatoms using a reference condition based on sites with a high than low mineral potential, while for macroinvertebrates, the responses were generally less evident, likely because of only minor effects of mining on water chemistry. Community composition and frequencies of occurrence of macroinvertebrate taxa were, however, highly similar between mine-influenced streams and reference streams with a high potential for minerals indicating that the communities are strongly structured by the natural influence of mineral deposits. Incorporating geochemistry into the reference condition would likely improve bioassessments of both taxonomic groups. Replicated monitoring in potentially impacted sites and reference sites would be the most efficient framework for detecting environmental impacts in streams draining through mineral-rich catchments.

Combined effects of local habitat, anthropogenic stress, and dispersal on stream ecosystems: a mesocosm experiment.

The effects of anthropogenic stressors on community structure and ecosystem functioning can be strongly influenced by local habitat structure and dispersal from source communities. Catchment land uses increase the input of fine sediments into stream channels, clogging the interstitial spaces of benthic habitats. Aquatic macrophytes enhance habitat heterogeneity and mediate important ecosystem functions, being thus a key component of habitat structure in many streams. Therefore, the recovery of macrophytes following in-stream habitat modification may be prerequisite for successful stream restoration. Restoration success is also affected by dispersal of organisms from the source community, with potentially the strongest responses in relatively isolated headwater sites that receive a limited amount of dispersing individuals. We used a factorial design in a set of stream mesocosms to study the independent and combined effects of an anthropogenic stressor (sand sedimentation), local habitat (macrophytes, i.e., moss transplants), and enhanced dispersal (two levels: high vs. low) on organic matter retention, algal accrual rate, leaf decomposition, and macroinvertebrate community structure. Overall, all responses were simple additive effects with no interactions between treatments. Sand reduced algal accumulation, total invertebrate density, and density of a few individual taxa. Mosses reduced algal accrual rate and algae-grazing invertebrates, but enhanced organic matter retention and the number of detritus and filter feeders. Mosses also reduced macroinvertebrate diversity by increasing the dominance by a few taxa. Mosses reduced leaf mass loss, possibly because the organic matter retained by mosses provided an additional food source for leaf-shredding invertebrates and thus reduced shredder aggregation into leaf packs. The effect of mosses on macroinvertebrate communities and ecosystem functioning was distinct irrespective of the level of dispersal, suggesting strong environmental control of community structure. The strong environmental control of macroinvertebrate community composition even under enhanced dispersal suggests that re-establishing key habitat features, such as natural stream vegetation, could aid ecosystem recovery in boreal streams.

Influence of water color and catchment lake cover on stream macroinvertebrate communities: Ecological insights into browning effects.

Browning of streams due to increased export of dissolved organic carbon (DOC) and iron has been observed in vast areas of the northern hemisphere with likely adverse ecological effects. Lake basins in stream catchments can moderate DOC export and influence stream communities, which complicates understanding of the effects of DOC. In this study, we explored the independent and interactive effects of water color (proxy for DOC and iron) and catchment lake cover on benthic macroinvertebrate communities in 94 medium-sized boreal forest streams. We first investigated the role of lake basins and other catchment characteristics in controlling water color. We then studied the effects of water color and catchment lake cover on macroinvertebrate community composition, biodiversity, and functional feeding traits. Water color correlated negatively with catchment lake cover, whereas the correlation with peatland cover and drainage intensity was positive. PERMANOVA and GLS analyses indicated that both color and catchment lake cover had a distinct independent effect on invertebrate community composition and community attributes, without significant interactions. Color had an independent negative effect on EPT (Ephemeroptera, Plecoptera, Trichoptera) taxa richness irrespective of lake cover. Increasing water color had negative effect on relative abundance of grazer, but no significant effect on shredder trait, while lake cover had a negative effect on both of the traits. Lake cover exhibited a negative influence on collector-gatherers, and a positive effect on filter feeders, while the predators were positively affected by both factors. The results highlight that water color influences the community structure of boreal stream ecosystems, and the effects are similar regardless of catchment lake cover. Mitigation measures should be emphasized, aimed at reducing DOC and iron runoff, in land use planning and river basin management.

Important collaborative conditions for successful economic outcomes of work disability management: A mixed methods multiple case study.

BACKGROUND: Work disability management (WDM) interventions have usually focused on a single factor and its impact on outcomes such as employee health or work disability costs. Research on company-level WDM activities and their economic impact is scarce. OBJECTIVE: The aim of this study was to explain the change in company-level work disability costs and their relation to WDM practices, and to identify the mechanisms of impact through which the successful economic outcome emerged. METHODS: The study design was a convergent mixed methods design with a multiple case study. The data from 14 business units concerned business context, personnel, investments in and processes of WDM, and the costs of work disability in 2010-2013. The data were constructed into case descriptions which were analysed using qualitative comparative analysis. The economic analysis was carried out from the employers' perspective. RESULTS: Five business units gained net benefits of approximately 1.5-2.5% of the payroll sum from their investments in WDM. These benefits were characterised by a combination of four strategic processes: i) dismantling barriers to co-operation, ii) improving the visibility of the strategic goals of work ability management in everyday practice, iii) WDM actions targeting the company's main work disability risks, and iv) the facilitation of multi-actor co-operation through co-ordination and flow of information. CONCLUSION: Strategic processes to support the effectiveness of WDM were found. When aiming for economic success in work disability management, in addition to measuring and managing disability costs, it is also essential to maintain collaborative operations in everyday practice.

The association between the use of shift schedule evaluation tool with ergonomics recommendations and occupational injuries: A 4-year prospective cohort study among healthcare workers.

OBJECTIVE: This study aimed to find out whether utilizing a shift schedule evaluation tool with ergonomics recommendations for working hours has favorable effects on the incidence of occupational injuries. METHODS: This 4-year prospective cohort study (2015-2018) consisted of a dynamic cohort of healthcare shift workers (N=29 237) from ten hospital districts and six cities in Finland. Working hour characteristics and occupational injuries were measured with daily registry data. Multilevel generalized linear model was used for the analyses, and the estimates were controlled for hierarchical structure of the data and confounders. RESULTS: Ward heads of the cities used the shift schedule evaluation tool 3.2 times more often than ward heads of the hospital districts. Overall incidence of workplace and commuting injuries did not differ between users and non-users of the evaluation tool. The incidence of dislocations, sprains, and strains was lower in the users than non-users [adjusted odds ratio (OR) 0.88, 95% confidence interval (CI) 0.78-0.99]. Approximately 13% of this association was mediated by increase in realized shift wishes and 10% by increase in single days off. In subgroup analyses, the incidence of workplace injury (OR 0.83, 95% CI 0.69-0.99), and among types of injuries, the incidence of dislocations, sprains, and strains (OR 0.69, 95% CI 0.55-0.85) and falling, slipping, tripping, or overturning (OR 0.75, 95% CI 0.58-0.99) were lower in users than non-users among employees of the cities, but no association was found among employees of the hospital districts. CONCLUSION: The use of ergonomics recommendations for working hours is associated with a reduced risk of occupational injuries.

Income gradient in psychotherapy use and psychotropic drug purchases: A longitudinal register study in Finnish employed population.

OBJECTIVE: We examined the income gradient changes in the use of long-term rehabilitative psychotherapy and psychotropic drug purchases in men and women during a 9-year follow-up. METHODS: We used register data from a random sample of the working-age population (18-64 years) with information on annual income, psychotherapy use and psychotropic drug purchases from 2011 to 2019 (N = 736 613, 49.7% women). Sex-stratified generalized estimating equations logistic regression models with predicted marginal probabilities were used to examine change in the treatment use rates over time for income quartiles. RESULTS: Treatment rates increased during the follow-up, with men having lower rates than women. There were no significant differences in psychotherapy use rates between the income quartiles during the follow-up in men. A small income gradient in women (the wealthiest group with the highest use rate) remained stable throughout the follow-up. As for psychotropic drug purchases, the rates increased more among the poorest income quartile compared to the wealthiest quartile in both men and women. In the last year of the follow-up, the initial income gradient (wealthiest group having the highest psychotropic drug purchase rate) had become reversed, and the poorest group had the highest psychotropic drug purchase rate. CONCLUSION: In psychotherapy use, no income gradient was found in men, while a stable income gradient was found in women. Psychotropic drug purchases have previously been more common in the wealthiest groups, but more recently among the poorest. The findings indicate that gender and income have distinct relationships with the treatment modality over time.

The Effect of Employee-Oriented Flexible Work on Mental Health: A Systematic Review.

The effect of flexible work on mental health is not well known. The aim of this systematic review was to assess the effects of employee-oriented flexible work on mental health problems and associated disability. Literature searches were conducted in the PubMed, Scopus, Web of Sciences, Cochrane Library, PsycINFO, ProQuest and EconPapers databases from their inception through October-November 2020. Sixteen studies on the associations of worktime control, working from home, or flexible working arrangements with mental health related outcomes were included in the review: one cluster randomized controlled trial, two non-randomized controlled trials, two cross-over studies, and 11 prospective cohort studies. Three reviewers independently assessed the met-hodological quality of the included studies and extracted the data. The included studies differed in design, intervention/exposure, and outcome, so meta-analysis was not carried out and qualitative results were reported. A few prospective cohort studies found that low employees' control over worktime increases the risk of depressive symptoms, psychological distress, burnout, and accumulated fatigue. One cross-over and a few cohort studies found small beneficial effects of working partly from home on depressive symptoms, stress, and emotional exhaustion. A small number of controlled trials, cross-over or cohort studies found that flexible working arrangements increase employees' control over working hours, but have only modest beneficial effects on psychological distress, burnout, and emotional exhaustion. This systematic review suggests that employee-oriented flexible work may have small beneficial effects on mental health. However, randomized controlled trials and quasi-experimental studies are needed to identify the health effects of flexible work.

National recommendations for shift scheduling in healthcare: A 5-year prospective cohort study on working hour characteristics.

BACKGROUND: National recommendations to decrease the health and safety risks of working hours are often given based on the increasing knowledge of the associations between working hour characteristics and health. However, the utilization of the recommendations, and their potential to change the actual working time patterns in healthcare sector is unclear. OBJECTIVE: We investigated the extent to which the national recommendations are utilized in shift scheduling, when they are integrated as a shift schedule evaluation tool into the shift scheduling software. Second, we examined whether the use of the tool results in changes that are in line with the recommendations. DESIGN: A prospective cohort study with a 5-year follow-up. PARTICIPANTS: A total of 36,663 healthcare workers with objective data on daily working hours in 10 hospital districts and 6 large cities. METHODS: We investigated the annual use of the evaluation tool, and the effects of using the tool on annual changes in working hour characteristics from 2015 to 2019 while adjusting for the hierarchical structure of the data, age, sex, shift work, night work, work contract days and the type of shift scheduling software. Utilizing intention-to-treat principle, the employees in wards using the tool were compared to non-users by multi-level generalized linear models. RESULTS: Continuous use (during at least 10 scheduling periods) of the evaluation tool increased from 2% in 2015 to 20% in 2018. In the fully adjusted model, the use of the evaluation tool was associated with the decrease of >6 consecutive workdays (OR 0.73, 95% CI 0.66, 0.81), >4 consecutive night shifts (OR 0.86, 95% CI 0.77, 0.95), and proportion of <11-hour shift intervals (difference 0.63, 95% CI 0.43, 0.83). The proportion of single days off (difference 0.33, 95% CI 0.15, 0.51), and >40-hour work weeks (OR 1.16, 95% CI 1.10, 1.22), as well as the proportion of ≥12-hour work shifts (OR 1.22, 95% CI 1.07, 1.38) increased. Realized shift wishes decreased (difference 0.76, 95% CI 0.12, 1.41). The use of the tool was associated with more frequent changes towards the recommendations in the cities compared to the hospital districts, and among the older age groups compared to the ≤30-year-old employees. CONCLUSIONS: National recommendations embedded in the shift schedule evaluation tool were used continuously by one fifth of the employees, and were associated with several, albeit modest changes towards the given recommendations. Changes in working hour characteristics depended on organization indicating for differences in the implementation of the recommendations. TWEETABLE ABSTRACT: The national recommendations for safer working hour characteristics embedded in a shift schedule evaluation tool are associated with several, albeit modest changes in working hour characteristics.

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design.

BACKGROUND: Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability. METHODS: We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied. RESULTS: The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group. CONCLUSIONS: This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.

The Time-Varying Effect of Participatory Shift Scheduling on Working Hour Characteristics and Sickness Absence: Evidence from a Quasi-Experiment in Hospitals.

Participatory shift scheduling for irregular working hours can influence shift schedules and sickness absence. We investigated the effects of using participatory shift scheduling and shift schedule evaluation tools on working hour characteristics and sickness absence. We utilized a panel data for 2015-2019 with 16,557 hospital employees (6143 in the intervention and 10,345 in the control group). Difference-in-differences regression with ward-level clustered standard errors was used to estimate the average treatment effect on the treated coefficients relative to timing of the intervention with 95% confidence intervals (CI). Using participatory scheduling tool increased long working hours and weekend work and had delayed effects on the short (1-3 days) sickness absences. Increased effects were observed: 0.2 [95% CI 0.0-0.4] days for the second, and 0.8 [95% CI 0.5-1.0] for the third year after the onset of intervention. An average increase of 0.5 [95% CI 0.1-0.9] episodes on all sickness absence episodes was observed for the third year. Using the shift schedule evaluation tool with the participatory shift scheduling tool attenuated the adverse effects. To conclude, participatory shift scheduling increased some potentially harmful working hour characteristics but its effects on sickness absence were negligible, and further attenuated by using the shift schedule evaluation tool.

Risk Assessment of Gypsum Amendment on Agricultural Fields: Effects of Sulfate on Riverine Biota.

Gypsum (CaSO4 ∙2H2 O) amendment is a promising way of decreasing the phosphorus loading of arable lands, and thus preventing aquatic eutrophication. However, in freshwaters with low sulfate concentrations, gypsum-released sulfate may pose a threat to the biota. To assess such risks, we performed a series of sulfate toxicity tests in the laboratory and conducted field surveys. These field surveys were associated with a large-scale pilot exercise involving spreading gypsum on agricultural fields covering 18% of the Savijoki River (Finland) catchment area. The gypsum amendment in such fields resulted in approximately a four-fold increase in the mean sulfate concentration for a 2-month period, and a transient, early peak reaching approximately 220 mg/L. The sulfate concentration gradually decreased almost to the pregypsum level after 3 years. Laboratory experiments with Unio crassus mussels and gypsum-spiked river water showed significant effects on foot movement activity, which was more intense with the highest sulfate concentration (1100 mg/L) than with the control. Survival of the glochidia after 24 and 48 h of exposure was not significantly affected by sulfate concentrations up to 1000 mg/L, nor was the length growth of the moss Fontinalis antipyretica affected. The field studies on benthic algal biomass accrual, mussel and fish density, and Salmo trutta embryo survival did not show gypsum amendment effects. Gypsum treatment did not raise the sulfate concentrations even to a level just close to critical for the biota studied. However, because the effects of sulfate are dependent on both the spatial and the temporal contexts, we advocate water quality and biota monitoring with proper temporal and spatial control in rivers within gypsum treatment areas. Environ Toxicol Chem 2022;41:108-121. © 2021 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

The Effect of Using Participatory Working Time Scheduling Software on Employee Well-Being and Workability: A Cohort Study Analysed as a Pseudo-Experiment.

Shift workers are at increased risk of health problems. Effective preventive measures are needed to reduce the unfavourable effects of shift work. In this study we explored whether use of digital participatory working time scheduling software improves employee well-being and perceived workability by analysing an observational cohort study as a pseudo-experiment. Participants of the Finnish Public Sector cohort study with payroll records available between 2015 and 2019 were included (N = 2427). After estimating the propensity score of using the participatory working time scheduling software on the baseline characteristics using multilevel mixed-effects logistic regression and assigning inverse probability of treatment weights for each participant, we used generalised linear model to estimate the effect of using the participatory working time scheduling software on employees' control over scheduling of shifts, perceived workability, self-rated health, work-life conflict, psychological distress and short sleep (≤6 h). During a 2-year follow-up, using the participatory working time scheduling software reduced the risk of employees' low control over scheduling of shifts (risk ratio [RR] 0.34; 95% CI 0.25-0.46), short sleep (RR 0.70; 95% CI 0.52-0.95) and poor workability (RR 0.74; 95% CI 0.55-0.99). The use of the software was not associated with changes in psychological distress, self-rated health and work-life conflict. In this observational study, we analysed as a pseudo-experiment, the use of participatory working time scheduling software was associated with increased employees' perceived control over scheduling of shifts and improved sleep and self-rated workability.

The effects of using participatory working time scheduling software on sickness absence: A difference-in-differences study.

BACKGROUND: Participatory working time scheduling is a collaborative approach to scheduling shift work. As a potential way of improving work time control, it may provide a means to reducing sickness absence in shift work. So far, experimental and quasi-experimental studies on the effects of increased work time control on sickness absence are lacking. OBJECTIVE: To investigate the effects of using digital participatory working time scheduling software on ward-level sickness absence among Finnish hospital employees. PARTICIPANTS AND METHODS: This quasi-experimental study compared the amount of sickness absence in hospital wards using a participatory working time scheduling software (n=121 wards) and those continuing with traditional working time scheduling (n=117 wards) between 2014 and 2017. We used continuous panel data from 238 hospital wards with a total number of 9000 hospital employees (89% of women, primarily nursing staff). The ward-level measures consisted of number of employees, working hours, sickness absence spells per employee, and short (1-3) sickness absence days per employee. Two-way fixed effects and event study regressions with clustered standard errors were used to estimate the effect of using participatory scheduling software on sickness absence. RESULTS: Sickness absence spells and short (1-3) sickness absence days decreased by 6% and 7%, respectively in the wards using participatory scheduling compared to those using traditional scheduling. The effect became stronger as the time measured in quarters of using the participatory working time scheduling software increased. CONCLUSIONS: The effects of using participatory working time scheduling software indicated less ward-level sickness absence measured as spells and days in comparison to continuing with traditional scheduling. The encouraging findings are relevant not only to the health care sector but also to other sectors in which irregular shift work is a necessity. This study was registered with ClinicalTrials.gov (NCT02775331) before starting the intervention phase.

The effects of using participatory working time scheduling software on working hour characteristics and wellbeing: A quasi-experimental study of irregular shift work.

BACKGROUND: Studies in the health care sector indicate that good work time control is associated with better perceived wellbeing but also with non-ergonomic work schedules, such as compressed work schedules. Participatory working time scheduling is a collaborative approach to scheduling shift work. Currently, there is a lack of information on whether working hour characteristics and employees' wellbeing in irregular shift work change after implementing participatory working time scheduling. OBJECTIVE: To investigate the effects of using digital participatory working time scheduling software on working hour characteristics and well-being among Finnish hospital employees. PARTICIPANTS AND METHODS: We compared changes in objective working hour characteristics and wellbeing between 2015 and 2017 among employees (n = 677, mainly nurses and practical nurses) when using participatory working time scheduling software (participatory scheduling, n = 283) and traditional shift scheduling (traditional scheduling, n = 394). The statistical analyses were conducted using the repeated measures general linear model and the generalized logit model for binomial and multinomial variables adjusted for age, sex, education, shift work experience, control over scheduling of shifts at baseline (where applicable) and hospital district. RESULTS: The proportion of long work shifts (≥ 12 h) increased to a greater extent (F = 4.642, p = 0.032) with the participatory scheduling than with the traditional scheduling. In comparison to traditional scheduling, the perceived control over scheduling of shifts increased (OR 3.24, 95% CI 1.73-6.06) and excessive sleepiness in connection with evening shifts decreased (OR 0.40, 95% CI 0.16-0.99) significantly with participatory scheduling. None of the other wellbeing variables showed statistically significant changes in the adjusted models. CONCLUSIONS: The proportion of long work shifts and perceived control over scheduling of shifts increased more among employees using participatory working time scheduling than among those using traditional scheduling. Otherwise, using participatory working time scheduling software had little effect on both objectively measured working hour characteristics and perceived wellbeing in comparison to traditional scheduling. The results merit confirmation in a larger sample with a longer follow-up. Tweetable abstract Participatory working time scheduling combines individual flexibility and staffing requirements in shift work.

Labor Market Participation Before and After Long-Term Part-Time Sickness Absence in Finland: A Population-Based Cohort Study.

OBJECTIVE: To examine trends in labor market participation among those with long-term part-time or long-term full-time sickness absence. METHODS: Finnish population-based cohort study including 3406 individuals with greater than 30-day part-time sickness absence in 2011 and 42,944 individuals with greater than 30-day full-time sickness absence in 2011. RESULTS: Compared to previous years, the rates of sickness absence and vocational rehabilitation increased after 2011 in both groups. Sickness absence rate was higher in 2012 in the full-time sickness absence group than in the part-time sickness absence group. An increasing trend in unemployment after 2011 was observed in both groups, but the absolute level of unemployment was higher in the full-time sickness absence group. CONCLUSION: Long-term part-time sickness absence seems to mark a decline in labor market participation, but the decline is smaller than that in employees with full-time sickness absence.