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ObjectivesUnhealthy behaviours are associated with increased sickness absence (SA), but few studies have considered person-oriented approach in these associations. Using latent class analysis, we examined clustering of unhealthy behaviours among Finnish municipal employees and their associations with subsequent SA.DesignA prospective register-linkage study.SettingUnhealthy behaviours (low leisure-time physical activity, non-daily fruit and vegetable consumption, insufficient sleep, excessive alcohol use and tobacco use) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19- to 39-year-old employees of the City of Helsinki, Finland.ParticipantsA total of 4002 employees (81% women) of the City of Helsinki, Finland.Primary outcome measuresThe questionnaire data were prospectively linked to employer’s SA register through March 2020. Associations between latent classes of unhealthy behaviours and subsequent SA (1–7 days/8+ days/all lengths) were examined using negative binomial regression.ResultsAmong women, a three-class latent class model was selected: (1) few unhealthy behaviours (84%), (2) excessive alcohol and tobacco use (12%) and (3) several unhealthy behaviours (5%). Women belonging to classes 2 and 3 had increased SA rates compared with those in class 1, regardless of the length of SA spells. Among men, a 2-latent class model was selected: (1) few unhealthy behaviours (53%) and (2) several unhealthy behaviours (47%). Men belonging to class 2 had increased rates of 1–7 days’ SA compared with men in class 1.ConclusionsThis study suggests that preventive actions aiming to reduce employees’ SA should consider simultaneously several unhealthy behaviours. Targeted interventions may benefit of identifying the clustering of these behaviours among occupational groups.

ObjectivesThe Abilitator is a patient-reported outcome measure (PROM) of work ability and functioning of those in a weak labour market position. It covers items for work ability and self-rated health, for example, and summary scales for social, psychological, cognitive and physical functioning, as well as everyday skills. The aim of this study was to evaluate the intrarater test–retest reliability, internal consistency and basic psychometric properties of the Finnish version of the Abilitator.Design, setting and outcomeThe test–retest study was conducted in European Social Fund projects in 2018–2019. The participants completed two Abilitator questionnaires over 7–14 days. The internal consistency analysis was based on data collected in 2017–2019 in services for the long-term unemployed. The reliability was assessed using correlations (r, rs, intraclass correlation coefficient (ICC)), agreement with Bland-Altman analysis and internal consistency with Cronbach’s alpha.ParticipantsThe test–retest study had 67 participants (52% men, mean age 43.9 years) and the internal consistency study 10 923 (48% men, mean age 38.58 years), respectively. Of all the participants, 80% had been unemployed for over a year.ResultsThe test–retest r or rs ranged from 0.71 to 0.93 and ICC from 0.74 to 0.93 for the items and summary scales. An exception was the life satisfaction item, with an rs of 0.60 and ICC of 0.45. A statistically significant difference was observed in the summary scale for social functioning (t=−2.01, p=0.049). Agreement was observed for all variables except social functioning. Alphas for summary scales ranged from 0.74 to 0.91.ConclusionsThe Finnish version of the Abilitator is a reliable PROM for the target group and has acceptable to excellent intrarater test–retest reliability and internal consistency, apart from the life satisfaction item. Further testing is needed for the social functioning summary scale.

ObjectiveAn intervention was carried out at the occupational healthcare services (OHS) of the City of Helsinki beginning in 2016. We investigated the association between the intervention and employee sick leaves using interrupted time series analysis.DesignRegister-based cohort study with a quasi-experimental study design.SettingEmployees of the City of Helsinki.ParticipantsWe analysed individual-level register-based data on all employees who were employed by the city for any length of time between 2013 and 2018 (a total 86 970 employees and 3 014 075 sick leave days). Sick leave days and periods that were OHS-based constituted the intervention time series and the rest of the sick leave days and periods contributed to the comparison time series.InterventionRecommendations provided to physicians on managing pain and prescribing sick leave for low back, shoulder and elbow pain.Outcome measuresNumber of sick leave days per month and sick leave periods per year.ResultsFor all sick leave days prescribed at OHS, there was no immediate change in sick leave days, whereas a gradual change showing decreasing number of OHS-based sick leave days was detected. On average, the intervention was estimated to have saved 2.5 sick leave days per year per employee. For other sick leave days, there was an immediate increase in the level of sick leave days after the intervention and a subsequent gradual trend showing decreasing number of sick leave days.ConclusionsThe intervention may have reduced employee sick leaves and therefore it is possible that it had led to direct cost savings. However, further evidence for causal inferences is needed.

ObjectivesPain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics.MethodsThe Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models.ResultsAcute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19–1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10–1.50] for acute/subacute and 1.43 [1.23–1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08–1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations).ConclusionsThese results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.

Objectives To investigate whether changes in psychosocial and physical working conditions are associated with subsequent psychotropic medication in ageing employees. Methods Data were from the Helsinki Health Study, a cohort study of Finnish municipal employees, aged 40–60 years at phase 1 (2000–2002). Changes in psychosocial and physical working conditions were measured between phase 1 and phase 2 (2007). Survey data were longitudinally linked to data on prescribed, reimbursed psychotropic medication purchases (Anatomical Therapeutic Chemical) obtained from the registers of the Social Insurance Institution of Finland between the phase 2 survey and December 2013 (N=3587; 80% women). Outcomes were any psychotropic medication; antidepressants (N06A); anxiolytics (N05B); and sedatives and hypnotics (N05C). Cox regression analyses were performed. Results During the follow-up, 28% of the participants were prescribed psychotropic medication. Repeated exposures to low job control, high job demands and high physical work load were associated with an increased risk of subsequent antidepressant and anxiolytic medication. Increased and repeated exposure to high physical work load, increased job control and repeated high job demands were associated with subsequent sedative and hypnotic medication. Age and sex-adjusted HR varied from 1.18 to 1.66. Improvement in job control was associated with a lower risk of anxiolytic, but with a higher risk of sedatives and hypnotic medication. Decreased physical work load was associated with a lower risk of antidepressant and anxiolytic medications. Conclusion Improvement in working conditions could lower the risk of mental ill-health indicated by psychotropic medication.