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Purpose Employers increasingly use 'return to work' (RTW) coordinators to support work ability and extend working careers, particularly among employees with reduced work ability. We examined whether applying this model was associated with changes in employee sickness absence and disability retirements. Methods We used data from the Finnish Public Sector study from 2009 until 2015. Employees where the model was introduced in 2012 constituted the cases (n = 4120, one municipality) and employees where the model was not in use during the follow-up, represented the controls (n = 5600, two municipalities). We analysed risk of disability retirement in 2013-2015 and risk of sickness absence after (2013-2015) vs. before (2009-2011) intervention by case-control status. Results The incidence of disability retirement after the intervention was lower in cases compared to controls both in the total population (hazard ratio HR = 0.49, 95% CI 0.30-0.79) and in the subgroup of participants with reduced work ability (HR = 0.34, 95% CI 0.12-0.99). The risk of sickness absence increased from pre-intervention to post-intervention period both among cases and controls although the relative increase was greater among cases (RR post- vs. pre-intervention  = 1.26, 95% CI 1.14-1.40) than controls (RR post- vs. pre-intervention  = 1.03, 95% CI 0.97-1.08). In the group of employees with reduced work ability, no difference in sickness absence trends between cases and controls was observed. Conclusions These findings suggest that RTW-coordinator model may increase employee sickness absence, but decrease the risk of disability retirement, i.e., permanent exclusion from the labour market., (© 2021. The Author(s).)

Workplace discrimination may affect the health of the exposed employees, but it is not known whether workplace discrimination is also associated with an increased risk of long-term sickness absence. The aim of this study was to examine the longitudinal associations of changes in and onset of workplace discrimination with the risk of long-term sickness absence. Data on workplace discrimination were obtained from 29,597 employees participating in survey waves 2004, 2006, 2008 and/or 2010 of the Finnish Public Sector Study. Four-year changes in long-term sickness absence (≥10 days of medically certified absence with a mental or non-mental diagnosis) were assessed. This covered successive study waves in analyses of onset of workplace discrimination as well as fixed effect analyses of change in workplace discrimination (concurrent i.e. during the exposure year and 1-year lagged i.e. within one year following exposure), by using each employee as his/her own control. The risk of long-term sickness absence due to mental disorders was greater for employees with vs. without onset of workplace discrimination throughout the 4-year period, reaching a peak at the year when the onset of discrimination was reported (adjusted risk ratio 2.13; 95% confidence interval (CI) 1.80-2.52). The fixed effects analyses showed that workplace discrimination was associated with higher odds of concurrent, but not 1-year lagged, long-term sickness absence due to mental disorders (adjusted odds ratio 1.61; 95% CI 1.33-1.96 and adjusted odds ratio 1.02; 95% CI 0.83-1.25, respectively). Long-term sickness absence due to non-mental conditions was not associated with workplace discrimination. In conclusion, these findings suggest that workplace discrimination is associated with an elevated risk of long-term sickness absence due to mental disorders. Supporting an acute effect, the excess risk was confined to the year when workplace discrimination occurred., Competing Interests: The authors have declared that no competing interests exist.

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

Background: Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability., Methods: We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies-the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)-as 'nested pseudo-trials'. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times., Results: Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81-0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81-1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point., Conclusions: Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking., (© The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence., Methods: We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAF external )., Findings: For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70·9 days per 10 person-years), depressive disorders (26·5 days per 10 person-years), and external causes (such as injuries and poisonings; 12·8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1·30, 95% CI 1·21-1·40; PAF external 8·9%) and low physical activity (1·23, 1·14-1·34; 7·8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1·90, 1·41-2·56; 15·2%), smoking (1·70, 1·42-2·03; 11·8%), low physical activity (1·67, 1·42-1·96; 19·8%), and obesity (1·38, 1·11-1·71; 5·6%) were associated with absences due to depressive disorders; heavy episodic drinking (1·64, 1·33-2·03; 11·3%), obesity (1·48, 1·27-1·72; 6·6%), smoking (1·35, 1·20-1·53; 6·3%), and being overweight (1·20, 1·08-1·33; 6·2%) were associated with absences due to external causes; obesity (1·82, 1·40-2·36; 11·0%) and smoking (1·60, 1·30-1·98; 10·3%) were associated with absences due to circulatory diseases; low physical activity (1·37, 1·25-1·49; 12·0%) and smoking (1·27, 1·16-1·40; 4·9%) were associated with absences due to respiratory diseases; and obesity (1·67, 1·34-2·07; 9·7%) was associated with absences due to digestive diseases., Interpretation: Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk., Funding: NordForsk, British Medical Research Council, Academy of Finland, Helsinki Institute of Life Sciences, and Economic and Social Research Council., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives This study aimed to develop and validate a risk prediction model for long-term sickness absence. Methods Survey responses on work- and lifestyle-related questions from 65 775 public-sector employees were linked to sickness absence records to develop a prediction score for medically-certified sickness absence lasting >9 days and ≥90 days. The score was externally validated using data from an independent population-based cohort of 13 527 employees. For both sickness absence outcomes, a full model including 46 candidate predictors was reduced to a parsimonious model using least-absolute-shrinkage-and-selection-operator (LASSO) regression. Predictive performance of the model was evaluated using C-index and calibration plots. Results Variance explained in ≥90-day sickness absence by the full model was 12.5%. In the parsimonious model, the predictors included self-rated health (linear and quadratic term), depression, sex, age (linear and quadratic), socioeconomic position, previous sickness absences, number of chronic diseases, smoking, shift work, working night shift, and quadratic terms for body mass index and Jenkins sleep scale. The discriminative ability of the score was good (C-index 0.74 in internal and 0.73 in external validation). Calibration plots confirmed high correspondence between the predicted and observed risk. In >9-day sickness absence, the full model explained 15.2% of the variance explained, but the C-index of the parsimonious model was poor (<0.65). Conclusions Individuals' risk of a long-term sickness absence that lasts ≥90 days can be estimated using a brief risk score. The predictive performance of this score is comparable to those for established multifactorial risk algorithms for cardiovascular disease, such as the Framingham risk score.

Background: We investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design., Methods: Finnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey., Results: Periods of heavy drinking were associated with increased odds of self-certified short-term (1-3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence., Conclusion: Increase in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Knowledge about factors influencing return to work (RTW) after depression-related absence is highly relevant, but the evidence is scattered. We performed a systematic search of PubMed and Embase databases up to February 1, 2016 to retrieve cohort studies on the association between various predictive factors and return to work among employees with depression for review and meta-analysis. We also analyzed unpublished data from the Finnish Public Sector study. Most-adjusted estimates were pooled using fixed effects meta-analysis. Eleven published studies fulfilled the eligibility criteria, representing 22 358 person-observations from five different countries. With the additional unpublished data from the 14 101 person-observations from the Finnish Public Sector study, the total number of person-observations was 36 459. The pooled estimates were derived from 2 to 5 studies, with the number of observations ranging from 260 to 26 348. Older age (pooled relative risk [RR] 0.95; 95% confidence interval [CI] 0.84-0.87), somatic comorbidity (RR = 0.80, 95% CI 0.77-0.83), psychiatric comorbidity (RR = 0.86, 95% CI 0.83-0.88) and more severe depression (RR = 0.96, 95% CI 0.94-0.98) were associated with a lower rate of return to work, and personality trait conscientiousness with higher (RR = 1.06, 95% CI 1.02-1.10) return to work. While older age and clinical factors predicted slower return, significant heterogeneity was observed between the studies. There is a dearth of observational studies on the predictors of RTW after depression. Future research should pay attention to quality aspects and particularly focus on the role of workplace and labor market factors as well as individual and clinical characteristics on RTW., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives The aim of this study was to investigate the association between the length of sickness absence and sustained return to work (SRTW) and the predictors of SRTW in depression, anxiety disorders, intervertebral disc disorders, and back pain in a population-based cohort of employees in the Finnish public sector. Methods We linked data from employers' registers and four national population registers. Cox proportional hazards regression analysis with a cluster option was applied. SRTW was defined as the end of the sickness benefit period not followed by a recurrent sickness benefit period in 30 days. Results For depression, the median time to SRTW was 46 and 38 days among men and women, respectively. For anxiety disorders, the figures were 24 and 22 days, for intervertebral disc disorders, 42 and 41 days, and, for back pain, 21 and 22 days among men and women respectively. Higher age and the persistence of the health problem predicted longer time to SRTW throughout the diagnostic categories. Comorbid conditions predicted longer time to SRTW in depression and back pain among women. Conclusions This large cohort study adds scientific evidence on the length of sickness absence and SRTW in four important diagnostic categories among public sector employees in Finland. Further research taking into account, eg, features of the work environment is suggested. Recommendations on the length of sickness absence at this point should be based on expert opinion and supplemented with research findings.

Aims: Among employees with diabetes, comorbidity may considerably deteriorate working capacity. We examined how socioeconomic status, lifestyle factors and job strain were related to work disability in individuals with diabetes with and without comorbidity., Methods: In this pooled analysis of individual-participant data from occupational cohorts from Finland (Finnish Public Sector Study FPS), UK (Whitehall II) and France (GAZEL), 1925 employees with diabetes were followed on average for 4 years. Participants were categorized into four groups, according to their baseline comorbidity status and subsequent work disability, as: non-comorbid diabetes with no/low work disability; comorbid diabetes with no/low work disability; non-comorbid diabetes with moderate/high work disability; and comorbid diabetes with moderate/high work disability. The risk of work disability was assessed with multinomial regression, using Group 1 (the first listed above) as the reference group., Results: Participants with low socioeconomic status had increased odds for higher work disability, irrespective of comorbidity (OR = 3.12; 95% CI 2.25-4.33, among participants with no comorbidity, and OR = 2.61; 95% CI 1.93-3.51 among those with comorbidity). Obesity was cross-sectionally associated with comorbidity (OR = 1.95; 95% CI 1.35-2.83 for comorbidity without disability), and this association was particularly pronounced among those whom became work disabled (OR = 2.61; 95% CI 1.89-3.60 for comorbidity with disability). Job strain was associated with high/moderate work disability, only among participants with comorbidity (OR = 1.63; 95% CI 1.14-2.34)., Conclusions: Pooled data from three cohort studies showed that low socioeconomic status, obesity, and job strain are linked to both comorbidity and increased work disability in employees with diabetes., (© 2015 the Nordic Societies of Public Health.)

Objectives: We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis., Methods: This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009., Results: Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability., Conclusions: Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.

Background: Privatisations of public sector organisations are not uncommon, and some studies suggest that such organisational changes may adversely affect employee health. In this study, we examined whether transfer of work from public sector hospital units to commercial enterprises, without major staff reductions, was associated with an increased risk of long-term sickness absence among employees., Methods: A cohort study of 962 employees from four public hospital laboratory and radiology units in three hospitals which were privatised during the follow-up and 1832 employees from similar units without such organisational changes. Records of new long-term sick leaves (>90 days) were obtained from national health registers and were linked to the data. Mean follow-up was 9.2 years., Results: Age- and sex-adjusted HR for long-term sickness absence after privatisation was 0.83 (95% CI 0.68 to 1.00) among employees whose work unit underwent a change from a public organisation to a commercial enterprise compared with employees in unchanged work units. Further adjustments for occupation, socioeconomic status, type of job contract, size of residence and sick leaves before privatisation had little impact on the observed association. A sensitivity analysis with harmonised occupations across the two groups replicated the finding (multivariable adjusted HR 0.92 (0.70-1.20))., Conclusions: In this study, transfer of work from public organisation to commercial enterprise did not increase the risk of long-term sickness absence among employees.

Organizational justice perceptions have been suggested to be associated with symptoms of mental health but the nature of the association is unknown due to reporting bias (measurement error related to response style and reversed causality). In this study, we used prospective design and long-term (>9 days) sickness absence with psychiatric diagnosis as the outcome measure. Participants were 21,221 Finnish public sector employees (the participation rate at baseline in 2000-2002 68%), who responded to repeated surveys of procedural and interactional justice in 2000-2004 along with register data on sickness absence with a diagnosis of depression or anxiety disorders (822 cases). Results from logistic regression analyses showed that a one-unit increase in self-reported and work-unit level co-worker assessed interactional justice was associated with a 25-32% lower odds of sickness absence due to anxiety disorders. These associations were robust to adjustments for a variety of potential individual-level confounders including chronic disease (adjusted OR for self-reported interactional justice 0.77, 95% CI 0.65-0.91) and were replicated using co-worker assessed justice. Only weak evidence of reversed causality was found. The results suggest that low organizational justice is a risk factor for sickness absence due to anxiety disorders., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Poor indoor air quality (IAQ) and psychosocial problems are common in schools worldwide, yet longitudinal research on the issue is scarce. We examined whether the level of or a change in pupil-reported school environment (IAQ, school satisfaction, and bullying) predicts recorded sick leaves among teachers., Methods: Changes in the school environment were assessed using pupil surveys at two time points (2001/02 and 2004/05) in 92 secondary schools in Finland. Variables indicating change were based on median values at baseline. We linked these data to individual-level records of teachers' (n = 1678) sick leaves in 2001-02 and in 2004-05., Results: Multilevel multinomial logistic regression models adjusted for baseline sick leave and covariates showed a decreased risk for short-term (one to three days) sick leaves among teachers working in schools with good perceived IAQ at both times (OR = 0.6, 95% CI: 0.5-0.9), and for those with a positive change in IAQ (OR = 0.6, 95% CI: 0.4-0.9), compared to teachers in schools where IAQ was constantly poor. Negative changes in pupil school satisfaction (OR = 1.8, 95% CI: 1.1-2.8) and bullying (OR = 1.5, 95% CI: 1.0-2.3) increased the risk for short-term leaves among teachers when compared to teachers in schools where the level of satisfaction and bullying had remained stable. School environment factors were not associated with long-term sick leaves., Conclusions: Good and improved IAQ are associated with decreased teacher absenteeism. While pupil-related psychosocial factors also contribute to sick leaves, no effect modification or mediation of psychosocial factors on the association between IAQ and sick leave was observed.

The aim of this study was to examine whether vandalism, bullying, and truancy among pupils at school are associated with absence due to illness among teachers. Data on such problem behaviour of 17,033 pupils in 90 schools were linked to absence records of 2364 teachers. Pupil reported vandalism and bullying at the school-level were associated with teachers' short-term (1- to 3-day) absences. Cumulative exposure to various forms of pupils' problem behaviour was associated with even higher rates of short-term absences among teachers. No association was found between pupils' problem behaviour and teachers' long-term (>3-day) absences. In conclusion, there seems to be a link between pupils' problem behaviour and teachers' short-term absence due to illness. Further work should determine whether problem behaviour is a cause or a consequence of absences or whether the association is noncausal., (Copyright © 2011 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Objectives: We examined whether having a high percentage of pupils with special educational needs (SEN) in basic education schools increases the risk of sickness absence among teachers and whether this risk is dependent on the pupil-teacher ratio (PTR), an indicator of teacher resources at school., Methods: We obtained register data on 8089 teachers working in 404 schools in 10 municipalities in Finland during the school year 2004-2005. We used multilevel multinomial regression models to examine the risk of teachers' short- and long-term sickness absence in relation to the percentage of SEN pupils and the PTR at school. We tested the equality of trends in groups with high and low PTR using PTR × SEN interaction term., Results: After adjustment for teacher and school characteristics, the risk for long-term absences was higher among teachers at schools with a high percentage of SEN pupils than among teachers at schools with a low percentage of SEN pupils [odds ratio (OR) 1.5, 95% confidence interval (95% CI) 1.2-1.8). This was also the case for short-term absences (OR 1.4, 95% CI 1.2-1.7). In analyses stratified by the PTR levels, the association between the percentage of SEN pupils and long-term absences was 15% higher among teachers with a high PTR than among those with a low PTR (P for interaction=0.10)., Conclusions: Teachers' sickness absenteeism seems to increase with a higher percentage of SEN pupils, especially when the PTR is high. Teacher resources at schools that have a high percentage of SEN pupils should be well maintained to ensure the health of teachers.

Objective: This study examined whether indicators of poor health and health risk behaviors among hospital staff differ between the ward specialties., Methods: Across 21 hospitals in Finland, 8003 employees (mean age 42 years, 87% women, 86% nurses) working in internal medicine, surgery, obstetrics and gynecology, pediatrics, intensive care, and psychiatry responded to a baseline survey on health and health risk behaviors (response rate 70%). Responses were linked to records of sickness absence and medication over the following 12 months., Results: Psychiatric staff had higher odds of smoking [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 2.14-3.12], high alcohol use (OR 1.55, 95% CI 1.21-1.99), physical inactivity (OR 1.30, 95% CI 1.11-1.53), chronic physical disease (OR 1.19, 95% CI 1.04-1.36), current or past mental disorders (OR 1.81, 95% CI 1.50-2.17), and co-occurring poor health indicators (OR 2.65, 95% CI 2.08-3.37) as compared to those working in other specialties. They also had higher odds of sickness absence due to mental disorders (OR 1.40, 95% CI 1.02-1.92) and depression (OR 1.61, 95% CI 1.02-2.55) at follow-up after adjustment for baseline health and covariates. Personnel in surgery had the lowest probability of morbidity. No major differences between specialties were found in the use of psychotropic medication., Conclusion: The prevalence of hospital employees with an adverse health risk profile is higher in psychiatric wards than other specialties.

Context: It is unknown whether or not measuring sleep disturbances repeatedly, rather than at only one point in time, improves prediction of work disability., Study Objective: o examine sleep disturbance patterns over time as a risk marker for diagnosis-specific work disability., Design: Prospective cohort study linking repeatedly measured self-reported sleep disturbances with records of physician-certified work disability (sickness absence) from a national register. Participants responded to surveys in 2000-2002, and 2004, and were followed up for 12 mo., Setting: Public sector employees in Finland., Participants: 25,639 participants (mean age 45.6 yr, 82% female)., Main Outcome Measure: Incident diagnosis-specific sickness absence of > 9 days., Results: During a mean follow-up of 323 days, 4,975 employees (19%) had a new episode of sickness absence. In multivariable-adjusted models corrected for multiple testing, stable severe sleep disturbances, in comparison with no sleep disturbances, were associated with an increased risk of sickness absence due to diseases of the musculoskeletal system (hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.45-1.95), and injuries and poisonings (HR 1.64, 95% CI 1.23-2.18). Increases in sleep disturbances predicted subsequent sickness absence due to mental disorders (HR 1.59, 95% CI 1.32-1.91), and diseases of the musculoskeletal system (HR 1.44, 95% CI 1.27-1.64) According to net reclassification improvement analyses, measurement of sleep disturbance patterns rather than the level of sleep disturbances at one point in time improved prediction of all-cause sickness absence by 14%, and diagnosis-specific sickness absences up to 17% (P for improvement < 0.001)., Conclusions: Increasing and severe chronic sleep disturbances mark an increased risk of diagnosis-specific work disability.

Background: Although health is an important determinant of sickness absence, social relationships at the workplace may also affect levels of sick leaves. This study examined whether students' self-assessed satisfaction with school predicted sickness absence among teachers in Finnish secondary schools., Methods: We measured school satisfaction of 17 033 students aged 14-16 years from 90 schools by a survey (the School Health Promotion Study) and aggregated school-specific scores of students' school satisfaction. For analysis, we linked these school-level data to records of sickness absence in the survey year and the following year among 2364 teachers working in the same schools (the 10-Town Study). For sickness absence longer than 9 days, we obtained diagnoses from national health registers., Results: Multilevel Poisson and logistic regression models adjusted for relevant baseline covariates showed a rate ratio of 1.2 [95% confidence interval (95% CI): 1.0-1.5] for long-term (>3 days) sickness absence among teachers working in schools with two lowest thirds of student satisfaction compared with teachers in schools with high student satisfaction. The corresponding odds ratio (OR) was higher for sickness absence with a psychiatric diagnosis (OR 1.9, 95% CI: 1.1-3.2), more specifically, neurotic and stress-related disorders (OR 2.6, 95% CI: 1.2-5.9). Students' school satisfaction was not associated with teachers' short-term (1-3 days) sick leaves., Conclusions: These data suggest a link between social relationships at school, as indexed by students' school satisfaction, and teachers' sick leaves, with the strongest associations seen for absences with mental health diagnoses.

Background: In 2007, part of a drinking water distribution system was accidentally contaminated with waste water effluent causing a gastroenteritis outbreak in a Finnish town. We examined the acute and cumulative effects of this incidence on sick leaves among public sector employees residing in the clean and contaminated areas, and the additional costs of lost workdays due to the incidence., Methods: Daily information on sick leaves of 1789 Finnish Public Sector Study participants was obtained from employers' registers. Global Positioning System-coordinates were used for linking participants to the clean and contaminated areas. Prevalence ratios (PR) for weekly sickness absences were calculated using binomial regression analysis. Calculations for the costs were based on prior studies., Results: Among those living in the contaminated areas, the prevalence of participants on sick leave was 3.54 (95% confidence interval (CI) 2.97-4.22) times higher on the week following the incidence compared to the reference period. Those living and working in the clean area were basically not affected, the corresponding PR for sick leaves was 1.12, 95% CI 0.73-1.73. No cumulative effects on sick leaves were observed among the exposed. The estimated additional costs of lost workdays due to the incidence were 1.8-2.1 million euros., Conclusions: The prevalence of sickness absences among public sector employees residing in affected areas increased shortly after drinking water distribution system was contaminated, but no long-term effects were observed. The estimated costs of lost workdays were remarkable, thus, the cost-benefits of better monitoring systems for the water distribution systems should be evaluated.

Objective: To examine factors that predict the probability of an employee being granted in-patient multidisciplinary rehabilitation to sustain worklife participation., Design: A prospective cohort study., Subjects: A total of 49,264 public sector employees., Methods: Baseline characteristics were measured from survey responses and registers. Two types of rehabilitation were identified: early (for employees only at risk of their work capacity deteriorating in the near future) and later (for employees whose work capacity has already deteriorated substantially)., Results: During the mean 5.0-year follow-up, 1551 participants were granted early rehabilitation and 1293 received later rehabilitation. Early rehabilitation was predicted by a permanent job, high occupational status, good job control and job security, non-smoking and high physical activity. Both early and later rehabilitation were predicted by the use of painkillers, anxiety, and sickness absence. Later rehabilitation was also predicted by older age, poor self-rated health, and low educational level., Conclusion: Early rehabilitation and, to a lesser extent, later rehabilitation were more often granted to employees with few known risk factors. This finding suggests that preventive measures to reduce the risk of disability pension amongst high-risk employees through rehabilitation are not targeted as intended.

The aim of the study is to examine the risk of sickness absence in public sector employees with allergic rhinitis or asthma or both conditions combined. This is a prospective cohort study of 48,296 Finnish public sector employees. Data from self-reported rhinitis and asthma were obtained from survey responses given during either the 2000-2002 or 2004 periods. Follow-up data on sickness absences for the public sector employees surveyed were acquired from records kept by the employers. During the follow-up, mean sick leave days per year for respondents were 17.6 days for rhinitis alone, 23.8 days for asthma alone and 24.2 days for both conditions combined. Respondents with neither condition were absent for a mean of 14.5 days annually. The impact of asthma and rhinitis combined on the risk of sick leave days was marginal compared to asthma alone (RR 1.1; 95% CI 1.0-1.3). In the subgroup analysis (those with current asthma or allergy medication), the risk ratio for medically certified sickness absence (>3 days) was 2.0 (95% CI 1.9-2.2) for those with asthma and rhinitis combined. Rhinitis, asthma and both these conditions combined increased the risk of days off work., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Study Objective: To examine sleep disturbances as a predictor of cause-specific work disability and delayed return to work., Design: Prospective observational cohort study linking survey data on sleep disturbances with records of work disability (> or = 90 days sickness absence, disability pension, or death) obtained from national registers., Setting: Public sector employees in finland., Participants: 56,732 participants (mean age 44.4 years, 80% female), who were at work and free of work disability at the study inception., Measurements and Results: During a mean follow-up of 3.3 years, incident diagnosis-specific work disability was observed in 4,028 (7%) employees. Of those, 2,347 (60%) returned to work. Sleep disturbances 5-7 nights per week predicted work disability due to mental disorders (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.3-1.9) and diseases of the circulatory system (HR = 1.6, 95% CI 1.2-2.1), musculoskeletal system (HR = 1.6, 95% CI 1.4-1.8) and nervous system (HR = 1.5, 95% CI 1.0-2.2), and injuries and poisonings (HR = 1.6, 95% CI 1.2-2.1) after controlling for baseline age, sex, socioeconomic status, night/shift work, health behaviors (e.g., smoking, exercise), diagnosed somatic diseases, use of pain killers, depression, and anxiety. In addition, sleep disturbances prior to disability were associated with higher likelihood of not returning to work after work disability from musculoskeletal diseases (HR = 1.2, 95% CI 1.1-1.7) and, in men, after work disability due to mental disorders (HR = 4.4, 95% CI 1.7-11.1)., Conclusions: Sleep disturbances are associated with increased risk for subsequent disabling mental disorders and various physical illnesses. They also predict the outcome of work disability due to musculoskeletal disorders.

This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (>9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.

Study Objectives: This study examined whether obstructive sleep apnoea syndrome (OSAS) is associated with increased risk of work disability during six years following the diagnosis., Design: Prospective follow-up study., Setting: Ten municipalities and six hospital districts in Finland., Participants: A total of 766 employees with OSAS (cases), and their control subjects (n=3,827) matched for age, gender, socioeconomic position, type of employment contract and type of organization., Interventions: N/A., Measurements: Data on all (>9 days) or very long-term (>90 days) sickness absences and for disability pensions were obtained from national registers. Diagnosis of OSAS was determined according to the Hospital Discharge Register, which includes data on all hospital admissions., Results: According to the Cox proportional hazards models the hazard of the first sickness absence period (all sickness absences) during the follow-up was 1.7-fold (95% confidence interval (CI): 1.5-2.0) in male and 2.1-fold (95% CI: 1.8-2.4) in female sleep apnoea cases compared to controls after adjustments for sociodemographic factors. Both men and women with OSAS had a 2-fold increase in the risk for disability pension compared to controls. With regard to cause-specific work disability, employees with OSAS had a particularly pronounced risk of long-term work disability caused by injuries (HR 3.1 95% CI: 1.8-5.2) and mental disorders (HR: 2.8, CI 95%: 2.1-3.7)., Conclusions: These results suggest that OSAS is associated with an increased risk of both sickness absence and disability pension. They emphasize the need to identify the employees with this disorder and to improve general practitioners' knowledge about screening of sleep apnoea symptoms and indicators.

Background: The impact of sleep apnea on work disability, in terms of sickness absence and disability pension, is unclear. We sought to estimate the total number of lost workdays caused by sleep apnea either due to medically certified sickness absences or disability pensions during the 5 years prior to the year of a sleep apnea diagnosis., Methods: This is a register-linkage case-control study of Finnish public sector employees who had received a diagnosis of sleep apnea between 1995 and 2005 (n = 957) and randomly selected control subjects who had not received a diagnosis of sleep apnea (n = 4,785), matched for age, gender, socioeconomic position, type of employment, and organization. The annual sum of lost workdays, due to either medically certified sickness absences or disability pensions prior to diagnosis, was calculated for each participant (mean follow-up time, 5 years)., Results: After adjustment for comorbid conditions (eg, hypertension, ischemic heart disease, diabetes, asthma/other chronic lung disease, and depression), an increased risk of lost workdays was found in employees in whom sleep apnea developed compared to control subjects (rate ratio [RR], 1.61; 95% confidence interval [CI], 1.24 to 2.09 in men; and RR, 1.80; 95% CI, 1.43 to 2.28 in women). In women, the excess risk was already pronounced 5 years prior to the year of diagnosis, whereas in men the highest risk was noticed 1 year before the year of diagnosis., Conclusion: Sleep apnea may severely threaten work ability years before diagnosis. These results emphasize the importance of the early identification and treatment of employees with sleep apnea.

Background: Work stress is a recognized risk factor for mental health disorders, but it is not known whether work stress is associated with the morbidity among individuals with psychologic distress. Another shortcoming in earlier research is related to common method bias-the use of individual perceptions of both work stress and psychologic distress. This prospective study was assessed using the General Health Questionnaire (GHQ-12), which identified psychologic distress as a predictor of sickness absence and the effect of work-unit measures of job strain on sickness absence among cases., Methods: Survey data were collected on work stress, indicated by high job strain, for a cohort of public sector employees (6,663 women, 1,323 men), aged 18 to 62 at baseline in 2000-2002, identified as GHQ-12 cases. Coworker assessments of job strain were used to control for bias due to response style. A 2-year follow-up included recorded long-term (>7 days) medically certified sickness absence. Adjustments were made for age, socioeconomic position, baseline chronic physical disease, smoking, and heavy alcohol consumption., Results: Cases with psychologic distress had 1.3 to 1.4 times higher incidence of long-term sickness absence than non cases. Among cases, high job strain predicted sickness absence (hazard ratio 1.17 in women, 1.41 in men). The significant effect of job strain on sickness absence was found among workers in high socioeconomic positions (hazard ratio 1.54 for women, 1.58 for men) but not among employees in low socioeconomic positions (hazard ratio 1.06 for women, 1.31 for men)., Conclusions: Psychologic distress has an independent effect on medically certified sickness absence. The identification of employees with high job strain and the improvement of their working conditions should be considered as an important target in the prevention of adverse consequences of psychologic distress.

Background: The decline in acute event rates among patients with stable angina emphasizes the need for outcome events that are commonly experienced, externally observed and sensitive to changing functional impairments. In the absence of previous studies, we sought to determine the burden of medically certified spells of sickness absence among individuals with angina and their relation to risk factors and co-morbidity., Design and Methods: A prospective study of 33 148 employees and 1 year experience of medically certified sickness absence in 341 physician-diagnosed angina patients (417 absence spells, total absence days 9733)., Results: Among individuals with angina, sickness absence occurred at a rate of 125 spells per 100 person-years, with age and sex adjusted hazard ratios (compared with their colleagues with no chronic diseases) of 2.90 (95% confidence interval 2.51-3.36), greater than the effect of prolapsed intervertebral disc. Co-morbid diseases were stronger predictors of absence than behavioural risk factors or cardiovascular diseases, and explained 71% of the excess risk of absence in angina., Conclusion: In a working population, angina has a significant impact on sick leave, largely because of co-morbid diseases. Angina intervention studies that include employed patients should measure, and seek to reverse, this prognostic burden.

Objective: To study the allocation of rehabilitation measures provided by the Finnish Social Insurance Institution in relation to the characteristics and health status of rehabilitants., Design: A register linkage study., Subjects: A total of 67,106 full-time local government employees with a minimum of 10-month job contracts in 10 Finnish towns during the period 1994-2002., Methods: Data on the rehabilitation granted between 1994 and 2002, special medication reimbursements for chronic diseases, and disability retirement, were derived from the registers of the Social Insurance Institution as an indicator of chronic morbidity and linked to the employers' records on demographic characteristics and rates of sickness absence., Results: In comparison with non-rehabilitants, the rate of sickness absence (> 21 days) was 2.2-2.9-fold (95% confidence interval (CI) 2.0-3.0) higher, the odds ratios of special medication reimbursement 1.5-6.1-fold (95% CI 1.3-6.9) higher and disability retirement 3.1-7.5-fold (95% CI 2.7-9.3) higher among rehabilitants. Older women and employees in manual or lower-grade non-manual jobs predominated in the rehabilitation groups. The proportion of temporary employees receiving rehabilitation was low., Conclusion: Permanently employed older women with an excess burden of health problems predominate in the receipt of rehabilitation provided by the Social Insurance Institution.

Study Objectives: This study examined whether sleep disturbances after family death or illness are associated with an increase in health problems and delayed recovery., Design: Longitudinal observational cohort study., Setting: Ten cities in Finland., Participants: A population of 6032 male and 20,933 female city employees., Interventions: N/A., Measurements and Results: Self-reports of a family death or illness, the timing of the event, and postevent sleep duration and quality, measured by the Jenkins Scale, were linked with monthly sickness absence records from 36 months prior to the event to 30 months after the event. A repeated-measures Poisson regression analysis with the generalized estimating equation method showed no differences in the preevent absence rates between the employees with and without disturbed sleep. For employees with disturbed sleep, the rate of absence in the month the event occurred was 2.08-fold higher (95% confidence interval: 1.71, 2.53) compared with the employee's baseline level of sickness absence, and it was still 1.67-fold higher (95% confidence interval: 1.42, 1.98) 19 to 30 months after the event. The corresponding rate ratios were lower for the employees with undisturbed sleep after the event (1.49 and 1.16, respectively). Delayed recovery with disturbed sleep was observed after family illness but not after family death., Conclusion: These findings suggest that a long-term increase in sickness absence is particularly likely if a family illness is associated with sleep disturbances. Identifying people with sleep disturbances may be important in preventing health problems in the aftermath of a family death or illness.

We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires designed to assess organizational justice, workload and other factors. Hierarchical regression showed that after adjustment for age, income, and health behaviors low procedural and interactional justice were related to long sickness absence spells. In accordance with the uncertainty management model, these associations were dependent on experienced work-time control and perceived changes at work.

Study Objective: To examine whether the effects of work stress on sickness absence vary by the level of control the employees have over their working times., Design: Prospective cohort study. A survey of job strain, effort-reward imbalance, and control over daily working hours and days off was carried out in 2000-01. The survey responses were linked with registered data on the number of medically certified (>3 days) sickness absences from one year before the survey until the end of 2003. The mean follow up period was 28.2 (SD 8.1) months. Adjustments were made for demographics and behavioural health risks. Aggregated measures of worktime control according to workplaces were used to control for differences in reactivity and response style., Setting: Ten towns in Finland., Participants: 16 139 public sector employees who had no medically certified sickness absences in the year preceding the survey., Main Results: Among the women, individually measured control over daily working hours and days off moderated the association between work stress and sickness absence. The combination of high stress and good worktime control was associated with lower absence rates than a combination of high stress and poor worktime control. This finding was replicated in the analyses using workplace aggregates of worktime control. Among the men, the findings were less consistent and not replicable using aggregated measures of worktime control., Conclusions: Good control over working times reduces the adverse effect of work stress on sickness absence especially among female employees.

Objective: To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased sickness absence and mortality among employees., Design: Prospective cohort study over 7.5 years of employees grouped into categories on the basis of reductions of personnel in their occupation and workplace: no downsizing (< 8% reduction), minor downsizing (8-18%), and major downsizing (> 18%)., Setting: Four towns in Finland., Participants: 5909 male and 16 521 female municipal employees, aged 19-62 years, who kept their jobs., Main Outcome Measures: Annual sickness absence rate based on employers' records before and after downsizing by employment contract; all cause and cause specific mortality obtained from the national mortality register., Results: Major downsizing was associated with an increase in sickness absence (P for trend < 0.001) in permanent employees but not in temporary employees. The extent of downsizing was also associated with cardiovascular deaths (P for trend < 0.01) but not with deaths from other causes. Cardiovascular mortality was 2.0 (95% confidence interval 1.0 to 3.9) times higher after major downsizing than after no downsizing. Splitting the follow up period into two halves showed a 5.1 (1.4 to 19.3) times increase in cardiovascular mortality for major downsizing during the first four years after downsizing. The corresponding hazard ratio was 1.4 (0.6 to 3.1) during the second half of follow up., Conclusion: Organisational downsizing may increase sickness absence and the risk of death from cardiovascular disease in employees who keep their jobs

The objective of the study was to determine whether the double burden of and negative spillover between domestic and full-time paid work are associated with an increase in health problems. Survey responses were linked with sickness absence records in a cross-sectional study of 6442 full-time municipal employees. Women and men experiencing severe work-family spillover had a 1.5-1.6 (95% confidence intervals 1.1 to 2.0) times higher rate of sickness absence than those with no such experience. The corresponding odds ratios for psychological distress and suboptimal self-assessed health varied between 3.6 and 6.5 (2.3 to 11.0). Among the women, severe family-work spillover increased the risk of psychological distress and suboptimal health [odds ratios 2.0 (1.4 to 2.9) and 1.6 (1.1 to 2.3), respectively], and accumulated sole responsibilities were associated with a 1.5 (1.1 to 2.1) times higher odds ratio for psychological distress. Long domestic work hours (>50/week) were associated with a 1.5 (1.1 to 2.0) times higher rate of sickness absence among the men, but there was no such increase among the women. We conclude that negative work-family spillover especially is associated with health problems among both women and men, and negative family-work spillover is related to a poorer health status among women.

Objectives We examined whether sickness absence during participation in a state subsidized re-employment program among long-term unemployed people was associated with subsequent labor market attachment. Methods We linked 18 944 long-term unemployed participants (aged 18-60 years) of a six-month subsidized re-employment program in Finland to their records of sickness absence during the program and labor market status after the program. We used the latent class growth model to identify labor market attachment trajectories over a six-year follow-up period and multinomial logistic regression to investigate the association between sick- ness absence and labor market attachment trajectories. Results We identified four labor market attachment trajectories: "strengthening", (77%), "delayed" (6%), "leavers" (10%), and "non-attached" (7%). Sickness absence was associated with an increased risk of belonging to the leavers and non-attached trajectories. Having >30 days of sickness absence during the six-month re-employment program increased the risk for belonging to the future non-attached trajectory in all age groups, but in particular for those aged 30-44 [odds ratio (OR) 7.35, 95% confidence interval (CI) 4.85-11.14] and 18-29 years (OR 5.38, 95% CI 3.76-7.69). At these ages, having fewer than 30 days sickness absences was also associated with an elevated risk of belonging to the non-attached trajectory, while this risk was lower for those aged 45-60. Conclusions Sickness absence during participation in a subsidized re-employment program increased the risk for poor labor market attachment during the subsequent six years. The risk was particularly high among younger participants with >30 days of sickness absence. [ABSTRACT FROM AUTHOR]

Aims We examined differences in sickness absence in relation to at-risk drinking and abstinence, taking into account potential changes in consumption. Methods We used individual-participant data (n = 46,514) from four prospective cohort studies from Finland, France and the UK. Participants responded to a survey on alcohol use at two time points 4–6 years apart, and were linked to records of sickness absence for an ~6-year follow-up after the latter survey. Abstainers were those reporting no alcohol use in either survey. At-risk drinkers at T1 were labelled as 'former', at-risk drinkers at T2 as 'current' and at-risk drinkers at both times as 'consistent' at-risk drinkers. The reference group was low-risk drinkers at both times. Study-specific analyses were stratified by sex and socioeconomic status (SES) and the estimates were pooled using meta-analysis. Results Among men (n = 17,285), abstainers (6%), former (5%), current (5%) and consistent (7%) at-risk drinkers had an increased risk of sickness absence compared with consistent low-risk drinkers (77%). Among women (n = 29,229), only abstainers (12%) had a higher risk of sickness absence compared to consistent low-risk drinkers (74%). After adjustment for lifestyle and health, abstaining from alcohol was associated with sickness absence among people with intermediate and high SES, but not among people with low SES. Conclusions The U-shaped alcohol use—sickness absence association is more consistent in men than women. Abstinence is a risk factor for sickness absence among people with higher rather than lower SES. Healthy worker effect and health selection may partly explain the observed differences. Short summary In a pooled analysis from four cohort studies from three European countries, we demonstrated a U-shaped association between alcohol use and sickness absence, particularly among men. Abstinence from alcohol was associated with increased sickness absenteeism among both sexes and across socioeconomic strata, except those with low SES. [ABSTRACT FROM AUTHOR]

Background: The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood. Methods: We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21–34, 35–50 and >50 years.Results: A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21–34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28–1.46) and 35–50 years (HR = 1.22, 95% CI = 1.18–1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09–1.52) and 35–50 years (HR = 1.20, 95% CI = 1.03–1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years. Conclusions:The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age. [ABSTRACT FROM AUTHOR]

Aims: We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age. Methods: We used prospective population-based register data of 25–59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003–2010. Net days of sickness absence and disability pension in 2005–2006 were examined; the follow-up time for mortality was 2007–2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions. Results: Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0–16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4–7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8–4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up. Conclusions:Diabetes and work disability jointly increase the risk of death during working age. Diabetes with long-term work disability is associated with the highest risk of premature death, which highlights the importance of their prevention and early detection. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the impact of patient-overcrowding in hospital wards on diagnosis-specific mental disorders among hospital staff. In the study, researchers used routinely recorded patient bed occupancy rates between 2003 and 2004 in Finland. They found that hospital staff working in wards with a patient occupancy level 10 percentage units above the optimal during the initial year showed twice the risk of sickness absence because of depression.

Recent reviews show that self-reported psychosocial factors related to work, such as job demands and job control, are associated with employee mental health, but it is not known whether this association is attributable to reporting bias. The authors examined this question using objectively measured hospital ward overcrowding as an instrument. The extent of overcrowding provided a strong instrument for self-reported job demands but not for job control, and it was used to examine unbiased associations between self-reported job demands and sickness absence with a psychiatric diagnosis among 2,784 female nurses working in somatic illness wards in Finland. During the 12-month follow-up period (2004–2005), 102 nurses had an absence with a psychiatric diagnosis, 33 with a diagnosis of depressive disorder. Both greater extent of overcrowding and higher self-reported job demands were associated with increased risk of psychiatric absence. The latter association was stronger but less precisely estimated in an instrumental-variables analysis which took into account only the variation in self-reported job demands that was explained by overcrowding. Repeating these analyses with absence due to depressive disorders as the outcome led to similar results. Findings from this instrumental-variables analysis support the status of high self-reported job demands as a risk factor for absence with a psychiatric diagnosis. [ABSTRACT FROM PUBLISHER]

Study objective: To examine whether the effects of work stress on sickness absence vary by the level of control the employees have over their working times. Design: Prospective cohort study. A survey of lob strain, effort-reward imbalance, and control over daily working hours and days off was carried out in 2000-01. The survey responses were linked with registered data on the number of medically certified (>3 days) sickness absences from one year before the survey until the end of 2003. The mean follow up period was 28.2 (SD 8.1) months. Adjustments were made for demographics and behavioural health risks. Aggregated measures of worktime control according to workplaces were used to control for differences in reactivity and response style. Setting: Ten towns in Finland. Participants: 16 139 public sector employees who had no medically certified sickness absences in the year preceding the survey. Main results: Among the women, individually measured control over daily working hours and days off moderated the association between work stress and sickness absence. The combination of high stress and good worktime control was associated with lower absence rates than a combination of high stress and poor worktime control. This finding was replicated in the analyses using workplace aggregates of worktime control. Among the men, the findings were less consistent and not replicable using aggregated measures of worktime control. Conclusions: Good control over working times reduces the adverse effect of work stress on sickness absence especially among female employees. [ABSTRACT FROM AUTHOR]