A considerable proportion of shift workers have work schedule-related insomnia and/or excessive sleepiness, a phenomenon described as shift work disorder (SWD). There is yet a lack of evidence on ...whether or not employees recover from symptoms of SWD between work shifts. We studied whether SWD and its subtypes are associated with insomnia and excessive sleepiness during weekly non-work days and with 24-h sleep time. Hospital employees answered a survey on SWD, insomnia and excessive sleepiness on weekly non-work days, and 24-h sleep. To identify shift workers with night shifts (n=2,900, 18% with SWD) and SWD, we linked survey responses to employers’ register on working hours. SWD included three subtypes: insomnia only (SWD-I, 4%, n=102), excessive sleepiness only (SWD-Es, 8%, n=244), and both insomnia and excessive sleepiness (SWD-IEs, 6%, n=183). Based on regression analyses, SWD was associated with excessive sleepiness on non-work days (OR: 1.42, 95% CI: 1.07–1.88) and with insomnia on non-work days (0.53, 0.31–0.91). SWD-I was associated with excessive sleepiness on non-work days (2.25, 1.31–3.87) and with shorter sleep (7–7.5 h: 1.96, 1.06–3.63; ≤6.5h: 2.39, 1.24–4.59; reference: ≥8 h). The results suggest that especially employees with SWD-I may need longer time to overcome excessive sleepiness than allowed by their roster.
To examine the relation between long working hours and change in body mass index (BMI).
We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, ...US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35-40 h, reference), 41-48 h, 49-54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m
) or (2) overweight (BMI 25-29.9 kg/m
) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m
) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline.
Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90-1.00) for part-time work, 1.07 (1.02-1.12) for 41-48 weekly working hours, 1.09 (1.03-1.16) for 49-54 h and 1.17 (1.08-1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity.
This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.
Objectives: The aim of this study was to examine occupational class differences in working more than six months beyond the mandatory retirement age and factors that may contribute to these ...differences. Methods: The study comprised a prospective cohort study of a total of 5331 Finnish municipal employees (73% women) who were not on work disability pension and reached the age eligible for old-age pension in 2005-2011. Occupational class included four categories: managers and professionals, lower grade non-manual, skilled manual, and elementary occupations. Survey responses while at work were linked to national health and pension registers. Results: A total of 921 participants (17.3%) worked beyond the pensionable age. Compared with elementary workers, skilled manual workers had a similar probability gender-adjusted risk ratio (RR) 0.95, 95% confidence interval (95% CI) 0.72-1.23 while lower grade non-manual workers had a 2.03-fold (95% CI 1.59-2.58), and managers and professionals had a 1.79-fold (95% CI 1.41-2.27) probability of working beyond the pensionable age. Adjustment for physical workload (32.0% in lower non-manual, 36.7% in managers and professionals), work time control (20.4% and 11.4%) and perceived work ability (16.5% and 29.1%) contributed to the largest attenuation for these associations. Analyses using a counterfactual approach suggested greater mediated effects for physical workload and work time control than those observed in traditional mediation analyses. Conclusions: Employees with higher occupational classes are two times more likely to continue working beyond the retirement age compared to those with lower occupational classes. A large proportion of these differences were explained by having physically light job, better work time control, and better self-rated work ability among employees with high occupational class.
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.
Amongst people of working age, the return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is an important marker of success of surgery. We determined when patients are able to ...return to work after ACL reconstruction and identified factors that are associated with the timing of RTW.
We used logistic regression analyses to examine patient-related factors that may be associated with the length of RTW (above vs. below the median 59 days) after arthroscopic ACLR in a large cohort of patients working in the public sector in Finland (n = 803; n = 334 male, n = 469 female; mean age 41 years SD 8.6).
The mean length of RTW was 65 days (SD 41). Higher odds ratios (OR) were observed for age groups 40-49 and ≥ 50 years compared with ≤ 30 years old (OR 2.0, 95% confidence interval 1.3-3.1 and 2.0, 1.2-3.4, respectively); for lower level non-manual and manual work compared with higher level non-manual work (3.0, 2.0-4.3 and 4.9, 3.4-7.0, respectively); and for those who had been on sick leave > 30 days in the preceding year (2.0, 1.4-2.9). Sex, comorbid conditions, preceding antidepressant treatment and concomitant procedures were not associated with the length of RTW.
Factors associated with prolonged sick leave beyond the median time of 59 days are higher age, lower occupational status, and preoperative sick leaves.
In response to the economic consequences of ageing of the population, governments are seeking ways with which people might work into older age. We examined the association of working conditions and ...health with extended employment (defined as >6 months beyond the pensionable age) in a cohort of older, non-disabled employees who have reached old-age retirement.
A total of 4,677 Finnish employees who reached their old-age pensionable date between 2005 and 2011 (mean age 59.8 years in 2005, 73% women) had their survey responses before pensionable age linked to national health and pension registers, resulting in a prospective cohort study.
In all, 832 participants (17.8%) extended their employment by more than 6 months beyond the pensionable date. After multivariable adjustment, the following factors were associated with extended employment: absence of diagnosed mental disorder (OR 1.25, 95% confidence interval = 1.01-1.54) and psychological distress (OR 1.68; 1.35-2.08) and of the work characteristics, high work time control (OR 2.31; 1.88-2.84). The projected probability of extended employment was 21.3% (19.5-23.1) among those free of psychiatric morbidity and with high work time control, while the corresponding probability was only 9.2% (7.4-11.4) among those with both psychiatric morbidity and poor work time control. The contribution of chronic somatic diseases was modest.
In the present study, good mental health in combination with the opportunity to control work time seem to be key factors in extended employment into older age. In addition, high work time control might promote work life participation irrespective of employees' somatic disease status.
This study aimed to examine duration of sickness absence due to knee osteoarthritis (OA) and sustained return to work (RTW) among municipal employees, who had at least one compensated sickness ...absence period due to knee OA. The contribution of sociodemographic characteristics, diabetes and previous sickness absence were assessed. We differentiated between participants with and without total knee arthroplasty (TKA).
Data from 123 506 employees in the Finnish Public Sector Study were linked with national health and mortality register information. There were 3 231 sickness absence periods (2372 participants) due to knee OA in 2005-2011. Kaplan-Meier curves for sustained RTW were obtained and median time with inter-quartile range (IQR) calculated for those with and without TKA. Cox regression analyses were carried out in multivariable analyses.
The median time to RTW from the beginning of sickness absence was 21-28 days when TKA was not related to sickness absence and 92-145 days when it was. Among participants with no TKA, age 60-64, non-sedentary work, diabetes, and previous sickness absences predicted longer time to RTW, while pain medication predicted a shorter time. Among participants with TKA, non-sedentary work and previous sickness absences predicted a longer time to RTW.
The clinical relevance of the difference in time to RTW between employees with or without TKA was substantial. Employees with knee OA working in physically demanding jobs need work modifications after TKA, and this calls for a dialog between occupational health care professionals and workplaces.
Abstract
Purpose
Alternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the ...implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector.
Methods
Two city administrations (A and D) that implemented an alternative duty work policy to their employees (
n
= 5341 and
n
= 7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (
n
= 6976 and
n
= 6720). The outcomes were the number of annual days, all episodes, and short-term (
<
10 days) episodes during the 2 years before versus the 2 years after the intervention year. We applied repeated measures negative binomial regression analyses, using the generalized estimating equations method and the difference-in-difference analysis to compare the intervention and control cities (adjusted for sex, age, type of job contract, occupational class).
Results
During the five-year study period, the number of sickness absence days and episodes increased in both the intervention and control cities. Covariate-adjusted analysis of relative risk showed that the overall increase in post- versus pre-intervention sickness absence days was smaller in intervention City A, RR = 1.14 (95% CI = 1.09–1.21) than in control cities B and C, RR = 1.19 (95% CI =1.14–1.24), group × time interaction
p
< 0.02. In intervention City D, we found a corresponding result regarding all sickness absence episodes and short-term sickness absence episodes but not days.
Conclusions
This follow-up suggests that implementing an alternative duty work policy may marginally decrease employees’ sickness absences.
To examine sleep disturbances as a predictor of cause-specific work disability and delayed return to work.
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.
Public sector employees in finland.
56,732 participants (mean age 44.4 years, 80% female), who were at work and free of work disability at the study inception.
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).
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.
Abstract
Background
Hospital physicians’ work includes on-call duties to provide 24/7 health care. Previous studies using self-reported survey data have associated long working hours and on-call work ...with sleep difficulties. To reduce recall bias, we complemented survey data with payroll-based objective data to study whether hospital physicians’ realized working hours are associated with sleep.
Methods
The study was nested within the Finnish Public Sector study. We used survey data on 728 hospital physicians (mean age 43.4 years, 62% females) from 2015 linked to realized daily working hour data from 3 months preceding the survey. The associations of working hour characteristics with sleep quantity and quality were studied with multinomial logistic regression analysis adjusted for demographics, overall stressfulness of life situation, control over scheduling of shifts, and hospital district.
Results
One fourth (26%) of the participants reported short (≤6.5 h) average sleep duration. Frequent night work (> 6 shifts/91 days) was associated with short sleep (OR 1.87 95%CI 1.23–2.83) compared to no night work. Approximately one third (32%) of the physicians reported insufficient sleep. Physicians with long weekly working hours (> 48 hours) had higher odds for insufficient sleep (OR 1.78 95%CI 1.15–2.76) than physicians with short weekly working hours (< 40 hours). Insufficient sleep was also associated with frequent on-call duties (> 12 shifts/3 months OR 2.00 95%CI 1.08–3.72), frequent night work (OR 1.60 95%CI 1.09–2.37), and frequent short shift intervals (≤11 hours; > 12 times/3 months OR 1.65 95%CI 1.01–2.69) compared to not having these working hour characteristics. Nearly half of the physicians (48%) reported at least one sleep difficulty at least two times a week and frequent night work increased odds for difficulties in initiating sleep (OR 2.43 95%CI 1.04–5.69). Otherwise sleep difficulties were not associated with the studied working hour characteristics.
Conclusion
We used realized working hour data to strengthen the evidence on on-call work and sleep quality and our results advice to limit the frequency of night work, on-call shifts, short shift intervals and long weekly working hours to promote hospital physicians’ sufficient sleep.
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