Information and assurance from healthcare workers (HCWs) is reported by laypeople as a key factor in their decision to get vaccinated. However, previous research has shown that, as in the general ...population, hesitancy towards vaccines exists among HCWs as well. Previous studies further suggest that HCWs with a higher confidence in vaccinations and vaccine providers are more willing to take the vaccines themselves and to recommend vaccines to patients. In the present study with 2962 Finnish HCWs (doctors, head nurses, nurses, and practical nurses), we explored the associations between HCWs' vaccination confidence (perceived benefit and safety of vaccines and trust in health professionals), their decisions to accept vaccines for themselves and their children, and their willingness to recommend vaccines to patients. The results showed that although the majority of HCWs had high confidence in vaccinations, a notable share reported low vaccination confidence. Moreover, in line with previous research, HCWs with higher confidence in the benefits and safety of vaccines were more likely to accept vaccines for their children and themselves, and to recommend vaccines to their patients. Trust in other health professionals was not directly related to vaccination or recommendation behavior. Confidence in the benefits and safety of vaccines was highest among doctors, and increased along with the educational level of the HCWs, suggesting a link between confidence and the degree of medical training. Ensuring high confidence in vaccines among HCWs may be important in maintaining high vaccine uptake in the general population.
Socioeconomic disadvantage is a risk factor for many diseases. We characterised cascades of these conditions by using a data-driven approach to examine the association between socioeconomic status ...and temporal sequences in the development of 56 common diseases and health conditions.
In this multi-cohort study, we used data from two Finnish prospective cohort studies: the Health and Social Support study and the Finnish Public Sector study. Our pooled prospective primary analysis data comprised 109 246 Finnish adults aged 17–77 years at study entry. We captured socioeconomic status using area deprivation and education at baseline (1998–2013). Participants were followed up for health conditions diagnosed according to the WHO International Classification of Diseases until 2016 using linkage to national health records. We tested the generalisability of our findings with an independent UK cohort study—the Whitehall II study (9838 people, baseline in 1997, follow-up to 2017)—using a further socioeconomic status indicator, occupational position.
During 1 110 831 person-years at risk, we recorded 245 573 hospitalisations in the Finnish cohorts; the corresponding numbers in the UK study were 60 946 hospitalisations in 186 572 person-years. Across the three socioeconomic position indicators and after adjustment for lifestyle factors, compared with more advantaged groups, low socioeconomic status was associated with increased risk for 18 (32·1%) of the 56 conditions. 16 diseases formed a cascade of inter-related health conditions with a hazard ratio greater than 5. This sequence began with psychiatric disorders, substance abuse, and self-harm, which were associated with later liver and renal diseases, ischaemic heart disease, cerebral infarction, chronic obstructive bronchitis, lung cancer, and dementia.
Our findings highlight the importance of mental health and behavioural problems in setting in motion the development of a range of socioeconomically patterned physical illnesses. Policy and health-care practice addressing psychological health issues in social context and early in the life course could be effective strategies for reducing health inequalities.
UK Medical Research Council, US National Institute on Aging, NordForsk, British Heart Foundation, Academy of Finland, and Helsinki Institute of Life Science.
Abstract
Background
Psychosocial job stressor studies usually examine one exposure at a time and focus on individual workers. In this study we examined the accumulation of work stressors in work ...units and its association with psychological distress (PD) on work-unit level. We also investigated whether high workplace social capital modifies the effect.
Methods
We examined survey responses from 813 Finnish health and social services (HSS) work units, comprising 9 502 employees, in a cross-sectional study design. The survey was conducted in 2021. We calculated odds ratios for the association between accumulating job stressors and PD. We also analyzed the interaction between work stressors and the effect modification of high workplace social capital.
Results
We found that HSS work units with high percentage of employees having high job demands and low rewards (OR 7.2, 95% CI 3.7, 13.8) have an increased risk of higher PD in the work unit. We also found indication of high social capital possibly modifying the effect of job stressors on PD. The results suggest that accumulated job stressors are associated with PD on work unit level, with excess risk for PD compared to the stressors acting separately.
Conclusions
The results indicate that the effect of accumulating job stressors should be further studied on work-unit level. Participatory organizational-level and work-unit level interventions to tackle job stressors and to improve workplace social capital are warranted.
Objectives The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension. Methods The work stressors job strain, effort-reward imbalance ...(ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models. Results Work stressors were clustered: 50.8% had no work stressors observed-to-expected ratio (O/E)=1.2, 27.4% were exposed to one stressor (O/E=0.61-0.81), 17.7% to two stressors (O/E=0.91-1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9-2.1-fold 95% confidence interval (CI) 1.7-2.6 increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0-1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4-4.7-fold (95% CI 2.4-8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9-2.5-fold (95% CI 1.1-4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6-1.9-fold (95% CI 1.3-2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0-1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings. Conclusions Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors.
Aim: During glaciations, the distribution of temperate species inhabiting the Northern Hemisphere generally contracts into southern refugia; and in boreo-alpine species of the Northern Hemisphere, ...expansion from Northern refugia is the general rule. Little is known about the drivers explaining vast distributions of species inhabiting multiple biogeographic regions (major biogeographic regions defined by the European Environmental Agency). Here we investigate the fine-scale phylogeography and evolutionary history of the Eurasian common lizard (Zootoca vivipara), the terrestrial reptile with the world's widest and highest latitudinal distribution, that inhabits multiple biogeographic regions. Location: Eurasia. Methods: We generated the largest molecular dataset to date of Z. vivipara, ran phylogenetic analyses, reconstructed its evolutionary history, determined the location of glacial refuges and reconstructed ancestral biogeographic regions. Results: The phylogenetic analyses revealed a complex evolutionary history, driven by expansions and contractions of the distribution due to glacials and interglacials, and the colonization of new biogeographic regions by all lineages of Z. vivipara. Many glacial refugia were detected, most were located close to the southern limit of the Last Glacial Maximum. Two subclades recolonized large areas covered by permafrost during the last glaciation: namely, Western and Northern Europe and North-Eastern Europe and Asia. Main conclusions: In Z. vivipara, most of the glacial refugia were located in the South of their current distribution. Previous studies suggested the existence of Northern refuges, but the species' inability to overwinter on permafrost and the lack of genetic support suggest that the presence of a refugia in the north of the Alps is unlikely. This species currently inhabits boreo-alpine climates and retracted during previous glaciations into southern refugia, as temperate species. Two clades exhibited enormous geographic expansion that started from two distinct glacial refugia. These phylogeographic patterns were highly congruent with those of Vipera berus. Together they suggest that glacial retraction, the location of the refugia and absence of competition may have promoted the enormous geographic expansion of two clades.
Objectives: The aim of this study was to examine whether changes in work shifts and shift intensity are related to changes in difficulties to fall asleep, fatigue, and sleep length. Methods: ...Questionnaire responses of hospital employees (N=7727, 93% women) in 2008, 2012, 2014 and 2015 were linked to daily-based records of working hours during three months preceding each survey. We used conditional logistic regression and longitudinal fixed-effects analyses to investigate odds ratios (OR) and 95% confidence intervals (CI) for each 25% within-individual change in the proportion of working hour characteristics in relation to changes in fatigue, difficulties to fall asleep, and 24-hour sleep length. Results: Change in night but not in morning or evening shifts was associated with parallel changes in odds for longer sleep length (OR 1.45, 95% CI 1.28-1.64) and fatigue during free days (OR 1.38, 95% CI 1.16-1.64). Similarly, short shift intervals and having ＞2 but not ＞4 consecutive night shifts were associated with increased odds of fatigue during work and difficulties to fall asleep (OR 1.42, 95% CI 1.19-1.72 and OR 1.10, 95% CI 1.05-1.19, respectively). Among workers aged ≥50 years, the associations were the strongest between night shifts and longer sleep (OR 2.24, 95% CI 1.52-3.81) and between higher proportion of short shift intervals and fatigue during free days (OR 1.68, 95% CI 1.10-2.54). Conclusions: Among shift workers with fatigue or sleep problems, decreasing the proportion of night shifts and quick returns and giving preference to quickly forward-rotating shift systems may reduce fatigue.
The prevalence of shift work disorder (SWD) has been studied using self‐reported data and the International Classification of Sleep Disorders, Second Edition (ICSD‐2) criteria. We examined the ...prevalence in relation to ICSD‐2 and ICSD‐3 criteria, work schedules and the number of non‐day shifts (work outside 06:00–18:00 hours) using objective working‐hours data. Secondly, we explored a minimum cut‐off for the occurrence of SWD symptoms. Hospital shift workers without (n = 1,813) and with night shifts (n = 2,917) and permanent night workers (n = 84) answered a survey (response rate 69%) on SWD and fatigue on days off. The prevalence of SWD was calculated for groups with ≥1, ≥3, ≥5 and ≥7 monthly non‐day shifts utilizing the working hours registry. ICSD‐3‐based SWD prevalence was 2.5%–3.7% (shift workers without nights), 2.6%–9.5% (shift workers with nights) and 6.0% (permanent night workers), depending on the cut‐off of non‐day shifts (≥7–1/month, respectively). The ICSD‐2‐based prevalence was higher: 7.1%–9.2%, 5.6%–33.5% and 16.7%, respectively. The prevalence was significantly higher among shift workers with than those without nights (p‐values <.001) when using the cut‐offs of ≥1–3 non‐day shifts. Shift workers with nights who had ≥3 days with ICSD‐3‐based SWD symptoms/month more commonly had fatigue on days off (49.3%) than those below the cut‐off (35.8%, p < .05). The ICSD‐3 criteria provided lower estimates for SWD prevalence than ISCD‐2 criteria, similarly to exclusion of employees with the fewest non‐day shifts. The results suggest that a plausible cut‐off for days with ICSD‐3‐based SWD symptoms is ≥3/month, resulting in 3%–6% prevalence of SWD.
Objectives Epidemiological studies suggest that long working hours and shift work may increase the risk of chronic diseases, but the "toxic" elements remain unclear due to crude assessment of working ...time patterns based on self-reports. In this methodological paper, we present and evaluate objective register-based algorithms for assessment of working time patterns and validate a method to retrieve standard payroll data on working hours from the employer electronic records. Methods Detailed working hour records from employers' registers were obtained for 12 391 nurses and physicians, a total 14.5 million separate work shifts from 2008–2013. We examined the quality and validity of the obtained register data and designed 29 algorithms characterizing four potentially health-relevant working time patterns: (i) length of the working hours; (ii) time of the day; (iii) shift intensity; and (iv) social aspects of the working hours. Results The collection of the company-based register data was feasible and the retrieved data matched with the originally published shift plans. The transferred working time records included <0.01% missing data. Two percent were duplicates that could be easily removed. The 29 variables of working time patterns, generated for each year, were stable across the follow-up (year-to-year correlation coefficients from r=0.7–0.9 for 23 variables), their distributions were as expected, and correlations of the variables within the four main dimensions of working hours were plausible. Conclusion The developed method and algorithms allow a detailed characterization of four main dimensions of working time patterns potentially relevant for health. We recommend this method for future large-scale epidemiological studies.
The physiological and behavioral mechanisms underlying life‐history trade‐offs are a continued source of debate. Testosterone (T) is one physiological factor proposed to mediate the trade‐off between ...reproduction and survival. We use phenotypic engineering and multiple laboratory and field fitness‐related phenotypic traits to test the effects of elevated T between two bank voleMyodes glareolusgroups: dominant and subordinate males. Males with naturally high T levels showed higher social status (laboratory dominance) and mobility (distance between capture sites) than low‐T males, and the effect of T on immune response was also T group specific, suggesting that behavioral strategies may exist in male bank voles due to the correlated responses of T. Exogenous T enhanced social status, mate searching (polygon of capture sites), mobility, and reproductive success (relative measure of pups sired). However, exogenous T also resulted in the reduction of immune function, but only in males from the high‐T group. This result may be explained either by the immunosuppression costs of T or by differential sensitivity of different behavioral strategies to steroids. Circulating T levels were found to be heritable; therefore, female bank voles would derive indirect genetic benefits via good genes from mating with males signaling dominance.
While marriage and education help maintain older adults' health, their joint association with mortality remains unclear. This cross-national study examined the combined effect of marriage and ...education on the mortality of older Japanese and Finnish adults.
Data on 22,415 Japanese and 11,993 Finnish adults, aged 65-74 years, were obtained from the Japan Gerontological Evaluation Study of 2010-2012 and the Finnish Public Sector Study of 2008-2009 and 2012-2013. We followed up on respondents' survival status for 5 years using public records. Marital status, educational level, and other variables in both datasets were harmonized.
The Cox proportional hazards model showed that unmarried men had a higher mortality risk than married men in both countries (hazard ratio HR 1.47; 95% confidence interval CI, 1.21-1.79 for Japanese and HR 1.94; 95% CI, 1.29-2.91 for Finnish); no such difference was observed in women. The highest mortality risk was observed in unmarried men with tertiary education in both Japan (HR 1.85; 95% CI, 1.21-2.83) and Finland (HR 2.21; 95% CI, 1.26-3.89), when adjusted for baseline age, health-related behaviors, and illnesses.
Our findings showed similarity in the combined effect of marriage and education between Japan and Finland, differing from observations in countries with more apparent socioeconomic health disparities. Further studies should examine the reasons for the excessive mortality risk in highly educated, unmarried men in both countries and consider whether selection bias led to underestimation of the true risk in unmarried older adults with lower education.
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