From Work Ability Research to Implementation.

Work ability research started in Finland in the 1990s due to the challenges of work force aging. The employment rates of older workers (55+) were below 40% and early retirement and work disability rates were rather common in many European countries. The work ability concept and methods were developed and broad international research activities started in the 1990s. A comprehensive promotion model for work ability was created aiming to prevent work ability from declining during aging. However, to be able to impact the work ability is a complicated and difficult task, and requires effects on human resources, work arrangements, and management. Therefore, only a limited number of intervention studies have shown an improvement of work ability during aging. This article introduces some possibilities regarding how to make work ability interventions more successful.

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.

Work-related biomechanical exposure and job strain in midlife separately and jointly predict disability after 28 years: a Finnish longitudinal study.

Objectives We investigated whether the extent of biomechanical exposures and job strain in midlife separately and jointly predict disability in old age. Methods Participants of the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 (aged 44-58 years) responded to disability questionnaires in 2009 (1850 women and 1082 men). Difficulties in performing five activities of daily living (ADL) and seven instrumental ADL (IADL) were used to assess severity of disability (score range: 0-12, 0=no disability). Information on biomechanical exposures and job strain was collected by questionnaire at baseline. Adjusted prevalence proportion ratios (PR) and 95% confidence intervals (95% CI) were modelled using mixed negative binomial regression with robust variance. The joint effect of two exposures was quantified using the concept of relative excessive risk due to interaction (RERI). Results The overall prevalence of disability (score: 1-12) was 46.7% (women: 41%; men: 57%). Compared to low-level exposures in an adjusted model, the PR of high baseline biomechanical exposures for each one unit increase in the disability score was 1.31 (95% CI 1.10-1.55) and PR of high job strain was 1.71 (95% CI 1.26-2.32). Associations were rather similar in gender-stratified analyses. Furthermore, the joint effect (high strain/high biomechanical) was multiplicative (women: PR 1.32, 95% CI 1.21-1.45; men: PR 1.27, 95% CI 1.13-1.44), but no additive effect was observed when fully adjusted. Conclusion High biomechanical exposure and job strain in midlife were strongly associated with the severity of disability in later life. The workplace could serve as arena for preventive interventions regarding disability in old age.

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.

Examining the factorial structure, measurement invariance and convergent and discriminant validity of a novel self-report measure of work ability: work ability--personal radar.

For identification of groups and domains for work ability promotion, brief self-report measure, work ability - personal radar (WA-PR), based on the 'the house of work ability' model is presented and psychometrically evaluated in the structural equation framework using data from technological sector (N = 3754). The house model had acceptable fit to the data. In addition, factor loadings in the model were invariant across groups, demonstrating metric invariance of the WA-PR. Scalar invariance of WA-PR was fully demonstrated across men and women, and partially demonstrated across age and employee groups. Comparisons between groups revealed lower levels of health and functional capacity, but higher levels of four other WA-PR dimensions in older employees. In addition, all house structures showed convergence with alternative work ability measures. WA-PR demonstrated potential for effective measurement of multiple work ability dimensions from employees' perspective. It provides means for efficient location of relevant domains and focus groups for work ability promotion. PRACTITIONER SUMMARY: A novel approach to multidimensional work ability measurement was developed to tackle the challenges of work ability promotion. The properties of the instrument were psychometrically evaluated in structural equation modelling framework. Instrument demonstrated potential for locating relevant domains and focus groups for work ability promotions at workplaces and organisations.

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.

Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study.

The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44-58 years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30-70 % for having one more mobility limitation during the following 28 years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20-40 %) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.

Inverse effects of midlife occupational and leisure time physical activity on mobility limitation in old age--a 28-year prospective follow-up study.

OBJECTIVES: To evaluate in a sample of initially middle-aged municipal employees whether leisure time (LPA) or occupational physical activity (OPA) was associated with mobility limitation (ML) in old age. DESIGN: Prospective population-based follow-up. SETTING: Municipalities in Finland. PARTICIPANTS: Public sector employees from the Finnish Longitudinal Study on Municipal Employees (FLAME) initially aged 44 to 58 (N = 5,200). MEASUREMENTS: Baseline data were collected in 1981, including LPA (average exercise within previous year: inactive (no exercise), moderate (some form of exercise ≤ 1 time per week), vigorous (brisk exercise ≥ 1 time per week)) and OPA (usual activities at work within previous year: light (light work sitting, standing, or moving around), moderate (moderate work moving around), vigorous (heavy physical work)). Number of MLs was assessed using a questionnaire (8 items) in 1985, 1992, 1997, and 2009; the latest mobility score available for each subject was used for analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for LPA and OPA predicting ML were estimated in a joint Poisson regression model adjusted for survival data; the other type of PA; and sociodemographic, socioeconomic, and health-related factors. RESULTS: Mean age at baseline was 50.3 ± 3.6; 56.9% of participants were female. Participants with vigorous OPA in midlife had greater risk of a unit increase in ML in old age than those with light OPA (fully adjusted IRR = 1.09, 95% CI = 1.03-1.16). Participants with vigorous LPA had lower risk of ML than inactive participants (fully adjusted IRR = 0.81, 95% CI = 0.76-0.86). CONCLUSION: Findings suggest that LPA and OPA in midlife have independent, inverse effects on mobility in old age in terms of a harmful effect of vigorous OPA and a protective effect of vigorous LPA.

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.

Perceived stress symptoms in midlife predict disability in old age: a 28-year prospective cohort study.

BACKGROUND: Stress has damaging effects on individual's health. However, information about the long-term consequences of mental stress is scarce. METHODS: This 28-year prospective cohort study examined on the associations between midlife stress and old age disability among 2,994 Finnish municipal professionals aged 44-58 years at baseline. Self-reported stress symptoms were assessed at baseline in 1981 and 4 years later in 1985 and perceived disability in 2009. For the baseline data, principal component analysis was used for differentiation into stress symptom profiles. The regression coefficient estimates for self-care disability (activities of daily living) and instrumental activities of daily living disability were estimated using left-censored regression. The odds ratios for mobility limitation were estimated using logistic regression. RESULTS: Four midlife stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. We saw a clear gradient of increasing disability severity in old age for increasing intensity of midlife stress symptoms. In comparison with the participants with no stress symptoms, the extensively adjusted left-censored and logistic regression models showed that in old age, disability scores were almost 2-4 units higher and risk for mobility limitation was 2-3 times higher for those with constant stress symptoms in midlife. CONCLUSIONS: Among occupationally active 44- to 58-year-old men and women, perceived stress symptoms in midlife correlated with disability 28 years later. Stress symptoms may be the first signs of decompensation of individual functioning relative to environmental demands, which may later manifest in disabilities.

Job strain among blue-collar and white-collar employees as a determinant of total mortality: a 28-year population-based follow-up.

OBJECTIVES: To investigate the effect of job demand, job control and job strain on total mortality among white-collar and blue-collar employees working in the public sector. DESIGN: 28-year prospective population-based follow-up. SETTING: Several municipals in Finland. PARTICIPANTS: 5731 public sector employees from the Finnish Longitudinal Study on Municipal Employees Study aged 44-58 years at baseline. OUTCOMES: Total mortality from 1981 to 2009 among individuals with complete data on job strain in midlife, categorised according to job demand and job control: high job strain (high job demands and low job control), active job (high job demand and high job control), passive job (low job demand and low job control) and low job strain (low job demand and high job control). RESULTS: 1836 persons died during the follow-up. Low job control among men increased (age-adjusted HR 1.26, 95% CI 1.12 to 1.42) and high job demand among women decreased the risk for total mortality HR 0.82 (95% CI 0.71 to 0.95). Adjustment for occupational group, lifestyle and health factors attenuated the association for men. In the analyses stratified by occupational group, high job strain increased the risk of mortality among white-collar men (HR 1.52, 95% CI 1.09 to 2.13) and passive job among blue-collar men (HR 1.28, 95% CI 1.05 to 1.47) compared with men with low job strain. Adjustment for lifestyle and health factors attenuated the risks. Among white-collar women having an active job decreased the risk for mortality (HR 0.78, 95% CI 0.60 to 1.00). CONCLUSION: The impact of job strain on mortality was different according to gender and occupational group among middle-aged public sector employees.

Work ability as a determinant of old age disability severity: evidence from the 28-year Finnish Longitudinal Study on Municipal Employees.

BACKGROUND AND AIMS: Lower occupational class correlates with a higher disability risk later in life. However, it is not clear whether the demands made by mental and physical work relative to individual resources in midlife predict well-being in old age. This study investigated prospectively whether work ability in midlife predicts disability severity in activities of everyday living in old age. METHODS: Data come from the population-based 28-year follow-up called Finnish Longitudinal Study of Municipal Employees. A total of 2879 occupationally active persons aged 44-58 years answered a questionnaire on work ability at baseline in 1981 and activities of daily living in 2009. At baseline, perceived work ability relative to lifetime best was categorized into excellent, moderate, and poor work ability. At follow-up, disability scales were constructed based on the severity and frequency of difficulties reported in self-care activities of daily living (ADL) and instrumental activities of daily living (IADL). RESULTS: There was a graded prevalence of ADL and IADL disability severity, according to excellent, moderate and poor midlife work ability (p<0.001). Employees with moderate midlife work ability had an 11 to 20% higher mean ADL or IADL disability severity score, compared with those with excellent midlife work ability (reference), incidence rate ratios (IRR) ranging from 1.11 (95% CI 1.01-1.22) to 1.20 (95% CI 1.10-1.30). Those with poor midlife work ability had a mean ADL or IADL disability severity score 27 to 38% higher than the referent, IRRs ranging from 1.27 (95% CI 1.09-1.47) to 1.38 (95% CI 1.25-1.53). Adjusting for socio-economics, lifestyle factors and chronic diseases only slightly attenuated the associations. CONCLUSIONS: Work ability, an indicator of the de- mands made by mental and physical work relative to individuals' mental and physical resources, predicted disability severity 28 years later among middle-aged municipal employees.

Work strain in midlife and 28-year work ability trajectories.

OBJECTIVES: We investigated the 28-year development trajectories of work ability among initially middle-aged male and female municipal employees and the association of perceived mental and physical work strain in midlife by work ability trajectory groups. METHODS: The baseline data of the Finnish longitudinal study of municipal employees (FLAME) were collected in 1981 (N=6257) with follow-ups in 1985, 1992, 1997, and 2009. Work ability was assessed in all the waves as present perceived work ability relative to lifetime best. Altogether, N=2690 had work ability data in 1981 and 2009, and at least for one wave in between these years, and were included in group-based semi-parametric mixture modeling trajectory analyses. Baseline differences in mental and physical work strain according to the work ability trajectories were assessed with MANCOVA (multivariate analysis of covariance). RESULTS: A five-group work ability trajectory model was identified for men and a four-group model for women. For the majority, a linear decline from excellent to moderate or moderate to poor work ability was observed while non-linear trajectories with sudden collapse and, in some cases, modest subsequent recovery of work ability were also observed. Individuals who maintained their work ability on an excellent-to-moderate level throughout the follow-up more often reported low mental and physical work strain in midlife. CONCLUSIONS: A substantial proportion of individuals seem to maintain their work ability on a moderate level from midlife to old age. Work strain may have far-reaching negative effects on individuals' work ability from midlife to old age, warranting vigilance in maintaining and promoting work ability throughout the lifespan.

Work ability in midlife as a predictor of mortality and disability in later life: a 28-year prospective follow-up study.

BACKGROUND: Poor work ability correlates with increased morbidity and early retirement from the workforce, but the association in old age is not known. We investigated work ability in midlife among white-collar and blue-collar employees as a predictor of mortality and disability 28 years later. METHODS: A total of 5971 occupationally active people aged 44-58 years participated in the Finnish Longitudinal Study of Municipal Employees (FLAME) in 1981. Perceived work ability relative to lifetime best was categorized as excellent, moderate or poor. In 2009, the ability to perform activities of daily living was assessed among 2879 respondents (71.0% of the survivors). Mortality data were available up to July 2009. RESULTS: At the 28-year follow-up, 1918 of the 5971 participants had died and 1403 had some form of disability. Rates of death per 1000 person-years among white-collar men were 7.7 for those with excellent work ability, 14.7 for those with moderate work ability and 23.5 for those with poor work ability. Among blue-collar men, the corresponding rates were 15.5, 20.2 and 25.3. In women, rates ranged between 6.3 and 10.6 per 1000 person-years. The age-adjusted hazard ratios (HRs) for mortality were two to three times higher among blue-collar male employees with lower work ability than among white-collar male employees with excellent work ability in midlife (i.e., the reference group). The odds of death or disability at follow-up compared with white-collar workers with excellent work ability were highest among blue-collar employees with poor work ability in midlife (odds ratio [OR] 4.56, 95% confidence interval [CI] 2.82-7.37 for men; OR 3.37, 95% CI 2.28-4.98 for women). Among the survivors, similar but slightly lower risks of disability 28 years later were found. INTERPRETATION: Perceived poor work ability in midlife was associated with accelerated deterioration in health and functioning and remains evident after 28 years of follow-up.

Strategic wellness management in Finland: The first national survey of the management of employee well-being.

OBJECTIVES: To examine the scope of strategic wellness management (SWM) in Finland. To measure management of wellness a strategic wellness management index (SWMI) was developed. METHODS: On the basis of the developed SWM model an Internet questionnaire was conducted for randomly selected employers representing seven business areas and three size categories. Corporate activities and SWMI for each employer and for business area and size groups were calculated. RESULTS: Results highlighted relatively good activity in strategic wellness (SW) processes and fairly low level of SWM procedures. The average values (± SD) of SWMI were 53.6 ± 12.3 for large, 42.8 ± 11.7 for medium-size, and 32.8 ± 12.1 for small companies. CONCLUSIONS: SWMI can be a positive new, strong concept to measure SW processes and thus improve both the well-being of the employees and the productivity of the enterprise.

Work ability and musculoskeletal disorders among workers from a public health institution.

OBJECTIVE: The study investigated the associations between diagnosed musculoskeletal disorders (MSD), work ability and demographics, work and lifestyle characteristics in a public health institution with a variety of occupations. METHODS: A cross-sectional study was carried out in a public health institution in Brazil. The subjects (n = 168) aged 20-69 answered a questionnaire on demographics, work, lifestyle characteristics and the work ability index. RESULTS: A univariate regression analysis was carried out with the presence of MSD as a dependent variable. Association was found in relation to the age group, type of work demand, tenure at the institution, body mass index, work in the nutrition and laundry sectors, being a maid in the previous job, auxiliary service and auxiliary maintenance occupations, work ability in relation to physical and mental demands, estimated work impairment due to diseases, sick leave in the past year, own prognosis of work ability in 2 years' time and mental resources: enjoying daily activities, being active and alert, being full of hope for the future. CONCLUSION: The presence of MSD affected several aspects of work ability.

Evaluating work ability and quality of life for clinical nurses in Taiwan.

This study investigated the work ability and its relationship with quality of life for the clinical nurses in Taiwan. The survey was of 1534 nursing professionals from 8 different hospitals. Work ability of nursing professionals varied by age, work experience, working departments and hospital types. Work ability of nurses increased with age until after the age of 45. Personal health condition and physical workload were the main factors contributing to the decline of the perceived work ability for senior nurses. For young nurses, the mental demands of work were a critical influence on their work ability. Moreover, work ability of nurses varied among hospital type and department. The work ability of nurses was strongly associated with the quality and safety of the work environment and leisure time management. For improving and maintaining the work ability of nurses, countermeasures such as enhancing the ability to cope with the job's mental demands for young nurses, and improving the job design to reduce physical workload for senior nurses are recommended.