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OBJECTIVE: This study aimed to compare the utility of risk estimation derived from questionnaires and administrative records in predicting long-term sickness absence among shift workers.METHODS: This prospective cohort study comprised 3197 shift-working hospital employees (mean age 44.5 years, 88.0% women) who responded to a brief 8-item questionnaire on work disability risk factors and were linked to 28 variables on their working hour and workplace characteristics obtained from administrative registries at study baseline. The primary outcome was the first sickness absence lasting ≥90 days during a 4-year follow-up.RESULTS: The C-index of 0.73 [95% confidence interval (CI) 0.70–0.77] for a questionnaire-only based prediction model, 0.71 (95% CI 0.67–0.75) for an administrative records-only model, and 0.79 (95% CI 0.76–0.82) for a model combining variables from both data sources indicated good discriminatory ability. For a 5%-estimated risk as a threshold for positive test results, the detection rates were 76%, 74%, and 75% and the false positive rates were 40%, 45% and 34% for the three models. For a 20%-risk threshold, the corresponding detection rates were 14%, 8%, and 27% and the false positive rates were 2%, 2%, and 4%. To detect one true positive case with these models, the number of false positive cases accompanied varied between 7 and 10 using the 5%-estimated risk, and between 2 and 3 using the 20%-estimated risk cut-off. The pattern of results was similar using 30-day sickness absence as the outcome.CONCLUSIONS: The best predictive performance was reached with a model including both questionnaire responses and administrative records. Prediction was almost as accurate with models using only variables from one of these data sources. Further research is needed to examine the generalizability of these findings.

Abstract The global rise in life expectancy transforms age structure consequently having impact to the sustainability of social protection systems and working life. This descriptive study aimed to illustrate the annual prevalence of sustainable working life across Swedish residential regions, and investigate differences between age groups, sex, or being identical or fraternal twin. The study sample included 81,231 twins with linkage to national register data on sickness absence, disability pension, unemployment, and residential regions. Regions were classified by Swedish municipalities into nine groups. Sustainable working life were then followed in 1998, 2003, 2008, and 2013. Annual prevalence and Generalized Estimating Equation (GEE) with log linear models for interaction test were used. Medium to large size municipalities (15–24%) had higher annual prevalence of sustainable working life than smaller municipalities (1–7%). Young adults in medium to large size municipalities had high annual prevalence of sustainable working life. We found no differences for sexes or being identical or fraternal twin. To conclude, annual prevalence of sustainable working life in 1998, 2003, 2008 and 2013 differed by region being highest in medium to large size municipalities which may have importance for targeting policies, regulations, and practices in a region-specific way. Further studies on residential regions and sustainable working life would be merited to confirm associations and other influential factors.

Objective Currently, little is known regarding changes in family situation with concurrent changes in working life. This study aimed to examine whether changes in family situation (based on living with children and/or marrying/divorcing) were associated with changes in working life and whether the associations were influenced by sex, genetics and early life environment.Design Prospective cohort study.Setting and participants Data from Swedish national registers of 16 410 twins were used. Fixed-effects logistic regression models assessing ORs with 95% CIs were applied to examine associations between changes in family situation and working life controlling for time-invariant effects and adjusted for covariates, and conditional models to account for confounding of genetics and early life environment.Results Changes in individuals life situation from being single and living without children to married and living with children were associated with transitioning from unsustainable (ie, having unemployment or sickness absence/disability pension) to sustainable working life (men: OR 2.40, 95% CI 2.26 to 2.56; women: OR 1.68, 95% CI 1.59 to 1.78). Changes from being married to single, in contrast, attenuated the likelihood of transitioning to a sustainable working life. Moreover, changes in men’s working life seem to be more dependent on changes in family situation compared with women. Genetic factors and early life environment play a role in the associations.Conclusions Family formation increases the likelihood of a more stable working life whereas divorce is a risk factor for work interruptions. Our study emphasises that family formation improves the work life situation and to a higher degree for men.

Abstract Research‐based knowledge is essential for effective conservation and restoration of threatened aquatic species and habitats. Here, our aim was to gather this knowledge on the lake‐dwelling grayling (Thymallus thymallus), typically a riverine fish. Such atypical populations are particularly vulnerable to anthropogenic impacts, including fishing pressure, climate change, eutrophication and waterway construction, some of which affect especially the early life stages. However, there is little information available to guide management and conservation of grayling in lakes. Accordingly, we assessed characteristics of the nursery areas in the threatened grayling population of Lake Puruvesi (eastern Finland). In particular, we used beach seines in two consecutive years to sample lakeshore sites (including islands) that were a priori presumed suitable for grayling. We assessed the occurrence of grayling fry (larvae and post‐larvae

Abstract Background Stability or changes of health behaviours have not been studied in association with incidence of disability pension (DP). The aims were to (1) investigate if stability or changes in health behaviours predict DP due to musculoskeletal diagnosis (MSD), (2) to evaluate if an association exists for DP in general, and (3) after taking familial confounding into account. Methods The study sample was 16,713 like-sexed twin individuals born in Sweden between 1935-1958 (6195 complete twin pairs) who had participated in two surveys 25 years apart, were alive, and not pensioned at the time of the latest survey. Cox proportional hazards analysis was used to assess the associations (hazard ratios (HR) with 95% confidence intervals (CI)) between stability and change in health behaviours (physical activity, tobacco and alcohol use, body mass index (BMI)), and number of pain locations collected at two time points 25 years apart and the incidence of DP until 2008. Results During the follow-up, 1843 (11%) individuals were granted DP with 747 of these due to MSD. A higher proportion of women were granted DP than men. Increase in BMI and stable use of tobacco products were predictors for DP due to MSD (HR 1.21-1.48) and DP in general (HR 1.10-1.41). The stability in the frequency of physical activity and increased frequency of physical activity were protective factors for DP due to MSD only when accounting for familial confounding. However, the number of pain locations (stability, increase, or decrease) was the strongest predictor for future DP due to MSD (HR 3.69, CI 2.99-4.56) and DP in general (HR 2.15, CI 1.92-2.42). In discordant pair analysis, the HRs for pain were lower, indicating potential familial confounding. Conclusions Health behaviours in adulthood, including an increase in pain locations were associated with the incidence of DP. The association between physical activity and DP was especially related to adulthood choices or habits, i.e., the individual decision about frequency of exercising. Thus, it is important to e.g. increase public awareness of the potential beneficial effects of exercise throughout life to avoid permanent exclusion from the labour market for medical reasons.

Abstract Background Self-reported disability pension (DP) and sickness absence are commonly used in epidemiological and other studies as a measure of exposure or even as an outcome. The aims were (1) to compare such self-reports with national register information in order to evaluate the validity of self-reported DP and sickness absence, and (2) to estimate the concordance of reporting behaviour in different twin zygosity groups, also by sex. Methods All Swedish twins born 1933-1958 who participated in the Screening Across the Lifespan Twin study (SALT) 1998-2003, were included (31,122 individuals). The self-reported DP and long-term sickness absence (LTSA) at the time of interview was compared to the corresponding register information retrieved from the National Social Insurance Agency by calculating the proportions of agreements, kappa, sensitivity, specificity, concordance rates, and chi-square test, to evaluate construct validity. Results The proportions of overall agreement were 96% and specificity 99% for both DP and LTSA, while the sensitivity was 70% for DP and 45% for LTSA. Kappa estimates were 0.76 for DP, and 0.58 for LTSA. The proportions of positive agreement were 64% for DP and 42% for LTSA. No difference in response style was found between zygosity groups among complete twin pairs for DP and LTSA. Results were similar for women and men and across age. Kappa estimates for DP differed somewhat depending on years of education, 0.68 (college/university) vs. 0.77 (less than 13 years in school) but not for LTSA. Conclusions Self-reported DP data may be very useful in studies when register information is not available, however, register data is preferred especially for LTSA. The same degree of twin similarity was found for truthful self-report of DP and LTSA in both monozygotic and dizygotic twin pairs. Thus, the response style was not influenced by genetic factors. One consequence of this would be that when estimating the relative importance of genetic and environmental effects from twin models, heritability estimates would not be biased.

OBJECTIVE: This study aimed to find out whether utilizing a shift schedule evaluation tool with ergonomics recommendations for working hours has favorable effects on the incidence of occupational injuries. METHODS: This 4-year prospective cohort study (2015–2018) consisted of a dynamic cohort of healthcare shift workers (N=29 237) from ten hospital districts and six cities in Finland. Working hour characteristics and occupational injuries were measured with daily registry data. Multilevel generalized linear model was used for the analyses, and the estimates were controlled for hierarchical structure of the data and confounders. RESULTS: Ward heads of the cities used the shift schedule evaluation tool 3.2 times more often than ward heads of the hospital districts. Overall incidence of workplace and commuting injuries did not differ between users and non-users of the evaluation tool. The incidence of dislocations, sprains, and strains was lower in the users than non-users [adjusted odds ratio (OR) 0.88, 95% confidence interval (CI) 0.78–0.99]. Approximately 13% of this association was mediated by increase in realized shift wishes and 10% by increase in single days off. In subgroup analyses, the incidence of workplace injury (OR 0.83, 95% CI 0.69–0.99), and among types of injuries, the incidence of dislocations, sprains, and strains (OR 0.69, 95% CI 0.55–0.85) and falling, slipping, tripping, or overturning (OR 0.75, 95% CI 0.58–0.99) were lower in users than non-users among employees of the cities, but no association was found among employees of the hospital districts. CONCLUSION: The use of ergonomics recommendations for working hours is associated with a reduced risk of occupational injuries.

Abstract Background In health care, the shift work is arranged as irregular work shifts to provide operational hours for 24/7 care. We aimed to investigate working hour trends and turnover in health care via identification of time-related sequences of work shifts and absences among health care employees. The transitions between the work shifts (i.e., morning, day, evening, and night shifts), and absences (days off and other leaves) over time were analyzed and the predictors of change in irregular shift work were quantified. Methods A longitudinal cohort study was conducted using employer-owned payroll-based register data of objective and day-to-day working hours and absences of one hospital district in Finland from 2014 to 2019 (n = 4931 employees). The working hour data included start and end of work shifts, any kind of absence from work (days off, sickness absence, parental leave), and employee’s age, and sex. Daily work shifts and absences in 2014 and 2019 were used in sequence analysis. Generalized linear model was used to estimate how each identified sequence cluster was associated with sex and age. Results We identified four sequence clusters: “Morning” (60% in 2014 and 56% in 2019), “Varying shift types” (22% both in 2014 and 2019), “Employee turnover” (13% in 2014 and 3% in 2019), and “Unstable employment (5% in 2014 and 19% in 2019). The analysis of transitions from one cluster to another between 2014 and 2019 indicated that most employees stayed in the same clusters, and most often in the “Varying shift types” (60%) and “Morning” (72%) clusters. The majority of those who moved, moved to the cluster “Morning” in 2019 from “Employee turnover” (43%), “Unstable employment” (46%) or “Varying shift types” (21%). Women were more often than men in the clusters “Employee turnover” and “Unstable employment”, whereas older employees were more often in “Morning” and less often in the other cluster groups. Conclusion Four clusters with different combinations of work shifts and absences were identified. The transition rates between work shifts and absences with five years in between indicated that most employees stayed in the same clusters. The likelihood of a working hour pattern characterized by “Morning” seems to increase with age.

Objectives To investigate the concurrent changes in part-time work and sickness absence (SA) in healthcare. Another aim was to investigate the role of age and sex on different concurrent trajectory groups.Design Prospective cohort study.Setting Public hospital districts (n=10) and cities (n=11) in Finland.Participants Payroll-based objective working hour data of the healthcare sector in Finland for 28 969 employees in 2008–2019 were used. The final sample included those working shifts with 3 consecutive years of data and without baseline (≥14 days) SA.Primary outcomes Part-time work (yes or no) and months of SA.Measures Group-based trajectory modelling to identify concurrent changes in part-time work, and months of SA while controlling the time-variant amount of night work and multinomial regression models for relative risk (RR) with 95% CIs were used.Results Four-group trajectory model was the best solution: group 1 (61.2%) with full-time work and no SA, group 2 (16.9%) with slowly increasing probability of part-time work and low but mildly increasing SA, group 3 (17.6%) with increasing part-time work and no SA, and group 4 (4.3%) with fluctuating, increasing part-time work and highest and increasing levels of SA. Men had a lower (RR 0.49–0.75) and older age groups had a higher likelihood (RRs 1.32–3.79) of belonging to trajectory groups 2–4.Conclusions Most of the sample were in the trajectory group with full-time work and no SA. The probability of part-time work increased over time, linked with concurrent low increase or no SA. A minor group of employees had both an increased probability of part-time work and SA. Part-time work and other solutions might merit attention to promote sustainable working life among healthcare employees.

Abstract The aim was to investigate occurrence and duration of sickness absence (SA) among young employees with previous depression/anxiety in private and public sectors. This population-based prospective study included 11,519 Swedish twin individuals of age 19–29 years that were followed regarding SA during 2006–2016. Data on previous depression/anxiety came from two screening surveys in 2005. Data on SA and employment sector were received from national registries. Descriptive statistics and logistic regression were used, also controlling for familial factors. Proportion of employees with SA was significantly higher among those with, as compared to those without, previous depression/anxiety, regardless the employment sector. Individuals with previous depression/anxiety had increased risk for future SA, in both private (OR 2.25, 95% CI 1.90–2.66) and public sectors (OR 2.10, 95% CI 1.73–2.54). Familial factors played a role in the association among employees in the private sector. A higher proportion of long-term SA was observed among employees with previous depression/anxiety in the private as compared to the public sector. To conclude, previous depression/anxiety tends to increase risk for SA among young employees in both employment sectors, whereas long-term SA seemed to be more prevalent among those in the private as compared to the public sector.

Objectives To develop a risk prediction algorithm for identifying work units with increased risk of violence in the workplace.Design Prospective cohort study.Setting Public sector employees in Finland.Participants 18 540 nurses, social and youth workers, and teachers from 4276 work units who completed a survey on work characteristics, including prevalence and frequency of workplace violence/threat of violence at baseline in 2018–2019 and at follow-up in 2020–2021. Those who reported daily or weekly exposure to violence or threat of violence daily at baseline were excluded.Exposures Mean scores of responses to 87 survey items at baseline were calculated for each work unit, and those scores were then assigned to each employee within that work unit. The scores measured sociodemographic characteristics and work characteristics of the work unit.Primary outcome measure Increase in workplace violence between baseline and follow-up (0=no increase, 1=increase).Results A total of 7% (323/4487) of the registered nurses, 15% (457/3109) of the practical nurses, 5% of the social and youth workers (162/3442) and 5% of the teachers (360/7502) reported more frequent violence/threat of violence at follow-up than at baseline. The area under the curve values estimating the prediction accuracy of the prediction models were 0.72 for social and youth workers, 0.67 for nurses, and 0.63 for teachers. The risk prediction model for registered nurses included five work unit characteristics associated with more frequent violence at follow-up. The model for practical nurses included six characteristics, the model for social and youth workers seven characteristics and the model for teachers included four characteristics statistically significantly associated with higher likelihood of increased violence.Conclusions The generated risk prediction models identified employees working in work units with high likelihood of future workplace violence with reasonable accuracy. These survey-based algorithms can be used to target interventions to prevent workplace violence.

Perceived privacy and its association with short sickness absences at the office suggest that occupational health care has a potential role in prevention when premises are developed. Employees' views of possibilities to concentrate at the office should be especially considered. In addition, individual support for workability may be necessary. Objective: To investigate perceived task privacy in 2022 associated with short (1–3 days) self-certified sickness absence (SA) in 2023. Methods: A prospective cohort of 1400 Finnish office workers with survey data in 2022 about, for example, task privacy, telework, and office type were linked with employer-owned register data of SA in 2022–2023. Poisson regression models were used to obtain risk ratios with 95% confidence intervals. Results: Each one-unit increase in task privacy was associated with a less likely short SA (risk ratio, 0.83–0.89; 95% confidence interval, 0.74–0.97), also across the amount of telework in 2022. The association was only statistically significant in activity-based offices. Conclusions: Each one-unit increase in perceived task privacy at the office was associated with less likely short, self-certified, 1–3 days SA. Task privacy is an important factor to be considered in offices. [ABSTRACT FROM AUTHOR]

Administrative data accumulating daily from hospitals would provide new possibilities to assess work shifts and patient care. We aimed to investigate associations of work unit level average work shift length and length of patient in-hospital stay, and to examine the role of nurse-patient-ratio, year, night work, age, work units and working hours at the work units for these estimations. The data for this study were based on combined administrative day-to-day patient and pay-roll based objective working hour data of employees of one hospital district in Finland for 2013-2019. Three patient measures were calculated: the overall length of in-hospital stay, the length of in-hospital stay before a medical procedure and the length of in-hospital stay after a medical procedure. A Generalized Linear Mixed Model (GLMM) with multivariate normal random effects was used with Penalized Quasi-Likelihood for relative risk ratios (RR) with 95% confidence intervals (CI). The results showed that compared to 10 hours work shifts were associated with a decreased likelihood of the overall length of in-hospital stay (RR 0.94, 95% CI 0.94, 0.95) and length of in-hospital stay after a medical procedure among all occupations (RR 0.94, 95% CI 0.92, 0.97). These associations retained the magnitude and direction in the models additionally adjusted for work, employee, and patient characteristics, and the associations were weaker for nurses than among all occupations. To conclude, compared with the standard work shifts, 8-10 hours work shifts seem to be associated with longer, and >10 hours work shifts with shorter length of in-hospital stay. Administrative data provides feasible possibilities to investigate working hours and length of in-hospital stay.

Objectives Chronic thromboembolic pulmonary hypertension (CTEPH) is associated with thrombotic states including elevated coagulation factor VIII (FVIII). Pulmonary endarterectomy (PEA) is the main treatment for CTEPH, and efficient anticoagulation is essential to prevent thromboembolism recurrence after surgery. We aimed to characterize longitudinal changes in FVIII and other coagulation biomarkers after PEA. Methods Coagulation biomarker levels were measured at baseline and up to 12 months after operation in 17 consecutive patients with PEA. Temporal patterns of coagulation biomarkers, and correlation of FVIII with other coagulation biomarkers, were analyzed. Results Baseline FVIII levels were elevated in 71% of the patients (mean 216 ± 67 IU/dl). FVIII doubled 7 days after PEA, peaking at 471 ± 87 IU/dl, and gradually returned to respective baseline levels within 3 months. Postoperative fibrinogen levels were also elevated. Antithrombin decreased at 1 to 3 days, D-dimer increased at 1 to 4 weeks, and thrombocytosis was observed at 2 weeks. Conclusions FVIII is elevated in most patients with CTEPH. After PEA, early but transient elevation of FVIII and fibrinogen, and delayed reactive thrombocytosis, occurs, and warrants careful postoperative anticoagulation to prevent thromboembolism recurrence.

BackgroundThe association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working

Aim: To investigate concurrent changes in short shift intervals (< 11 h) and workload among hospital employees. Design and Data Sources: This cohort study of 1904 employees in one hospital district in Finland utilised data on employees' working hours for short shift intervals and workload based on the patient classifications aggregated to a 3‐week period level across 2 years, 2018–2019. The data was analysed by group‐based trajectory modelling and multinominal regression models. Results: The seven trajectories model had the best fit to the data—Group 1: very few short shift intervals that are decreasing and low workload (15.0%); Group 2: a low amount of short shift intervals that are decreasing and stable low workload (14.2%); Group 3: moderate amount of short shift intervals that are slightly increasing and low workload (25.1%); Group 4: a low amount of short shift intervals that are slightly decreasing and stable low workload that is slightly increasing (12.1%): Group 5: a moderate amount of both short shift intervals and workload (19.8%): Group 6: short shift intervals that are clearly decreasing, with higher than the average workload decreasing (5.6%); Group 7: moderate amount of short shift intervals and very high workload (8.3%). Conclusions: Only a minority of hospital employees were found to have both high workloads and insufficient recovery possibilities, but the time‐related increases in objective workload were not compensated by better recovery possibilities in working hours. For shift scheduling, it is noteworthy that older employees might seek to work at units in which the workload is lower, which could be considered to support workability. Reporting Method: Record. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed to examine the contribution of shift work, work time control (WTC) and informal caregiving, separately and in combination, to sleep disturbances in ageing employees. METHODS: Survey data were obtained from two prospective cohort studies with repeated measurements of working conditions, informal caregiving, and sleep disturbances. We used fixed-effect conditional logistic regression analysis to examine whether within-individual changes in shift work, WTC and informal caregiving were associated with changes in sleep. Secondary analyses included between-individuals comparison using standard logistic regression models. Results from the two cohorts were pooled using meta-analysis. RESULTS: Low WTC and informal caregiving were associated with sleep disturbances in within-individual analyses [odds ratios (OR) ranging between 1.13 (95% confidence interval 1.01–1.27) and 1.48 (95% CI 1.29–1.68)] and in between-individuals analyses [OR 1.14 (95% CI 1.03–1.26) to 1.33 (1.19–1.49)]. Shift work alone was not associated with sleep disturbances, but accumulated exposure to shift work, low WTC and informal caregiving was associated with higher risk of sleep disturbances (OR range 1.21–1.76). For some of the sleep outcomes, informal caregiving was related to a higher risk of sleep disturbances when WTC was low and a lower risk when WTC was high. CONCLUSIONS: Informal caregiving and low WTC are associated with risk of sleep disturbances among ageing employees. The findings also suggest that low WTC in combination with informal caregiving may increase the risk of sleep disturbances whereas high WTC may alleviate the adverse impact of informal caregiving on sleep.