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Lauri Kokkinen1,2, Elina Viitanen11School of Health Sciences, University of Tampere, Tampere, 2Unit of Expertise for Work Organizations, Finnish Institute of Occupational Health, Turku, FinlandBackground: Service production structures of public health care, once established, have proved extremely difficult to change. For this study, we reviewed discussions that took place in management teams at a Finnish central hospital over a period of nine months. The aim of the research was to analyze whether the management team meetings brought forth new and radical alternatives as to how service production could be reorganized. In addition to this, we were also interested in any possible problems that could be solved using these alternative models of service production, and also how preconditions to the application of different alternatives came about and how they eventually concluded.Methods: Our data were derived from 24 management team meetings that took place between August 2007 and May 2008, and were fully videotaped. Data were collected from eight different management teams; the meetings of each were videotaped three times. The management teams reviewed represented three different hierarchical levels, ie, top management, division management, and operational unit management. Data were analyzed according to theory-based content analysis. As a theoretical framework, we utilized Kingdon’s model to enable us to understand why some issues and problems are brought to the agenda of the change process and go on to become concrete policies while others fail to do so.Results: During the study period, a threat of mass resignation of nursing staff caused a considerable change to the agenda of the management team meetings, introducing alternatives with the potential to renew the existing structures of operation in a radical manner.Conclusion: According to our analysis, the threat of mass resignation acted as a window of opportunity, linking the lack of nursing staff (problem) to operational and structural changes (alternative solutions).Keywords: hospital, nursing staff, mass resignation, change

Due to shortage in workforce and difficulties in recruiting social and health-care managers, it is crucial to investigate and develop the work well-being of managers. The existing evidence mostly concerns clinical contexts in social and health-care. We studied work well-being through the following categories: (1) individual factors, (2) social factors, (3) professional support from the manager, (4) work-related factors, and (5) organizational factors. The study aims to investigate (1) management levels, (2) years of experience in management, and (3) professional groups that are connected to their work well-being in these categories. We conducted a survey (N = 281) and formed logistic regression models to answer the research questions. Working as an upper-level manager, having more than 26 years of managerial experience, and working as a physician or in a group 'other' are factors that are positively connected to work wellbeing. While in the middle of one's managerial career (6–25 years) or working as a nurse manager is negatively connected to work well-being. This study produces specific knowledge to understand the factors connected to social and health-care managers' work well-being and to identify those groups that are at a risk of experiencing poor well-being at work. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to compare the sickness absence (SA; over 10 days) rates of migrant and non-migrant care workers in Finland., Methods: Two cohorts were randomly sampled from nationwide registers and analysed together in a three-year follow-up design (2011-2013, 2014-2016). The pooled data consisted of 78,476 care workers, of whom 5% had a migrant background. Statistical methods included cross-tabulations and Poisson regression modelling., Results: Thirty-five percent of the Finnish-born care workers had at least one SA during the follow-up. Care workers from the post-2004 EU countries (30%, at least one SA), Russia, the Former Soviet Union and the Balkan states (25%) and the Global South and East (21%) had fewer episodes of SA than the Finnish-born care workers. The two latter groups also had lower SA rates after we controlled for occupation, gender, age, income and region of residence. Care workers from Western Europe and the Global North (36%) had higher SA rates than the Finnish-born care workers., Conclusions: The following explanations were discussed: population-level health differences - migrants from lower-income non-EU countries are generally healthier than the Finnish-born population (due to, e.g., the 'healthy migrant effect'); discrimination in recruitment and employment - migrants from lower-income non-EU countries need to be healthier than Finnish-born jobseekers to gain employment (in the care sector or more broadly); and sickness presenteeism - migrants from lower-income non-EU countries underuse their right to sickness allowance (due to, e.g., job insecurity). It is likely that these mechanisms affect migrants differently depending on, for example, their countries of origin and social status in Finland., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Aims: This paper describes the use of three governance tools for health in all policies utilised to facilitate implementation in the municipality of Kuopio, Finland: impact assessments, a city mandate (the Kuopio strategy), and shared budgets., Methods: An explanatory case study was used. Data sources included semistructured interviews with 10 government employees and scholarly literature. Realist scientific methods were used to reveal mechanisms underlying the use of tools in health in all policies., Results: Strong evidence was found supporting initial and new theory/hypotheses regarding the use of each tool in achieving positive implementation outcomes. Impact assessments facilitated health in all policies by enhancing understanding of health implications. The Kuopio strategy aided in implementation by giving credence to health in all policies work via formal authority. Shared budgets promoted intersectoral discussions and understanding, and a sense of ownership, in addition to allowing time to be spent on health in all policies work and not financial deliberation., Conclusions: Findings confirm the efficacious use of three governance tools in implementing health in all policies in Kuopio. Knowledge and evidence-based guidelines on local health in all policies implementation are needed as this policy approach continues to be recognised and adopted as a means to promote population health and health equity., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Previous studies have shown that manual workers use less psychotherapy than non-manual workers. However, little is known about the match between the use and the need of psychotherapy in different occupational grades. Our study investigates how the prevalence of mental distress corresponds to psychotherapy use rate in different occupational grades by gender., Methods: The data were collected from the Rise of Mental Vulnerability Study (use of psychotherapy) and the FinHealth 2017 Study (prevalence of mental distress). Adjusting for age, we calculated General Health Questionnaire (GHQ-12) caseness (a measure for mental distress), a 3-year psychotherapy use rate, and the ratio between GHQ caseness and the psychotherapy use rate in 3 occupational grades (upper non-manual employees, lower non-manual employees, and manual workers) for men and women separately., Results: In men, for 1 person having used psychotherapy there were 10 persons experiencing mental distress in upper non-manual workers, 14 in lower non-manual workers, and 31 in manual workers. In women, for 1 person having used psychotherapy, there were 6 persons experiencing mental distress in upper non-manual workers, 9 in lower non-manual workers, and 18 in manual workers., Conclusions: At the population level, manual employees use considerably less long-term psychotherapy than upper non-manual workers although their level of mental distress is high. This indicates a mismatch between symptoms and therapy, which was higher for men in all occupational grades.

Objectives: There is a need for up-to-date research on health-care and social managers' work well-being. The purpose was to develop a questionnaire for measuring health-care and social managers' subjective work well-being and to determine whether their background factors are connected to their work well-being., Material and Methods: The authors developed a questionnaire based on their previous health-care and social managers' work well-being framework. It covers 5 separate categories: 1) individual factors, 2) social factors, 3) professional support from one's own manager, 4) organizational factors, and 5) work-related factors. Using statistical methods, the authors examined the questionnaire's internal validity, its fit with the framework, and the connections between several background factors and work well-being. The survey data (N = 281) were collected from South Osthrobothnia and Central Osthrobothnia in Finland., Results: The questionnaire's internal validity was good, and it fit rather well with the authors' previous framework. Managers' work well-being was highest for the category of "professional support from one's own manager" and lowest for "organizational factors." The authors found connections between different categories of work well-being and a) years of managerial experience, b) level of management, and c) occupational group., Conclusions: The questionnaire gives a holistic view of managers' work well-being and is suit- able for measuring work well-being in the social- and health-care context. An examination showed that there is a need to improve the individual situations of the social- and health-care managers. The questionnaire can be used to assess managers' work well-being and to build a knowledge base for developing organizational policies. Int J Occup Med Environ Health. 2022;35(6):665-78., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP., Methods: A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation., Results: Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees., Conclusion: At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting., (© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Using fuzzy-set Qualitative Comparative Analysis (fsQCA), we present an alternative method for studying the social determinants of health (SDHs) that focuses on their configurational paths leading to population health outcomes. In our worked example, we examine the macrosocial determinants of infant mortality based on data covering 149 countries. First, we applied regression techniques to assess the net effects of key macrosocial determinants. Second, we used fsQCA to analyze the same data and identify the configurational paths. We calibrated the macrosocial determinants in terms of both advantages and disadvantages and revealed the configurations of (dis)advantages consistently linked to high infant mortality rates and low infant mortality rates. The regression analysis showed that the net effects of national economic performance, democracy level, inequality, and women's autonomy were all statistically significant. Together, they explained 83% of the variance in infant mortality rates between countries. Following the fuzzy-set analysis, the two main configurational paths to achieve low infant mortality rates were high women's autonomy together with high economic performance and high women's autonomy together with low inequality and full democracy. The main paths that left countries burdened with high infant mortality rates were low economic performance together with either low women's autonomy or high inequality. We conclude that different SDH configurations may lead to the same health outcomes. Therefore, it may not always be sufficient to say which variables matter the most universally, and by using fsQCA, it is possible to move from treating SDHs as competing independent variables to using them in configurations to explain health outcomes., (Copyright © 2022 The Author. Published by Elsevier Ltd.. All rights reserved.)

Background: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke., Methods: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family., Findings: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women., Interpretation: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time., Funding: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226., Competing Interests: None declared., (© 2022 The Author(s).)

Much of what has been written about decreased work ability is based on quantitative studies and has been written from the perspective of professionals, service providers or authorities. In our qualitative study, we sought to understand how affected individuals themselves perceive and experience the multifaceted factors that are related to their decreased work ability. Sixteen individuals in Finland with musculoskeletal diseases (MSD) participated in semi-structured interviews. The participants were potential clients of a multi-professional service pilot model, the TOIKE Work Ability Centre. Narrative and thematic analyses were utilised. The study found that individuals with decreased work ability have differing perspectives towards returning to work and often complex life situations. Five distinctive groups were identified based on self-assessed health, work ability and orientation towards work or pension: (1) the Successful; (2) the Persevering; (3) the Forward-looking; (4) the Stuck; and (5) the Pension-oriented. Health problems, unemployment, age discrimination, financial difficulties and skill deficits were the major challenges of the interviewees. Furthermore, they perceived the service and benefit systems as complicated. The TOIKE service proved useful to some of them. However, many had not utilised it due to a lack of understanding of its purpose. Identifying the distinctive groups and their needs may improve interventions. Ultimately, this may help to achieve Target 8.5 of the UN Sustainable Development Goals, which advocates the right to employment for all ages and for those with disabilities.

Background: Disparities in mortality have been firmly established across occupational grades and the incomes they earn, but this line of research has failed to include individuals' relationships to capital, as suggested by class analysists., Methods: According to Wright's classification, the research generated 10 mutually exclusive classes based on occupation and investment income: worker; capitalist worker; professional; capitalist professional; supervisor; capitalist supervisor; manager; capitalist manager; self-employed; and capitalist self-employed. The study participants (n=268 239) were randomly selected from the Statistics Finland population database and represent 33% of Finnish men aged 30-64 years. The mortality data were monitored over the 1995-2014 period., Results: The sociodemographic-adjusted HRs for mortality were lowest for capitalist managers (HR 0.50; 95% CI 0.36 to 0.69) as compared with that for workers without a capitalist class advantage. A positive occupational class gradient was found from managers to supervisors to workers. The capitalist class advantage independently affected the disparities in mortality within this occupational hierarchy., Conclusion: Different occupational class locations protect against premature death differently, and the capitalist class advantage widens the premature-death disparities among the occupational classes. To monitor and explain social inequalities in health in a more nuanced way, future research on investment income as well as the operationalisation of the capitalist class advantage is encouraged., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Much of the research about Health in All Policies (HiAP) implementation is descriptive, and there have been calls for more evaluative evidence to explain how and why successes and failures have occurred. In this cross-case study of six state- and national-level governments (California, Ecuador, Finland, Norway, Scotland and Thailand), we tested hypotheses about win-win strategies for engaging policy-makers in HiAP implementation drawing on components identified in our previous systems framework., Methods: We used two sources of data - key informant interviews and peer-reviewed and grey literature. Using a protocol, we created context-mechanism-outcome pattern configurations to articulate mechanisms that explain how win-win strategies work and fail in different contexts. We then applied our evidence for all cases to the systems framework. We assessed the quality of evidence within and across cases in terms of triangulation of sources and strength of evidence. We also strengthened hypothesis testing using replication logic., Results: We found robust evidence for two mechanisms about how and why win-win strategies build partnerships for HiAP implementation - the use of shared language and the value of multiple outcomes. Within our cases, the triangulation was strong, both hypotheses were supported by literal and contrast replications, and there was no support against them. For the third mechanism studied, using the public-health arguments win-win strategy, we only found evidence from Finland. Based on our systems framework, we expected that the most important system components to using win-win strategies are sectoral objectives, and we found empirical support for this prediction., Conclusions: We conclude that two mechanisms about how and why win-win strategies build partnerships for HiAP implementation - the use of shared language and the value of multiple outcomes - were found as relevant to the six settings. Both of these mechanisms trigger a process of developing synergies and releasing potentialities among different government sectors and these interactions between sectors often work through sectoral objectives. These mechanisms should be considered when designing future HiAP initiatives and their implementation to enhance the emergence of non-health sector policy-makers' engagement.

Our study sought to examine the implementation of Health 2015 [a public health programme prepared following the principles of Health in All Policies (HiAP)] between 2001 and 2015 in the context of welfare state restructuring. We used data from the realist multiple explanatory case study by HARMONICS, which focused on political factors (processes) that lead to the (un)successful implementation of programmes following the principles of HiAP. We analyzed data-key informant interviews, grey and scholarly literature-from our Finnish case to examine how Health 2015 implementation has been affected by the changing role of the state. We find that the dismantling of formal funding allocation decreased the capacity of national authorities to exert control over municipalities' health promotion work, diluting the financial arrangements regarding municipal obligations. As a result, most municipalities failed to contribute to Health 2015, resulting in losses for health promotion activities. Our results also point to joining the EU. Whereas the procedures for preparing Finland's unanimous positions on EU matters were useful in harmonizing ideologies on various policy issues between different ministries, joining the EU also increased commercial interests and the strength of the lobby system, leading to the prioritization of economic objectives over public health objectives. Finally, our informants also highlighted the changing relationship between the state and the market, manifested in market deregulation and increasing influence of pro-growth arguments during the implementation of Health 2015., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: The aim of the study was to investigate sickness absence due to mental disorders in human service occupations., Methods: Participants (n = 1,466,100) were randomly selected from two consecutive national 9-year cohorts from the Statistics Finland population database; each cohort represented a 33% sample of the Finnish population aged 25-54 years. These data were linked to diagnosis-specific records on receipt of sickness allowance, drawn from a national register maintained by the Social Insurance Institution of Finland, using personal identification numbers., Results: Sociodemographic-adjusted hazard ratios (HRs) for sickness absence due to mental disorders in all human service occupations combined were 1.76 for men (95% confidence interval [CI], 1.70-1.84) and 1.36 for women (95% CI, 1.34-1.38) compared with men and women in all other occupations, respectively. Of the 15 specific human service occupations, compared with occupations from the same skill/education level without a significant human service component, medical doctors, psychologists, and service clerks were the only occupations with no increased hazard for either sex, and the HRs were highest for male social care workers (HR 3.02; 95% CI, 2.67-3.41)., Conclusions: Most human service occupations had an increased risk of sickness absence due to mental disorders, and the increases in risks were especially high for men., (Copyright © 2018 Elsevier Inc. All rights reserved.)

As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (HIA) in Finland, we analyzed all 235 government bills on tax legislation over the years 2007-2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiAP., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Objectives: To examine antidepressant use among male and female human service professionals., Methods: A random sample of individuals between 25 years and 54 years of age (n=752 683; 49.2% women; mean age 39.5 years). Information about each individual's filled antidepressant prescriptions from 1995 to 2014 was provided by the Social Insurance Institution. First, antidepressant use in five broad human service categories was compared with that in all other occupations grouped together, separately for men and women. Then, each of the 15 human service professions were compared with all other occupations from the same skill/education level (excluding other human services professions). Cox models were applied and the results are presented as HRs for antidepressant use with 95% CIs., Results: The hazard of antidepressant use was higher among men working in human service versus all other occupations with the same skill/occupational level (1.22, 95% CI 1.18 to 1.27), but this was not the case for women (0.99, 95% CI 0.98 to 1.01). The risks differed between professions: male health and social care professionals (including medical doctors, nurses, practical nurses and home care assistants), social workers, childcare workers, teachers and psychologists had a higher risk of antidepressant use than men in non-human service occupations, whereas customer clerks had a lower risk., Conclusions: Male human service professionals had a higher risk of antidepressant use than men working in non-human service occupations. Gendered sociocultural norms and values related to specific occupations as well as occupational selection may be the cause of the elevated 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.)

Background: There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP., Methods: Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies - HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process., Results: We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP - the Health 2015 Strategy - in Finland, from 2001 onward., Conclusions: This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.

Background: Although income level may play a significant part in mortality among migrants, previous research has not focused on the relationship between income, migration and mortality risk. The aim of this register study was to compare all-cause mortality by income level between different migrant groups and the majority settled population of Finland., Methods: A random sample was drawn of 1,058,391 working age people (age range 18-64 years; 50.4% men) living in Finland in 2000 and linked to mortality data from 2001 to 2014. The data were obtained from Statistics Finland. Cox proportional hazards models were used to investigate the association between region of origin and all-cause mortality in low- and high-income groups., Results: The risk for all-cause mortality was significantly lower among migrants than among the settled majority population (hazards ratio (HR) 0.57; 95% confidence interval (CI) 0.53-0.62). After adjustment for age, sex, marital status, employment status and personal income, the risk of mortality was significantly reduced for low-income migrants compared with the settled majority population with a low income level (HR 0.46; 95% CI 0.42-0.50) and for high-income migrants compared with the high-income settled majority (HR 0.81; 95% CI 0.69-0.95). Results comparing individual high-income migrant groups and the settled population were not significant. Low-income migrants from Africa, the Middle East and Asia had the lowest mortality risk of any migrant group studied (HR 0.32; 95% CI 0.27-0.39)., Conclusions: Particularly low-income migrants seem to display a survival advantage compared with the corresponding income group in the settled majority population. Downward social mobility, differences in health-related lifestyles and the healthy migrant effect may explain this phenomenon.

Purpose: This study aimed to examine the long-term changes and socioeconomic disparities in hospitalization for affective and neurotic disorders among the Finnish working-age population from 1976 to 2010., Methods: Register-based study, consisting of a 5-year follow-up of 3,223,624 Finnish working-age (18-64-year old) individuals in seven consecutive cohorts. We calculated the hazard ratios of psychiatric hospitalization for different occupational classes using Cox regression models., Results: The risk of hospitalization for affective and neurotic disorders increased in all occupational classes after the economic recession in the 1990s, and then decreased in the 2000s. Before the 2000s, the risk was the highest among manual workers. In the 2000s the disparities between upper-level non-manual employees and other occupational classes increased. Hospitalization rates remained high among female manual workers and non-manual lower-level employees., Conclusions: This study revealed important similarities and differences between occupational classes in terms of long-term changes in hospitalization for affective and neurotic disorders. The results suggest that the labor market changes and healthcare reforms during the 1990s and 2000s in Finland have been more beneficial for higher than for lower occupational classes.

Background: The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change., Methodology: National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years., Principal Findings: Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed., Conclusions/significance: A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010.

Objective: To determine whether transitions in the hospitalization structure of different occupational groups have followed similar trends., Methods: Secular trends for all-cause hospitalization and five main diagnostic categories among six occupational groups were examined between 1976 and 2010 in Finland. The register-based study consisted of a 5-year follow-up of 1,126,499 Finnish working-aged residents in seven consecutive cohorts., Results: Altogether 451,737 hospitalizations were investigated in 1976 to 2010. The risks of all-cause hospitalization, mental disorders, and respiratory illnesses remained relatively stable, whereas that of musculoskeletal disorders increased (between 31% and 90%) and that of cardiovascular diseases decreased (between 41% and 62%) in all occupational groups. The highest variation was found for cancer., Conclusions: A common health transition pattern seems to have occurred in the occupational groups studied. Nevertheless, the health disparities between the groups were sustained.

Purpose: The aim of this study was to investigate the differences in hospitalizations between different industries in the Finnish working-age population between 1976 and 2010., Methods: Participants (n = 3,769,355) were randomly selected from seven independent consecutive national cohorts in the Statistics Finland population database, each representing a 25% sample of the working-age (18-65-year-old) population. These data were linked with diagnosis-specific records on hospitalizations, drawn from the National Hospital Discharge Registry (mean follow-up time per cohort was 4.1 years) using personal identification numbers., Results: Sociodemographics-adjusted models showed differences between the proportional hazard ratios of employment industries in all-cause hospitalization. These differences remained fairly stable (hazard ratio [HR], 0.95-1.24) throughout the 35-year period. The differences between industries varied the most in hospitalizations for mental disorders. These differences were substantial during 1976 to 1980 (HR, 1.16-2.29), decreased considerably and remained moderate between 1981 and 2000 (HR, 0.92-1.64), and then increased notably between 2001 and 2010 (HR, 1.09-2.34)., Conclusions: The cause-specific hospitalizations of different employment industries have varied, but the differences in all-cause hospitalizations have remained fairly stable, with the ranking among industries remaining almost the same over the past 35 years., (Copyright © 2014 Elsevier Inc. All rights reserved.)

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.

Purpose: The purpose of this study is to examine components of good personnel management and how they come true in accounts of social and health care managers., Design/methodology/approach: The data were obtained by means of a postal survey sent to middle-line managers in positions above the first-line management level in the responsibility area of Tampere University Hospital. The questionnaire was sent to 703 managers; 433 sent in responses indicating a response rate of 62 percent., Findings: Middle-line managers considered themselves as interactive, responsibility-sharing and understanding leaders, but found shortcomings in the leadership style of their superiors. Only 18 percent of the middle-line managers received feedback and only 42 percent received support from their superiors when needed. There were significant differences between genders, activity sectors and professional backgrounds in the responders' accounts concerning personnel management practices., Research Implications/limitations: The results of this study reliably describe how middle-line managers consider things to be, not necessarily how things are in reality., Practical Implications: The findings confirm the assumption that the importance of personnel management is still not perfectly understood in the upper management levels of the social and health care sector. At the same time the self-evaluations of middle-line managers implied an ambition towards better personnel management., Originality/value: This study identifies components of good personnel management from literature and uses them as the basis for analysing the data.