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BACKGROUND: Faster recovery from work may help to prevent work-related ill health. AIMS: To provide a preliminary assessment of the range and nature of interventions that aim to improve recovery from cognitive and physical work. METHODS: A scoping review to examine the range and nature of the evidence, to identify gaps in the evidence base and to provide input for systematic reviews. We searched for workplace intervention studies that aimed at enhancing recovery. We used an iterative method common in qualitative research to obtain an overview of study elements, including intervention content, design, theory, measurements, effects and cost-effectiveness. RESULTS: We found 28 studies evaluating seven types of interventions mostly using a randomized controlled study design. For person-directed interventions, we found relaxation techniques, training of recovery experiences, promotion of physical activity and stress management. For work-directed interventions, there were participatory changes, work-break schedules and task variation. Most interventions were based on the conservation of resources and affect-regulation theories, none were based on the effort-recovery theory. The need for recovery (NfR) and the recovery experiences questionnaires (REQ) were used most often. Study authors reported a beneficial effect of the intervention in 14 of 26 published studies. None of the studies that used the NfR scale found a beneficial effect, whereas studies that used the REQ showed beneficial effects. Three studies indicated that interventions were not cost-effective. CONCLUSIONS: Feasible and possibly effective interventions are available for improving recovery from cognitive and physical workload. Systematic reviews are needed to determine their effectiveness.
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Promoção da Saúde/métodos , Saúde Ocupacional , Estresse Ocupacional/prevenção & controle , Carga de Trabalho , Exercício Físico , Humanos , Doenças Profissionais/prevenção & controle , Admissão e Escalonamento de Pessoal , Terapia de Relaxamento , Estresse Psicológico/prevenção & controleRESUMO
BACKGROUND: In Finland, patient health records are structured in the same way. Patient data entries are grouped using national headings and each data entry must have at least one heading. AIMS: To determine the use of national headings for the documentation of work ability data and to gather the experience of professionals on usefulness, ease of use and usability of national headings in occupational health services (OHSs). METHODS: An electronic questionnaire and a semi-structured themed interview were used to collect data. Data were analysed using SPSS Statistics 24 and interview material was analysed by deductive content analysis using ATLAS.ti. RESULTS: A total of 359 people completed the questionnaire. Most of the work ability data were documented using the headings history, plan and current status. More than half of respondents felt that using national headings improved quality and allowed greater control. Almost all respondents thought that learning to use national headings was easy. During the interviews (n = 19), all respondents felt that use of national headings improved the quality of documentation. However, more than half stated that national headings were not well suited to documentation of work ability data. CONCLUSION: These results can be used to develop national documentation standards, as well as electronic health records, to support healthcare professionals' interactions with working-age patients. Earlier studies of national headings in OHSs were not found.
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Documentação/métodos , Registros de Saúde Pessoal , Saúde Ocupacional/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Documentação/estatística & dados numéricos , Finlândia , Humanos , Pesquisa Qualitativa , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. METHOD: We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32). CONCLUSIONS: Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.
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Transtorno Depressivo/etiologia , Estresse Ocupacional/complicações , HumanosRESUMO
AIMS: To investigate if diabetes is associated with a higher risk of occupational (workplace or commuting) injury. METHODS: Medication data from the Finnish Prescription Register were used to identify diabetes cases in 2004 in a large employee cohort (the Finnish Public Sector study). These data were linked to injury records obtained from the Federation of Accident Insurance Institutions. A total of 1020 diabetes cases (median age 52 years, range 20 to 65 years; 66% women) and their 5234 age- and sex-matched controls were followed up until 2011. Sex-stratified Cox proportional hazards models, adjusting for age, occupational status, obesity and health behaviours, were applied. Because of the small number of men in the cohort, injury types and locations were only examined among women. RESULTS: During the median follow-up of 6.7 years, 25% of the participants with diabetes (n=252) and 20% of those without (n=1051) experienced an occupational injury. The association between diabetes and injury was stronger in women than men (P=0.048). Diabetes was associated with a higher risk of workplace (hazard ratio 1.37, 95% CI 1.11 to 1.69) and commuting (hazard ratio 1.36, 95% CI 1.03 to 1.79) injury in women. With regard to different injury types and locations, diabetes was associated with bone fractures, dislocations, sprains and strains, and injuries to upper and lower extremities. In men, there was an association between insulin-treated diabetes and commuting injury (hazard ratio 3.14, 95% CI 1.52 to 6.49). CONCLUSIONS: Diabetes was associated with workplace and commuting injuries in women. Men with insulin-treated diabetes had a higher risk of commuting injuries.
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Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/etiologia , Ocupações/estatística & dados numéricos , Fatores de Risco , Local de Trabalho/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Adverse effects of antidepressants are most common at the beginning of the treatment, but possible also later. We examined the association between antidepressant use and work-related injuries taking into account the duration of antidepressant use. METHOD: Antidepressant use and work-related injuries between 2000 and 2011 were measured among 66 238 employees (mean age 43.8 years, 80% female) using linkage to national records (the Finnish Public Sector study). We analysed data using time-dependent modelling with individuals as their own controls (self-controlled case-series design). RESULTS: In 2238 individuals who had used antidepressants and had a work-related injury during a mean follow-up of 7.8 years, no increase in the risk of injury was observed in the beginning of antidepressant treatment. However, an increased injury risk was seen after 3 months of treatment (rate ratio, compared with no recent antidepressant use, 1.27, 95% confidence interval 1.10-1.48). This was also the case among those who had used only selective serotonin reuptake inhibitors (n = 714; rate ratio 1.41, 95% confidence interval 1.08-1.83). CONCLUSIONS: Antidepressant use was not associated with an increased risk of work-related injury at the beginning of treatment. Post-hoc analyses of antidepressant trials are needed to determine whether long-term use of antidepressants increases the risk of work-related injury.
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Antidepressivos/efeitos adversos , Traumatismos Ocupacionais/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Adulto JovemRESUMO
AIMS: To examine work disability trajectories among employees with and without diabetes and identify lifestyle-related factors associated with these trajectories. METHODS: We assessed work disability using records of sickness absence and disability pension among participants with diabetes and age- sex-, socio-economic status- and marital status-matched controls in the Finnish Public Sector Study (1102 cases; 2204 controls) and the French GAZEL study (500 cases; 1000 controls), followed up for 5 years. Obesity, physical activity, smoking and alcohol consumption were assessed at baseline and the data analysed using group-based trajectory modelling. RESULTS: Five trajectories described work disability: 'no/very low disability' (41.1% among cases and 48.0% among controls); 'low-steady' (35.4 and 34.7%, respectively); 'high-steady' (13.6 and 12.1%, respectively); and two 'high-increasing' trajectories (10.0 and 5.2%, respectively). Diabetes was associated with a 'high-increasing' trajectory only (odds ratio 1.90, 95% CI 1.47-2.46). Obesity and low physical activity were similarly associated with high work disability in people with and without diabetes. Smoking was associated with 'high-increasing' trajectory in employees with diabetes (odds ratio 1.88, 95% CI 1.21-2.93) but not in those without diabetes (odds ratio 1.32, 95% CI 0.87-2.00). Diabetes was associated with having multiple ( ≥ 2) risk factors (21.1 vs. 11.4%) but the association between multiple risk factors and the 'high-increasing' trajectory was similar in both groups. CONCLUSIONS: The majority of employees with diabetes have low disability rates, although 10% are on a high and increasing disability trajectory. Lifestyle-related risk factors have similar associations with disability among employees with and without diabetes, except smoking which was only associated with poorer prognosis in diabetes.
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Absenteísmo , Diabetes Mellitus/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Emprego/tendências , Estilo de Vida , Licença Médica/tendências , Adulto , Estudos de Coortes , Emprego/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pensões/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Fatores de Risco , Licença Médica/estatística & dados numéricos , Avaliação da Capacidade de TrabalhoRESUMO
BACKGROUND: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women. METHODS: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. RESULTS: During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19). CONCLUSIONS: Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.
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Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Estresse Psicológico , Progressão da Doença , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Risco , Índice de Gravidade de Doença , População BrancaRESUMO
BACKGROUND: Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses. OBJECTIVES: To examine the association between job strain and body mass index (BMI) in a large adult population. METHODS: We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222). RESULTS: A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up. CONCLUSIONS: In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.
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Índice de Massa Corporal , Emprego/psicologia , Sobrepeso/epidemiologia , Sobrepeso/psicologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/psicologia , Razão de Chances , Aumento de PesoRESUMO
BACKGROUND: Mild therapeutic hypothermia (TH) improves survival after out-of-hospital cardiac arrest (OHCA). This treatment was implemented in most Finnish intensive care units (ICUs) in 2003. The aim of this study was to find out whether hospital mortality of ICU-treated OHCA patients has changed in the era of TH. METHODS: This was a retrospective study of data collected prospectively into the database of the Finnish Intensive Care Consortium during the years 2000-2008. The study population consisted of 3958 patients for whom cardiac arrest was registered as the reason for ICU admission and who were transferred to the ICU from the emergency department. We divided the patients into those treated in the pre-hypothermia era (2000-2002) and those treated in the hypothermia era (2003-2008). We investigated whether the treatment period had any impact on hospital mortality. RESULTS: There were no differences between the periods regarding the age or initial Glasgow Coma Scores of the patients. Mean severity of illness was higher in the latter period. Despite this, mortality decreased: the hospital mortality rate was 57.9% in 2000-2002 and 51.1% in 2003-2008, P < 0.001. In a multivariate logistic regression analysis, treatment in 2003-2008 was associated with a reduced risk of in-hospital death (adjusted odds ratio 0.54, 95% confidence interval 0.45-0.64 and P < 0.001). Survival improved markedly between the years 2002 and 2003. This improvement has persisted, but there has been no further improvement. CONCLUSION: Concurrently with the implementation of TH, hospital mortality of OHCA patients treated in Finnish ICUs decreased.
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Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Intervalos de Confiança , Cuidados Críticos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: This study examined whether asthma alone or together with chronic comorbidity is associated with an increased risk of long-term work disability. METHODS: We examined data from 2332 asthmatic and 66 354 nonasthmatic public sector employees in Finland who responded to a survey between 1997 and 2004. Respondents were coded as persistent asthmatics based on the special reimbursement for continuous asthma medication by the Social Insurance Institution. Data on long-term work disability (sickness absences or disability pensions > 90 days) were obtained from national registers. The risk of work disability was examined by Cox proportional hazard models adjusted for age, gender, socioeconomic status, type of employment contract, and type of employer. RESULTS: Asthma increased the risk of all-cause long-term work disability with hazard ratio (HR) 1.8 (95% CI 1.62-2.09) compared with controls (no asthma). Asthma and one other chronic comorbidity increased the risk of long-term all-cause work disability with HR 2.2 (95% CI 1.78-2.83). Asthma together with two or more other chronic conditions increased the risk with HR 4.5 (95% CI 2.98-6.78). Asthma and depression increased the risk with HR 3.6, and the risk was especially high for permanent work disability (HR 6.8). Among those with asthma, there were more women, obese individuals (BMI ≥ 30), ex-smokers, and lower-grade nonmanual workers. CONCLUSIONS: Asthma is associated with an increased risk of long-term all-cause work disability. The risk increases further with chronic comorbidities and is especially high in patients with asthma and depression.
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Absenteísmo , Asma/epidemiologia , Pessoas com Deficiência , Adulto , Estudos de Coortes , Comorbidade , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
The aim is to examine whether characteristics of social relationships predict extended employment beyond the pensionable age among Finnish public sector workers. The study population consisted of 4014 participants (83% women, age 62.56 ± 1.21) of the Finnish Retirement and Aging Study followed between 2014 and 2019. Extended employment was defined as the difference between actual retirement date and individual age-related pensionable date and classified into three groups: no extension (retired on pensionable age or extended by < 3 months), short extension (3 months-< 1 year), and long extension (≥ 1 year) beyond the pensionable date. Characteristics of social relationships and engagement were assessed 18 months prior to the pensionable date. Social engagement was classified into consumptive social participation, formal social participation, informal social participation, and other social participation. Data were analyzed using multinomial regression analysis. Of total study participants, 17.8% belonged to short- and 16.5% belonged to long-extension group. Adjusted for age, occupational status, self-rated health and depression, and having a working spouse (OR 2.34, 95% CI 1.39-3.95) were associated with long extension of employment beyond the pensionable age when compared to no extension among men. Likewise, among women, living alone (OR 1.60, 95% CI 1.28-2.00), having a working spouse (1.85, 1.39-2.45), and high consumptive (1.32, 1.07-1.65), high formal (1.47, 1.17-1.85), and other social participation (0.79, 0.63-0.98) were associated with long extension. Having a working spouse, living alone, and high consumptive social participation were associated with short extension. Several characteristics of social relationships, such as having a working spouse, living alone, and high frequency of social engagement, predicted an extension of employment beyond the pensionable age. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10433-021-00603-z.
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Selection for different fitness optima between sexes is supposed to operate on several traits. As fitness-related traits are often energetically costly, selection should also act directly on the energetics of individuals. However, efforts to examine the relationship between fitness and components of the energy budget are surprisingly scarce. We investigated the effects of basal metabolic rate (BMR, the minimum energy required for basic life functions) and body condition on long-term survival (8 winter months) with manipulated densities in enclosed populations of bank voles (Myodes glareolus). Here, we show that survival selection on BMR was clearly sex-specific but density-independent. Both the linear selection gradient and selection differential for BMR were positive in females, whereas survival did not correlate with male characteristics. Our findings emphasize the relative importance of individual physiology over ecological factors (e.g. intra-specific competition). Most current models of the origin of endothermy underline the importance of metabolic optima in females, whose physiology evolved to fulfil demands of parental provisioning in mammals. Our novel findings of sex-specific selection could be related to these life history differences between sexes.
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Arvicolinae/fisiologia , Metabolismo Energético/fisiologia , Estações do Ano , Seleção Genética/fisiologia , Animais , Feminino , Masculino , Densidade Demográfica , Análise de Regressão , Fatores Sexuais , Análise de SobrevidaRESUMO
OBJECTIVE: To study the effect of a preventive vocationally oriented intervention on rates of sickness absence and disability pension in employees considered to be at risk of future work disability. DESIGN: An observational register-based study of public sector employees. SUBJECTS: 2236 intervention programme participants and 8944 matched controls were followed up for 8 years. METHODS: Multidisciplinary intervention was carried out at rehabilitation institutions. Data on demographics and sickness absences were obtained from employers' records and information about health at baseline, participation in the intervention and subsequent disability pension from national registers. RESULTS: Before the intervention participants had 17% more annual sick leave days and a 23% higher rate of absence spells lasting >21 days than controls. In the intervention year and 3 subsequent years, the sickness absence rate among participants reduced to that observed among controls but thereafter increased to the pre-intervention level (p for curvilinear trend <0.001 for absence days and 0.03 for absence spells). The association between the intervention and future disability pension was non-proportional among participants. Compared to controls, risk among participants was lower in the first 4 years of follow-up but thereafter returned to the previous higher level. The temporary decline in sickness absence attributable to the intervention totalled 6673 absence days per 1000 employees and the cumulative reduction in disability was 56.4 years. These direct health benefits may not fully cover the costs of the intervention. CONCLUSION: The risk of work disability can be temporarily reduced in employees at risk by means of a vocationally oriented multidisciplinary intervention programme.
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Reabilitação Vocacional , Aposentadoria/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pensões/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Medição de Risco , Licença Médica/tendênciasRESUMO
OBJECTIVE: The aim of this prospective study was to examine the link between individual and ecological workplace social capital and the co-occurrence of adverse lifestyle risk factors such as smoking, heavy drinking, physical inactivity and overweight. METHODS: Data on 25 897 female and 5476 male public sector employees were analysed. Questionnaire surveys conducted in 2000-2002 (baseline) and 2004-2005 (follow-up) were used to assess workplace social capital, lifestyle risk factors and other characteristics. Multilevel multinomial logistic regression analysis was used to examine associations between individual and ecological social capital and the co-occurrence of lifestyle risk factors. RESULTS: In the cross-sectional analysis adjusted for age, sex, marital status and employer, low social capital at work at both the individual and ecological level was associated with at least a 1.3 times higher odds of having more than two lifestyle risk factors versus having no risk factors. Similar associations were found in the prospective setting. However, additional adjustment for the co-occurrence of risk factors and socioeconomic status at baseline attenuated the result to non-significant. CONCLUSION: Social capital at work seems to be associated with a lowered risk of co-occurrence of multiple lifestyle risk factors but does not clearly predict the future risk of this co-occurrence.
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Estilo de Vida , Setor Público/estatística & dados numéricos , Meio Social , Local de Trabalho/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Métodos Epidemiológicos , Exercício Físico/fisiologia , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fumar/epidemiologia , Fatores Socioeconômicos , Local de Trabalho/estatística & dados numéricos , Adulto JovemRESUMO
AIMS: To examine whether job strain (ie, excessive demands combined with low control) is related to smoking cessation. METHODS: Prospective cohort study of 4928 Finnish employees who were baseline smokers. In addition to individual scores, coworker-assessed work unit level scores were calculated. A multilevel logistic regression analysis, with work units at the second level, was performed. RESULTS: At follow-up, 21% of baseline smokers had quit smoking. After adjustment for sex, age, employer and marital status, elevated odds ratios (ORs) for smoking cessation were found for the lowest vs the highest quartile of work unit level job strain (OR 1.43, 95% CI 1.17 to 1.75) and for the highest vs the lowest quartile of work unit level job control (OR 1.61, 95% CI 1.31 to 1.96). After additional adjustment for health behaviours and trait anxiety, similar results were observed. Further adjustment for socioeconomic position slightly attenuated these associations, but an additional adjustment for individual strain/control had little effect on the results. The association between job strain and smoking cessation was slightly stronger in light than in moderate/heavy smokers. The results for individual job strain and job control were in the same direction as the work unit models, although these relationships became insignificant after adjustment for socioeconomic position. Job demands were not associated with smoking cessation. CONCLUSIONS: Smoking cessation may be less likely in workplaces with high strain and low control. Policies and programs addressing employee job strain and control might also contribute to the effectiveness of smoking cessation interventions.
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Doenças Profissionais/psicologia , Abandono do Hábito de Fumar/psicologia , Estresse Psicológico/psicologia , Local de Trabalho/psicologia , Adulto , Métodos Epidemiológicos , Feminino , Finlândia/epidemiologia , Humanos , Controle Interno-Externo , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Setor Público , Fumar/epidemiologia , Fumar/psicologia , Classe Social , Estresse Psicológico/epidemiologiaRESUMO
BACKGROUND: Social workers have an elevated risk for mental disorders, but little is known about their antidepressant treatment. AIMS: To examine any and long-term antidepressant treatment among social workers in Finland, Sweden and Denmark. METHODS: We linked records from drug prescription registers to three prospective cohorts: the Finnish Public Sector study, years 2006-2011, and nation-wide cohorts in Sweden and Denmark, years 2006-2014, including a total of 1.5 million employees in (1) social work, (2) other social and health care professions, (3) education and (4) office work. We used Cox proportional hazards models to estimate hazard ratios for any and long-term (>6 months) antidepressant treatment among social workers compared to the three reference occupational groups and carried out meta-analyses. RESULTS: During follow-up, 25% of social workers had any prescriptions for antidepressants (19-24% reference occupations) and 20% for long-term treatment (14-19% reference occupations). The pooled effects for any and long-term treatment showed that probabilities were 10% higher in social workers compared to other health and social care professionals and 30% higher compared to education and non-human service professionals. Probabilities for any treatment in the three countries were relatively similar, but for long-term treatment social workers in Finland had a greater risk compared with other human service professions. LIMITATIONS: There were differences between the cohorts in the availability of data. Specific diagnoses for the antidepressant treatment were not known neither adherence to treatment. CONCLUSION: Social workers have a higher risk for any and long-term antidepressant treatment than other human and non-human service professionals.
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Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Pessoal de Saúde/psicologia , Assistentes Sociais/psicologia , Adulto , Estudos de Coortes , Dinamarca , Transtorno Depressivo/psicologia , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , SuéciaRESUMO
OBJECTIVE: In order to understand the reasons for the low priority given to work in primary health care among physicians, we studied differences in work stress, health and health related lifestyles between general practitioners (GPs) and hospital physicians. METHOD: A cohort of 226 GPs and 523 consultants from Finland responded to a questionnaire survey. The responses were linked to data on registered sickness absence. RESULTS: Compared with consultants, GPs reported higher job strain (OR 1.76, 95% CI 1.23 to 2.53) and perceived work overload (OR 2.29, 95% CI 1.65 to 3.16) but were less likely to report poor team climate (OR 0.65, 95% CI 0.46 to 0.91), procedural injustice (OR 0.49, 95% CI 0.34 to 0.72) and interactional injustice (OR 0.62, 95% CI 0.44 to 0.88). There were only small differences in lifestyle, perceived health, psychological distress and long sick leaves between GPs and consultants. Short sick leaves were more common among GPs, but this difference disappeared after controlling for work characteristics. CONCLUSION: In relation to the current recruitment crisis in primary health care and the studied working conditions, job strain and heavy workload outweigh the attractiveness of a good working climate and low organisational injustice. The non-significant differences in health may indicate that there are no differences in total work stress between GPs and consultants. In tackling the recruitment problems in the field of health care, it is of particular importance to be aware of the sector specific difficulties in working conditions.
Assuntos
Esgotamento Profissional/psicologia , Medicina de Família e Comunidade , Médicos Hospitalares , Carga de Trabalho/psicologia , Adulto , Atitude do Pessoal de Saúde , Esgotamento Profissional/economia , Esgotamento Profissional/prevenção & controle , Feminino , Finlândia , Humanos , Satisfação no Emprego , Masculino , Atenção Primária à Saúde , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Inquéritos e Questionários , Carga de Trabalho/estatística & dados numéricosRESUMO
OBJECTIVE: To determine the effects of multidisciplinary in-patient rehabilitation for chronic back or neck pain on sickness absences and analgesic purchases. DESIGN: A prospective observational study. SETTING: 10 towns in Finland. PARTICIPANTS: 34 838 local government employees, including 418 participants in rehabilitation for chronic back pain and 195 participants in rehabilitation for chronic neck pain between 1994 and 2002. MAIN OUTCOME MEASURES: The annual rates of short (1-3 days), long (>3 days), and very long (>21 days) sickness absences and the defined daily doses (DDD) of prescribed analgesics. RESULTS: The rate of very long (>21 days) sickness absence among the chronic back pain rehabilitees was 3.03-fold (95% CI 2.55 to 3.60) compared to the non-rehabilitees in the year before rehabilitation. This ratio declined to 1.88 (95% CI 1.65 to 2.37) three years after rehabilitation. No further decline in the rate of very long sickness absence was observed in the subsequent years. For chronic neck pain rehabilitees, no evidence of the effectiveness of rehabilitation on sickness absence was found. In relation to consumption of analgesics, the mean rate of DDDs declined among the back and neck pain rehabilitees after rehabilitation compared to the non-rehabilitees. CONCLUSIONS: Multidisciplinary in-patient rehabilitation for chronic back pain may decrease the risk of very long sickness absence for three years. In relation to rehabilitation for chronic neck pain, no changes in sickness absences were found.
Assuntos
Analgésicos/uso terapêutico , Dor nas Costas/reabilitação , Cervicalgia/reabilitação , Doenças Profissionais/reabilitação , Sistema de Registros , Licença Médica , Adulto , Doença Crônica , Esquema de Medicação , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Estudos Prospectivos , Análise de Regressão , Perfil de Impacto da Doença , Resultado do Tratamento , Tolerância ao Trabalho ProgramadoRESUMO
Standard of care for cancer is commonly a combination of surgery with radiotherapy or chemoradiotherapy. However, in some advanced cancer patients this approach might still remaininefficient and may cause many side effects, including severe complications and even death. Oncolytic viruses exhibit different anti-cancer mechanisms compared with conventional therapies, allowing the possibility for improved effect in cancer therapy. Chemotherapeutics combined with oncolytic viruses exhibit stronger cytotoxic responses and oncolysis. Here, we have investigated the systemic delivery of the oncolytic adenovirus and paclitaxel encapsulated in extracellular vesicles (EV) formulation that, in vitro, significantly increased the transduction ratio and the infectious titer when compared with the virus and paclitaxel alone. We demonstrated that the obtained EV formulation reduced the in vivo tumor growth in animal xenograft model of human lung cancer. Indeed, we found that combined treatment of oncolytic adenovirus and paclitaxel encapsulated in EV has enhanced anticancer effects both in vitro and in vivo in lung cancer models. Transcriptomic comparison carried out on the explanted xenografts from the different treatment groups revealed that only 5.3% of the differentially expressed genes were overlapping indicating that a de novo genetic program is triggered by the presence of the encapsulated paclitaxel: this novel genetic program might be responsible of the observed enhanced antitumor effect. Our work provides a promising approach combining anticancer drugs and viral therapies by intravenous EV delivery as a strategy for the lung cancer treatment.