Shift work with and without night shifts and breast cancer risk in a cohort study from Finland.

OBJECTIVES: To examine the association of shift work with and without night work with breast cancer among women in the public sector. METHODS: Using the Finnish Public Sector cohort study (N=33 359, mean age of 40.6 years at baseline), we investigated the associations of shift work and potential confounders with incident breast cancer. Exposure to permanent day work or shift work was defined from first two consecutive surveys from 2000, 2004, 2008 or 2012 and past information on exposure in a subcohort (n=20 786). Incident cases of breast cancer (n=1129) were retrieved from the National Cancer Register and the cohort members were followed to the end of 2016. HR and 95% CI from Cox proportional hazard regression models were calculated. RESULTS: Shift work with and without night shifts was not overall associated with breast cancer. When stratified according to age, both shift work without nights (HR 2.01, 95% CI 1.12 to 3.60) and shift work with nights (OR 2.05, 95% CI 1.04 to 4.01) were associated with an increased risk after a period of 10 years or more follow-up among women aged 50 years or older, when adjusted for age, socioeconomic status, children, smoking, alcohol and body mass index. In a subgroup with past information on exposure to shift work, the increased risk by longer exposure to shift work was not significant. CONCLUSIONS: This study provides support for an increased risk of breast cancer among elderly shift workers. However, insufficient information on exposure and intensity of night work may attenuate the risk estimates.

Association of rotating shift work schedules and the use of prescribed sleep medication: A prospective cohort study.

We examined whether working rotating shifts, with or without night work, is associated with the purchase of prescribed sleep medication, and whether the association is dependent on age. Data were obtained from a longitudinal cohort study of Finnish public sector employees who responded to questions on work schedule and background characteristics in 2000, 2004 and 2008. The data were linked to national register data on redeemed prescriptions of hypnotic and sedative medications, with up to 11 years of follow-up. Age stratified Cox proportional hazard regression models were computed to examine incident use of medication comparing two groups of rotating shift workers (those working shifts that included night shifts and those whose schedules did not include night shifts) with day workers who worked in a similar range of occupations. Shift work with night shifts was associated with increased use of sleep medication in all age groups, after adjustments for sex, occupational status, marital status, alcohol consumption, smoking and physical activity levels (hazard ratio [HR], [95% confidence interval, CI] 1.14 [1.01-1.28] for age group ≤39 years; 1.33 [1.19-1.48] for age group 40-49 years; 1.28 [1.13-1.44] for age group ≥50 years). Shift work without nights was associated with medication use in the two older age groups (HR [95% CI] 1.14 [1.01-1.29] and 1.17 [1.05-1.31] for age groups 40-49 years and >50 years, respectively). These findings suggest that circadian disruption and older age puts rotating shift workers, and especially those who work nights, at increased risk of developing clinically significant levels of sleep problems.

Ageing shift workers' sleep and working-hour characteristics after implementing ergonomic shift-scheduling rules.

We studied whether implementing binding ergonomic shift-scheduling rules change ageing (≥45 years) social and healthcare employees' (mean age 52.5 years, 95% women) working-hour characteristics (e.g. weekly working hours, number and length of night shifts, and short shift intervals) and sleep. We compared an intervention group (n = 253) to a control group (n = 1,234) by survey responses (baseline 2007/2008, follow-up 2012) and objective working-hour characteristics (intervention group n = 159, control group n = 379) from 91 days preceding the surveys. Changes in working-hour characteristics were analysed with repeated measures general linear models. The fully adjusted model (sociodemographics and full-/part-time work) showed that proportion of short shift intervals (<11 hr, p = .033) and weekend work (p = .01) decreased more in the intervention than in the control group. Changes in sleep outcomes were analysed with generalised logit model to binomial and multinomial variables. The fully adjusted model (sociodemographics, full-/part-time work, job strain, health behaviours, and perceived health) revealed higher odds in the intervention group for long sleep (≥9 hr; odds ratio [OR] 5.53, 95% confidence interval [CI] 2.21-13.80), and lower odds of short sleep (<6 hr; OR 0.72, 95% CI 0.57-0.92), having at least two sleep difficulties often (OR 0.55, 95% CI 0.43-0.70), and more specifically difficulties in falling asleep (OR 0.56, 95% CI 0.41-0.77), waking up several times per night (OR 0.43, 95% CI 0.34-0.55), difficulties in staying asleep (OR 0.64, 95% CI 0.49-0.82), and non-restorative sleep (OR 0.70, 95% CI 0.54-0.90) than the control group. In conclusion, implementation of ergonomic shift-scheduling rules resulted in minor changes in ageing employees' objective working hours and a consistent buffering effect against worsening of sleep.

Association of work-time control with sickness absence due to musculoskeletal and mental disorders: An occupational cohort study.

OBJECTIVES: Work-time control is associated with lower sickness absence rates, but it remains unclear whether this association differs by type of diagnosis and sub-dimension of work-time control (control over daily hours and control over time off) and whether certain vulnerable groups benefit more from higher levels of work-time control. METHODS: Survey data from the Finnish 10-town study in 2004 were used to examine if baseline levels of work-time control were associated with register data on diagnose-specific sickness absence for 7 consecutive years (n = 22 599). Cox proportional hazard models were conducted, adjusted for age, sex, education, occupational status, shift work including nights, and physical/mental workload. RESULTS: During follow-up, 2,818 individuals were on sick leave (≥10 days) due to musculoskeletal disorders and 1724 due to mental disorders. Employees with high (HR = 0.80, 95% CI 0.74-0.87; HR = 0.76, 95% CI 0.70-0.82, respectively) and moderate (HR = 0.83, 95% CI 0.77-0.90; HR = 0.85, 95% CI 0.79-0.91, respectively) levels of control over daily hours/control over time off had a decreased risk of sickness absence due to musculoskeletal disorders. Sub-group analyses revealed that especially workers who were older benefitted the most from higher levels of work-time control. Neither sub-dimension of work-time control was related to sickness absence due to mental disorders. CONCLUSIONS: Over a 7-year period of follow-up, high and moderate levels of work-time control were related to lower rates of sickness absence due to musculoskeletal disorders, but not due to mental disorders.

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.

Associations between shift work and use of prescribed medications for the treatment of hypertension, diabetes, and dyslipidemia: a prospective cohort study.

Objective This study examined the associations between shift work and use of antihypertensive, lipid-lowering, and antidiabetic medications. Methods Survey data from two cohorts of Finnish men (N=11 998) and women (N=49 944) working in multiple occupations where shift work was used were linked to national Drug Prescription Register data, with up to 11 years of follow-up. In each cohort, age-stratified Cox proportional hazard regression models were computed to examine any incident use of prescription medication for each of the three medical conditions, separately comparing each of two groups of rotating shift workers (those whose schedules included night shifts, and those whose schedules did not include night shifts) with day workers who worked in a similar range of occupations. Results In the larger cohort, among participants aged 40-49 at baseline, shift work without night shifts was associated with increased use of type-2 diabetes medication after adjustments for sex, occupational status, marital status, alcohol consumption, smoking, and physical activity [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.01-1.62], while shift work with night shifts was associated with increased use of dyslipidemia medication after adjustments (HR 1.33, 95% CI 1.12-1.57). There were no such associations among younger and older shift workers. Also in the larger cohort, among those aged <50 years at baseline, both types of shift work were associated with increased use of hypertension medication after adjustments [up to HR 1.20 (95% CI 1.05-1.37)]. There were no positive associations in the smaller cohort. Conclusions There was mixed evidence regarding the use of medications for cardiovascular risk factors by shift workers. Selection effects may have affected the associations.

Shift work with and without night work as a risk factor for fatigue and changes in sleep length: A cohort study with linkage to records on daily working hours.

We examined shift work with or without night work as a risk factor for fatigue and short or long sleep. In a prospective cohort study with 4- and 6-year follow-ups (the Finnish Public Sector study), we linked survey responses of 3,679 full-time hospital employees on sleep duration and fatigue to records on daily working hours in 2008 (baseline), 2012 and 2014. We used logistic regression to estimate risk ratios and their confidence intervals to examine whether continuous exposure to shift work or changes between shift work and day work were associated with short (≤6.5 hr) or long (≥9.0 hr) sleep over 24 hr and fatigue at work and during free days. Compared with continuous day work and adjusting for age, gender, education and fatigue/sleep duration at baseline, continuous shift work with night shifts was associated with increased fatigue during free days (risk ratio = 1.38, 95% confidence interval 1.17-1.63) and long sleep (risk ratio = 8.04, 95% confidence interval 2.88-22.5, without adjustment for education) after 6-year follow-up. Exposure to shift work without night shifts increased only long sleep after 6 years (risk ratio = 5.87, 95% confidence interval 1.94-17.8). A change from day work to shift work with or without night shifts was associated with an increased risk for long sleep, and a change from shift work to day work with a decreased risk for long sleep and fatigue. This study suggests that irregular shift work is a modifiable risk factor for long sleep and increased fatigue, probably reflecting a higher need for recovery.

Employee control over scheduling of shifts and objectively measured working hour characteristics: a cross-sectional analysis of linked register and survey data.

We aimed to study the association of perceived control over scheduling of shifts with objectively measured working hour characteristics in shift workers. The participants were 5128 hospital employees (91% women, 85% nursing personnel, average age 43 years) in period-based work (114:45h/3 weeks) from the 2015 Finnish Public Sector study. Survey responses to a measure of control over scheduling of shifts were linked to payroll data on working hour characteristics during the 91 days preceding the survey. We used multinomial logistic regression to assess differences in dichotomized proportion of working hour characteristics (being full-time worker, number of work shifts, long work weeks (>40h and >48h/week), long work shifts (>12-h), evening and night shifts, quick returns (<11h shift interval), single days off, weekend work, >4 consecutive work shifts, and variability of shift length with cut points at 10% or 25% between employees with high, intermediate, or low control over scheduling of shifts. Analyses were adjusted for age, sex, education, full-/part-time work (where applicable), duration of shift work experience, perceived work ability, children < 18 years in the household, and overall stressfulness of the life situation. Differences between age groups, men and women, and levels of work ability were examined using interaction terms. In adjusted analyses, the proportion of full-time workers was lower among employees with intermediate control over scheduling of shifts compared to those with high control (OR 0.78, 95% CI 0.61-0.98). High proportion (>25%) of weekend work was lower among employees with low control over scheduling of shifts compared to high control (OR 0.75, 95% CI 0.61-0.93). High proportion (>25%) of having >4 consecutive work shifts was associated with lower control over scheduling of shifts (OR 1.35, 95% CI 1.13-1.62). Variability of shift length was lower among employees with intermediate and low control over scheduling of shifts compared to those with high control (OR 0.78, 95% CI 0.66-0.93; OR 0.62, 95% CI 0.51-0.75, respectively). No association was observed between the level of control over scheduling of shifts and high proportion of long work weeks (>25% of >40h weeks and >10% of >48h weeks), long work shifts (>25%), quick returns (>25%), single days off (>25%), and evening or night shifts (>10%) in the whole sample. In subgroup analyses, women with low control over scheduling shifts had lower odds ratio (OR 0.58, 95% CI 0.37-0.91) and men had higher odds ratio (OR 2.97, 95% CI 1.26-6.98) for large proportion of >12-h shifts. In conclusion, the employees with high control over scheduling of shifts had slightly more often unsocial working hour characteristics than those with intermediate or low control over scheduling of shifts. The findings, however, suggest that good work time control in shift work can be possible without compromising shift ergonomics.

Permanent night workers´ sleep and psychosocial factors in hospital work. A comparison to day and shift work.

We aimed to study whether permanent night workers sleep and psychosocial factors differ from day workers and shift workers. The participants (n = 9 312, 92% females, average age 45 years, most commonly nurses and departmental secretaries) were day workers (DW, n = 2 672), shift workers (SW, n = 6 486) and permanent night workers (PNW, n = 154). The Finnish Public Sector survey responses from six hospital districts from 2012 were combined to payroll data from 91 days preceding the survey. The data were analyzed using Pearson χ2-test, one-way ANOVA and multinomial logistic regression analysis. The PNWs reported slightly longer average sleep length than the SWs or the DWs (7:27 vs. 7:13 and 7:10 h, p < 0.001). The PNWs reported least often difficulties in maintaining sleep (p < 0.001) compared to the SWs and the DWs. The PNWs reported most often difficulties to fall asleep and fatigue during free-time (p-values <0.001). The DWs and PNWs experienced less often work-life conflict than the SWs (25 and 26 vs. 38%, p < 0.001). The PNWs were more often satisfied with autonomy at work and appreciation and fair treatment by colleagues than the DWs or the SWs (p < 0.001). The SWs and PNWs reported remarkably higher occurrence of verbal (p < 0.001, OR 3.71, 95% CI 3.23-4.27 and OR 7.67, 95% CI 5.35-10.99, respectively) and physical workplace violence (p < 0.001, OR 9.24, 95% CI 7.17-11.90 and OR 28.34, 95% CI 16.64-43.06, respectively) compared to DWs. Conclusively, PNWs reported contradictory differences in sleep quality compared to DWs and SWs. PNWs are more often satisfied with their colleagues and autonomy at work than DWs or SWs but face workplace violence remarkably more often.

Association of changes in work shifts and shift intensity with change in fatigue and disturbed sleep: a within-subject study.

Objectives The aim of this study was to examine whether changes in work shifts and shift intensity are related to changes in difficulties to fall asleep, fatigue, and sleep length. Methods Questionnaire responses of hospital employees (N=7727, 93% women) in 2008, 2012, 2014 and 2015 were linked to daily-based records of working hours during three months preceding each survey. We used conditional logistic regression and longitudinal fixed-effects analyses to investigate odds ratios (OR) and 95% confidence intervals (CI) for each 25% within-individual change in the proportion of working hour characteristics in relation to changes in fatigue, difficulties to fall asleep, and 24-hour sleep length. Results Change in night but not in morning or evening shifts was associated with parallel changes in odds for longer sleep length (OR 1.45, 95% CI 1.28-1.64) and fatigue during free days (OR 1.38, 95% CI 1.16-1.64). Similarly, short shift intervals and having >2 but not >4 consecutive night shifts were associated with increased odds of fatigue during work and difficulties to fall asleep (OR 1.42, 95% CI 1.19-1.72 and OR 1.10, 95% CI 1.05-1.19, respectively). Among workers aged ≥50 years, the associations were the strongest between night shifts and longer sleep (OR 2.24, 95% CI 1.52-3.81) and between higher proportion of short shift intervals and fatigue during free days (OR 1.68, 95% CI 1.10-2.54). Conclusions Among shift workers with fatigue or sleep problems, decreasing the proportion of night shifts and quick returns and giving preference to quickly forward-rotating shift systems may reduce fatigue.

Are changes in objective working hour characteristics associated with changes in work-life conflict among hospital employees working shifts? A 7-year follow-up.

OBJECTIVE: To investigate whether changes in objective working hour characteristics are associated with parallel changes in work-life conflict (WLC) among hospital employees. METHODS: Survey responses from three waves of the Finnish Public Sector study (2008, 2012 and 2015) were combined with payroll data from 91 days preceding the surveys (n=2 482, 93% women). Time-dependent fixed effects regression models adjusted for marital status, number of children and stressfulness of the life situation were used to investigate whether changes in working hour characteristics were associated with parallel change in WLC. The working hour characteristics were dichotomised with cut-points in less than or greater than 10% or less than or greater than25% occurrence) and WLC to frequent versus seldom/none. RESULTS: Change in proportion of evening and night shifts and weekend work was significantly associated with parallel change in WLC (adjusted OR 2.19, 95% CI 1.62 to 2.96; OR 1.71, 95% CI 1.21 to 2.44; OR 1.63, 95% CI 1.194 to 2.22, respectively). Similarly, increase or decrease in proportion of quick returns (adjusted OR 1.45, 95% CI 1.10 to 1.89) and long work weeks (adjusted OR 1.26, 95% CI 1.04 to 1.52) was associated with parallel increase or decrease in WLC. Single days off and very long work weeks showed no association with WLC. CONCLUSIONS: Changes in unsocial working hour characteristics, especially in connection with evening shifts, are consistently associated with parallel changes in WLC.

Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis.

BACKGROUND: People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES: To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS: In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA: We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS: Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS: We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS: Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.

Objective working hour characteristics and work-life conflict among hospital employees in the Finnish public sector study.

This epidemiological cohort study, based on Finnish public sector data, investigated the associations between objective working hour characteristics and work-life conflict in day and shift work. The comprehensive data of hospital workers (n = 8 931, 92% women, average age 45 years), consisted of survey responses from 2012, linked with the payroll data of working hour characteristics from 91 days preceding the survey. Logistic regression analysis was used to investigate the associations between working hour characteristics and experiencing work-life conflict often/very often. The analyses were adjusted for age (< 39, 40-49 and >50 years), sex, level of education, marital status, number of small (0-6 years) and school-aged (7-18 years) children, and the overall stressfulness of the life situation. We also conducted stratified analyses of age and sex on the basis of significant interactions. Difficulties in combining work and life were more often associated with shift work without night shifts and shift work with night shifts than with day work (41% and 34 versus 27%; OR for shift work with night shifts 1.78, 95% CI 1.59-2.00, OR for shift work without night shifts 1.42, 95% CI 1.26-1.60). A high proportion (> 25%) of long (> 40h, (OR 1.26, 95% 1.14-1.39) and very long (> 48h, OR 1.31, 95% CI 1.15-1.49) weekly working hours were associated with work-life conflict, and in the stratified analysis, the latter was also true among women (OR 1.54, 95% CI 1.25-1.89). Of the unsocial working hour characteristics, a relatively large amount (> 10% of all shifts) of evening (OR 1.56, 95% CI 1.41-1.72) and night shifts (OR 1.46, 95%CI 1.32-1.61), a high proportion (> 25% of all shifts) of quick returns (< 11h) (OR 1.46, 95% CI 1.31-1.63), and weekend work (OR 1.44, 95% CI 1.31-1.58) were associated with work-life conflict. A large amount of single days off (> 25% of all days off) was associated with work-life conflict among men (OR 1.90, 95% CI 1.11-3.25), but not in the whole sample. When the two types of shift work were analyzed separately, shift work without night shifts and very long work weeks had higher odds (OR 1.47, 95% CI 1.20-1.80) of work-life conflict than shift work with night shifts. Conversely, weekend work and evening shifts had higher odds of work-life conflict among shift workers with night shifts (OR 1.74, 95% 1.55-1.96; (OR 1.57, 95% CI 1.40-1.77) than among those without night shifts. To conclude, this study shows that shift workers with and without night shifts more often have difficulties combining work and life than day workers. Several unsocial working hour characteristics, including long work weeks, evening and night shifts, weekend work, and quick returns, are associated with work-life conflict.

Occupational Exposure to Knee Loading and the Risk of Osteoarthritis of the Knee: A Systematic Review and a Dose-Response Meta-Analysis.

BACKGROUND: Osteoarthritis of the knee is considered to be related to knee straining activities at work. The objective of this review is to assess the exposure dose-response relation between kneeling or squatting, lifting, and climbing stairs at work, and knee osteoarthritis. METHODS: We included cohort and case-control studies. For each study that reported enough data, we calculated the odds ratio (OR) per 5,000 hours of cumulative kneeling and per 100,000 kg of cumulative lifting. We pooled these incremental ORs in a random effects meta-analysis. RESULTS: We included 15 studies (2 cohort and 13 case-control studies) of which nine assessed risks in more than two exposure categories. We considered all but one study at high risk of bias. The incremental OR per 5,000 hours of kneeling was 1.26 (95% confidence interval 1.17-1.35, 5 studies, moderate quality evidence) for a log-linear exposure dose-response model. For lifting, there was no exposure dose-response per 100,000 kg of lifetime lifting (OR 1.00, 95% confidence interval 1.00-1.01). For climbing, an exposure dose-response could not be calculated. CONCLUSION: There is moderate quality evidence that longer cumulative exposure to kneeling or squatting at work leads to a higher risk of osteoarthritis of the knee. For other exposure, there was no exposure dose-response or there were insufficient data to establish this. More reliable exposure measurements would increase the quality of the evidence.

Protective determinants of sickness absence among employees with multisite pain-a 7-year follow-up.

We identified factors protective of all-cause sickness absence (SA) among subjects with multisite musculoskeletal pain (MSP). The nationally representative source sample comprised 3420 actively working Finns aged 30 to 55 in year 2000 and alive at follow-up. Pain in 18 body locations was combined into four sites (neck, low back, upper limbs, and lower limbs). The baseline prevalence of MSP (pain in ≥ 2 sites) was 32%. Baseline data on sociodemographic factors, work ability, work, health, and lifestyle were gathered by questionnaire, interview, and clinical examination and linked with national registers on all-cause SA (periods lasting ≥10 workdays) for 2002 to 2008. Based on trajectory analysis, 74% of those with MSP had a low and 26% a high probability of SA. In logistic regression analysis, younger age, male sex, and professional occupational group were inversely associated with SA. Allowing for these, good physician-assessed work ability, physically light work, possibility to adjust workday length, encouraging workplace atmosphere, no problems with working community or mental stress, normal weight, and no sleep disorders were predictive of lower SA rates (odds ratios between 0.47 and 0.70). In a final stepwise model adjusted for age, sex, and occupational group, no exposure to lifting (odds ratio 0.58, 95% confidence interval 0.39-0.85) and to repetitive hand movements (0.57, 0.39-0.83), possibility to adjust workday length (0.73, 0.53-0.99), and normal weight (0.59, 0.40-0.87) were inversely associated with SA. In conclusion, several modifiable factors related to work and lifestyle were found as predictive of lower rates of longer SA among occupationally active subjects with MSP.

Work ability index and perceived work ability as predictors of disability pension: a prospective study among Finnish municipal employees.

OBJECTIVES: We analyzed the work ability index (WAI) and its first item (work ability score, WAS) - and subsequent four-year changes thereof - as predictors of disability pension (DP). METHODS: We linked survey responses of 5251 Finnish municipal employees, aged 44-58 years, to pension and death register data until 2009. Job content (physical, mental, or mixed) was based on observation. Baseline (1981) WAI was divided into poor (<27), moderate (28-36), and good/excellent (>37) and WAS into poor (0-5), moderate (6-7), and good/excellent (8-10). Four-year changes in these scores were classified as strong decline (

Does physical or psychosocial workload modify the effect of musculoskeletal pain on sickness absence? A prospective study among the Finnish population.

AIMS: Previously, among food industry workers, multisite pain predicted sickness absence (SA) only in those with low biomechanical workload. Here we studied among a wide range of occupations whether the relationship of pain with SA was modified by the level of physical or psychosocial workload. METHODS: A nationally representative sample (Health 2000 Survey) comprised 3420 occupationally active Finns aged 30-55 years. Baseline data on musculoskeletal pain during the preceding month, strenuous work history, current physical workload, job demands, job control, support at work, lifestyle, and chronic diseases were obtained in 2000/2001 by questionnaire, interview, and clinical examination. Musculoskeletal pain in 18 body locations was combined into four sites (neck, upper limbs, low back, and lower limbs) and classified as no pain, single-site pain, and multisite pain (2-4 sites). The data were linked with information from national registers on annual SA periods lasting ≥10 workdays for 2002-2008. Negative binomial regression analysis was used. RESULTS: At baseline, one-third of the study sample reported single-site and one-third multisite pain. Allowing for gender and age, the employees with multisite pain in strata with high physical workload and high job demands tended to have the highest risk of SA, but no statistically significant interactive effects between work factors and pain were observed. Further adjustment for health-related lifestyle and chronic diseases decreased the risk estimates in all strata. CONCLUSION: We did not find evidence for significant modification by physical or psychosocial workload of the relationship between musculoskeletal pain and SA periods lasting ≥10 workdays.

Increased risk of human parvovirus B19 infection in day-care employees: a cohort study among pregnant workers during an epidemic in Finland.

BACKGROUND: Human parvovirus B19 (B19V) infection during early pregnancy increases the risk of miscarriage. Studies have inconsistently shown an elevated risk of infection among women with occupational contacts with children. Methodological differences, particularly in defining occupational exposure and in the type of reference group, may explain the conflicting findings. METHODS: This cohort study compared B19V infections in pregnant day-care employees and healthcare professionals during a B19V epidemic in Finland. Women were identified from the files of nationwide trade unions and the National Supervisory Authority for Welfare and Health. Early-pregnancy maternal B19V IgG was analysed in 3710 women, and infections were defined as seroconversions after analysing in parallel the available umbilical cord blood samples of the 847 seronegative mothers. Independently of the serological status, the actual employment during pregnancy was assessed using registered information on employment history. RESULTS: B19V infections were more common among day-care employees (22/331, 6.6%), than among those working in healthcare (12/326, 3.7%). The adjusted HRs of B19V infection, using proportional hazard regression, was 2.63 (95% CI 1.27 to 5.46) among all women and 5.59 (95% CI 1.40 to 22.4) among nulliparous women. CONCLUSIONS: Day-care employees are at an increased risk of B19V infection, which warrants preventive measures.

Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain.

BACKGROUND: Physical conditioning as part of a return to work strategy aims to improve work status for workers on sick leave due to back pain. This is the second update of a Cochrane Review (originally titled 'Work conditioning, work hardening and functional restoration for workers with back and neck pain') first published in 2003, updated in 2010, and updated again in 2013. OBJECTIVES: To assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain. Further, to assess which aspects of physical conditioning are related to a faster return to work for workers with back pain. SEARCH METHODS: We searched the following databases to March 2012: CENTRAL, MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1982), PsycINFO (from 1967), and PEDro. SELECTION CRITERIA: Randomized controlled trials (RCTs) and cluster RCTs that studied workers with work disability related to back pain and who were included in physical conditioning programmes. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies.Three studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.In 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment.For acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers).For subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18).For chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD -4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03).Physical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning. AUTHORS' CONCLUSIONS: The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research.