To evaluate whether confounding by several known or suspected coronary heart disease risk factors are likely to explain the lower coronary heart disease risk among light alcohol drinkers compared with never-drinkers.
A population-based cross-sectional study.
Hypertension, body mass index (BMI), diabetes, depression, sleep disturbances, smoking, physical activity, life satisfaction, psychological distress, trait anxiety, independent and dependent life events, length of working hours, job control, job strain and effort-reward imbalance were compared between never-drinkers and light drinkers (
This study examined whether sleep duration changes during the transition from full-time work to statutory retirement and, if this were the case, which preretirement factors, including sociodemographic, work, lifestyle, and health factors, predict these changes.
Data from repeated surveys of the Finnish Public Sector study, linked to records of retirement, were used. The study population consisted of 5785 participants who retired on a statutory basis in 2000-2011 and who had responded to surveys on sleep duration at least once immediately before and after their retirement (mean number of repeat study waves 3.6). Linear regression analyses with generalized estimating equations were used to examine changes in sleep duration around retirement.
Before retirement there was a slight decrease in sleep duration. During the 4-year retirement transition, sleep duration increased from 7 hours 0 minutes (95% confidence interval [CI] 6 hours 54 minutes to 7 hours 6 minutes) to 7 hours and 22 minutes (95% CI 7 hours 16 minutes to 7 hours 27 minutes); thus, mean increase being 22 minutes. Increase in sleep duration was greatest in those who were short sleepers, heavy drinkers, or had sleep difficulties. After the retirement transition, sleep duration remained at approximately the same level, as no significant changes were observed.
This longitudinal study suggests that transition from full-time work to statutory retirement is associated with an increase in sleep duration.
Psychological factors may be important determinants of adherence to antihypertensive medication, as they have been repeatedly found to be associated with an increased risk of hypertension, coronary heart disease, and health-damaging behaviours. We examined the importance of several psychological attributes (sense of coherence, optimism, pessimism, hostility, anxiety) with regard to antihypertensive medication adherence assessed by pharmacy refill records.
A total of 1021 hypertensive participants, aged 26-63 years, who were employees in eight towns and 12 hospitals in Finland were included in the analyses.
We found 60% of patients to be totally adherent, 36% partially adherent, and 4% totally nonadherent. Multinomial regression analyses revealed high sense of coherence to be associated with lower odds of being totally nonadherent in contrast of being totally adherent (odds ratio=0.55; 95% confidence interval: 0.31-0.96). This association was independent of factors that influenced adherence to antihypertensive medication, such as sociodemographic characteristics, health-related behaviours, self-reported medical history of doctor-diagnosed comorbidity, and anteriority of hypertension status. The association was not specific to certain types of antihypertensive drugs.
High sense of coherence may influence antihypertensive medication-adherence behaviour. Aspects characterizing this psychological attribute, such as knowledge (comprehensibility), capacity (manageability), and motivation (meaningfulness) may be important determinants of adherence behaviour for asymptomatic illnesses, such as hypertension, in which patients often do not feel or perceive the immediate consequences of skipping medication doses.
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The dichotomy employed vs. unemployed is still a relevant, but rather crude measure of status in current labour markets. Also, studies concerning the association of employment status with health have to specify the type of the employment as well as the characteristics of the unemployment. This study aims to reveal differences and potential inequalities in physician visits among seven groups in the core-periphery structures of the labour markets.
A total of 16,000 Finns responded to a postal survey in 2003. Their visits to physicians in public primary health care, occupational health care, private health services, hospital outpatient clinics and dental care services during previous year were measured as indicators of service utilisation. Participants were classified as employees having a permanent or fixed-term and full-time or part-time contract and as those experiencing short-term, prolonged or long-term unemployment. Differences in the one-year coverage of physician visits between these groups of employees were analysed using logistic regression analyses where differences in the need for services were controlled for by including demographics and self-rated health assessments in the models.
Permanently employed respondents had visited a physician most often, and the need-adjusted regression models showed significantly lower odds ratios for a visit among fixed-term employees (OR 0.65, 95% CI 0.53-0.81) and in particular among the long-term unemployed (OR 0.21, 95% CI 0.14-0.31). A stratified analysis according to health care sector showed the lowest odds ratios in occupational health care and private physicians (ORs between 0.05 and 0.73) and also low odds ratios for dentists (ORs between 0.45 and 0.91), whereas visits to public primary health care were more common among non-permanent employees and the unemployed (ORs between 1.46 and 2.39).
The use of physician services varies according to labour market status, being relatively low among the non-permanently employed and the unemployed. This underuse is emphasised when clinical need is taken into account. The main reasons for the variance evidently lie in the structures of the Finnish health service system. The result may indicate non-optimal health care of the population on the periphery of the labour market, but it may also reflect the importance of employment status as a context for need and the decision to visit a physician.
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With the growth of atypical employment, there is increasing concern about the potential health-damaging effects of unstable employment. This prospective study of Finnish public-sector employees in 1998-2002 examined labor market trajectories and changes in health. At entry, all participants had a fixed-term job contract. Trajectories were measured by exposure to unstable employment during follow-up, destination employment status at the end of follow-up, and the way in which these elements were combined. Nonoptimal self-rated health at baseline was associated with high exposure to unstable employment and unemployment as the destination. After adjustment for health and psychological distress at baseline, a trajectory with stable employment as the destination was associated with a decreased risk of psychological distress at follow-up (odds ratio = 0.68, 95% confidence interval: 0.46, 0.98), whereas a trajectory toward the labor market periphery was related to increased risk of nonoptimal health (odds ratio = 2.54, 95% confidence interval: 1.47, 4.39) when compared with remaining in fixed-term employment. A significant dose-response relation was seen between the measure combining exposure to instability with destination employment status and nonoptimal health. This longitudinal study provides evidence of health-related selection into employment trajectories and suggests that the trajectories themselves carry different health risks.
This study aimed to examine the longitudinal association of workplace violence with disturbed sleep and the moderating role of organisational justice (ie, the extent to which employees are treated with fairness) in teaching.
We identified 4988 teachers participating in the Finnish Public Sector study who reported encountering violence at work. Disturbed sleep was measured in three waves with 2-year intervals: the wave preceding exposure to violence, the wave of exposure and the wave following the exposure. Data on procedural and interactional justice were obtained from the wave of exposure to violence. The associations were examined using repeated measures log-binomial regression analysis with the generalised estimating equations method, adjusting for gender and age.
Exposure to violence was associated with an increase in disturbed sleep (RR 1.32 (95% CI 1.15 to 1.52)) that also persisted after the exposure (RR 1.26 (95% CI 1.07 to 1.48)). The increase was higher among teachers perceiving the managerial practices as relatively unfair (RR 1.46 (95% CI 1.01 to 2.09) and RR 1.59 (95% CI 1.04 to 2.42) for interactional and procedural justice, respectively). By contrast, working in high-justice conditions seemed to protect teachers from the negative effect of violence on sleep.
Our findings show an increase in sleep disturbances due to exposure to workplace violence in teaching. However, the extent to which teachers are treated with justice moderates this association. Although preventive measures for violence should be prioritised, resources aimed at promoting justice at schools can mitigate sleep problems associated with workplace violence.
We examined whether having a high percentage of pupils with special educational needs (SEN) in basic education schools increases the risk of sickness absence among teachers and whether this risk is dependent on the pupil-teacher ratio (PTR), an indicator of teacher resources at school.
We obtained register data on 8089 teachers working in 404 schools in 10 municipalities in Finland during the school year 2004-2005. We used multilevel multinomial regression models to examine the risk of teachers' short- and long-term sickness absence in relation to the percentage of SEN pupils and the PTR at school. We tested the equality of trends in groups with high and low PTR using PTR × SEN interaction term.
After adjustment for teacher and school characteristics, the risk for long-term absences was higher among teachers at schools with a high percentage of SEN pupils than among teachers at schools with a low percentage of SEN pupils [odds ratio (OR) 1.5, 95% confidence interval (95% CI) 1.2-1.8). This was also the case for short-term absences (OR 1.4, 95% CI 1.2-1.7). In analyses stratified by the PTR levels, the association between the percentage of SEN pupils and long-term absences was 15% higher among teachers with a high PTR than among those with a low PTR (P for interaction=0.10).
Teachers' sickness absenteeism seems to increase with a higher percentage of SEN pupils, especially when the PTR is high. Teacher resources at schools that have a high percentage of SEN pupils should be well maintained to ensure the health of teachers.
The majority of the research on the effects of the psychosocial work environment on sickness absenteeism has focused on components of job strain and social support among public sector employees without stratification by socioeconomic status. The authors examined less-studied work-related psychosocial predictors of sickness absence in the private sector by socioeconomic status.
Questionnaire data on psychosocial factors at work were used to predict the rates of recorded short (1-3 days), long (4-21 days), and very long (over 21 days) sickness absences among 3,850 white- and blue-collar male and female employees in a large-scale enterprise. Multivariate Poisson regression models were adjusted for age, prior absence, and psychosocial factors at work.
In white-collar men, low role clarity was associated with a 3.0 (95% CI 1.3-7.1) times greater rate of very long absences than high role clarity. Low fairness in the division of labor predicted a 1.3-fold (95% CI 1.1-1.5) rate of long absences in blue-collar men. In blue-collar women, poor organizational climate was associated with a 1.6 (95% CI 1.0-2.5) times greater rate of short absence spells than favorable organizational climate but among white-collar women all associations between work-related psychosocial factors and sickness absenteeism were weak.
These findings indicate that the actions to reduce psychosocial risk factors of sickness absence should match the specific needs of each socioeconomic group.
This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (>9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.
Primary nursing and team nursing are two different ways of organizing nurses' work in hospital wards. This study examined whether primary nursing is associated with lower sickness absence rates than team nursing is.
Altogether 1213 nurses from 13 primary nursing wards and 13 team nursing wards participated in a 3-year observational study. The nurses' sickness absence records were linked with information on the organization of nursing in the wards.
After adjustment for demographic and ward characteristics, primary nursing, compared with team nursing, was associated with 26-42% higher annual rates of short (1-3 days) spells of sickness absence (P3 days) absences, depending on the year (P