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 (
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.
Cites: J Gen Intern Med. 2002 Jul;17(7):504-1112133140
Cites: Am J Nurs. 2001 Jun;101(6):37-43; quiz 4411441760
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.
An increasing proportion of the population lives in one-person households. The authors examined whether living alone predicts the use of antidepressant medication and whether socioeconomic, psychosocial, or behavioral factors explain this association.
The participants were a nationally representative sample of working-age Finns from the Health 2000 Study, totaling 1695 men and 1776 women with a mean age of 44.6 years. In the baseline survey in 2000, living arrangements (living alone vs. not) and potential explanatory factors, including psychosocial factors (social support, work climate, hostility), sociodemographic factors (occupational grade, education, income, unemployment, urbanicity, rental living, housing conditions), and health behaviors (smoking, alcohol use, physical activity, obesity), were measured. Antidepressant medication use was followed up from 2000 to 2008 through linkage to national prescription registers.
Participants living alone had a 1.81-fold (CI = 1.46-2.23) higher purchase rate of antidepressants during the follow-up period than those who did not live alone. Adjustment for sociodemographic factors attenuated this association by 21% (adjusted OR = 1.64, CI = 1.32-2.05). The corresponding attenuation was 12% after adjustment for psychosocial factors (adjusted OR = 1.71, CI = 1.38-2.11) and 9% after adjustment for health behaviors (adjusted OR = 1.74, CI = 1.41-2.14). Gender-stratified analyses showed that in women the greatest attenuation was related to sociodemographic factors and in men to psychosocial factors.
These data suggest that people living alone may be at increased risk of developing mental health problems. The public health value is in recognizing that people who live alone are more likely to have material and psychosocial problems that may contribute to excess mental health problems in this population group.
Occupational stress is assumed to arise from social arrangements that are partially determined by the modes of organization of work. However, there is little systematic research on the extent to which modes of organizing nursing work are related to stressful characteristics of work.
This study explored the relationship between modes of organizing nursing and stress.
Survey responses on modes of organization of nursing were collected from 27 ward sisters and those on stressful work characteristics from 568 nurses working in 27 wards with different nursing modes.
Four different nursing modes (primary, modular, team and functional nursing) were not consistently associated with stress. Statistically significant associations involved only certain features of these modes and specific components of stress. After the effects of demographic and ward characteristics were controlled for, hierarchical regression analyses showed that opportunity to write nursing notes decreased the likelihood of nurses' stress because of problems in interpersonal relationships. Writing nursing notes is common in patient-focused nursing modes (primary and modular nursing). Other features of nursing modes were not associated with stress.
In general, nursing mode is not associated with stressful job characteristics. However, certain aspects of patient-focused nursing reduce the likelihood of interpersonal problems among staff.
This study examined the relationship between methods of organizing nursing and employee satisfaction. Data were collected from 26 ward sisters and 568 nurses working in 26 bed wards with different stabilized nursing models. Methods of organizing nursing, such as primary, modular, team and functional nursing, were associated with job satisfaction. However, this association involved only certain features of these organizational models and specific components of satisfaction. After the effects of demographic and ward characteristics were partialed out, hierarchical regression analyses showed that patient-focused work allocation, opportunity to write nursing notes and accountability for patient care contributed to nurses' satisfaction with supervision and personal growth. The relationships of duty rota and liaison with other discipline to job satisfaction were weaker or non-existing.
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.
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