Little is known about the U-shaped relation between alcohol intake and health beyond findings related to cardiovascular disease. Medically certified sickness absence is a health indicator in which coronary heart disease is only a minor factor. To investigate the relation between alcohol intake and sickness absence, records regarding medically certified sick leaves from all causes were assessed for 4 years (1997-2000) in a cohort of 1,490 male and 4,952 female municipal employees in Finland. Hierarchical Poisson regression, adjusted for self-reported behavioral and biologic risk factors, psychosocial risk factors, and cardiovascular diseases, was used to estimate the rate ratios and their 95% confidence intervals, relating sickness absence to each level of alcohol consumption. For both men and women, a significant curvilinear trend was found between level of average weekly alcohol consumption and sickness absence. The rates of medically certified sickness absence were 1.2-fold higher (95% confidence interval: 1.1, 1.3) for never, former, and heavy drinkers compared with light drinkers. The U-shaped relation between alcohol intake and health is not likely to be explained by confounding due to psychosocial differences or inclusion of former drinkers in the nondrinkers category. Moderate alcohol consumption also may reduce health problems other than cardiovascular disease.
We examined the associations of contractual job insecurity (fixed-term vs permanent employment contract) and subjectively assessed job insecurity with sickness presenteeism among those who had no sickness absences during the study year.
Survey data from a sample of 18,454 Public sector employees were gathered in 2004 (the Finnish Public Sector study).
Fixed-term employees were less likely to report working while ill (odds ratio = 0.88, 95% confidence interval = 0.77 to 0.99) than permanent employees. Subjective insecurity was associated with higher levels of working while ill, and this association was stronger among older employees. These results remained after adjustments for demographics, health-related variables, and optimism.
Our results suggest that subjective job insecurity might be even more important than contractual insecurity when a public sector employee makes the decision to go to work despite feeling ill.
The aim of this study was to examine whether vandalism, bullying, and truancy among pupils at school are associated with absence due to illness among teachers. Data on such problem behaviour of 17,033 pupils in 90 schools were linked to absence records of 2364 teachers. Pupil reported vandalism and bullying at the school-level were associated with teachers' short-term (1- to 3-day) absences. Cumulative exposure to various forms of pupils' problem behaviour was associated with even higher rates of short-term absences among teachers. No association was found between pupils' problem behaviour and teachers' long-term (>3-day) absences. In conclusion, there seems to be a link between pupils' problem behaviour and teachers' short-term absence due to illness. Further work should determine whether problem behaviour is a cause or a consequence of absences or whether the association is noncausal.
We investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design.
Finnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1?year of the survey and control period refers to not being sickness absent within 1?year of the survey.
Periods of heavy drinking were associated with increased odds of self-certified short-term (1-3 days) sickness absence (multivariable-adjusted OR 1.21, 95%?CI 1.07 to 1.38 for all participants; 1.62, 95%?CI 1.19 to 2.21 for men and 1.15, 95%?CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95%?CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95%?CI 0.69 to 1.00). Both increase (OR=1.38, 95%?CI 1.21 to 1.57) and decrease (OR=1.27, 95%?CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence.
Increase in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk.
The impact of sleep apnea on work disability, in terms of sickness absence and disability pension, is unclear. We sought to estimate the total number of lost workdays caused by sleep apnea either due to medically certified sickness absences or disability pensions during the 5 years prior to the year of a sleep apnea diagnosis.
This is a register-linkage case-control study of Finnish public sector employees who had received a diagnosis of sleep apnea between 1995 and 2005 (n = 957) and randomly selected control subjects who had not received a diagnosis of sleep apnea (n = 4,785), matched for age, gender, socioeconomic position, type of employment, and organization. The annual sum of lost workdays, due to either medically certified sickness absences or disability pensions prior to diagnosis, was calculated for each participant (mean follow-up time, 5 years).
After adjustment for comorbid conditions (eg, hypertension, ischemic heart disease, diabetes, asthma/other chronic lung disease, and depression), an increased risk of lost workdays was found in employees in whom sleep apnea developed compared to control subjects (rate ratio [RR], 1.61; 95% confidence interval [CI], 1.24 to 2.09 in men; and RR, 1.80; 95% CI, 1.43 to 2.28 in women). In women, the excess risk was already pronounced 5 years prior to the year of diagnosis, whereas in men the highest risk was noticed 1 year before the year of diagnosis.
Sleep apnea may severely threaten work ability years before diagnosis. These results emphasize the importance of the early identification and treatment of employees with sleep apnea.
Research on temporary employment as a risk factor for work disability due to depression is mixed, and few studies have measured work disability outcome in detail. We separately examined the associations of temporary employment with (i) the onset of work disability due to depression, (ii) the length of disability episodes, and (iii) the recurrence of work disability, taking into account the possible effect modification of sociodemographic factors.
We linked the prospective cohort study data of 107 828 Finnish public sector employees to national registers on work disability (>9 days) due to depression from January 2005 to December 2011.
Disability episodes were longer among temporary than permanent employees after adjustment for age, sex, level of education, chronic somatic disease, and history of mental/behavioral disorders [cumulative odds ratio (COR) 1.37, 95% confidence interval (95% CI) 1.25-51). The association between temporary employment and the length of depression-related disability episodes was more pronounced among participants with a low educational level (COR 1.95, 95% CI 1.54-2.48) and older employees (>52 years; COR 3.67, 95% CI 2.83-4.76). The association was weaker in a subgroup of employees employed for = 50% of the follow-up period (95% of the original sample). Temporary employment was not associated with the onset or recurrence of depression-related work disability.
Temporary employment is associated with slower return to work, indicated by longer depression-related disability episodes, especially among older workers and those with a low level of education. Continuous employment might protect temporary employees from prolonged work disability.
Work stress is a recognized risk factor for mental health disorders, but it is not known whether work stress is associated with the morbidity among individuals with psychologic distress. Another shortcoming in earlier research is related to common method bias-the use of individual perceptions of both work stress and psychologic distress. This prospective study was assessed using the General Health Questionnaire (GHQ-12), which identified psychologic distress as a predictor of sickness absence and the effect of work-unit measures of job strain on sickness absence among cases.
Survey data were collected on work stress, indicated by high job strain, for a cohort of public sector employees (6,663 women, 1,323 men), aged 18 to 62 at baseline in 2000-2002, identified as GHQ-12 cases. Coworker assessments of job strain were used to control for bias due to response style. A 2-year follow-up included recorded long-term (>7 days) medically certified sickness absence. Adjustments were made for age, socioeconomic position, baseline chronic physical disease, smoking, and heavy alcohol consumption.
Cases with psychologic distress had 1.3 to 1.4 times higher incidence of long-term sickness absence than non cases. Among cases, high job strain predicted sickness absence (hazard ratio 1.17 in women, 1.41 in men). The significant effect of job strain on sickness absence was found among workers in high socioeconomic positions (hazard ratio 1.54 for women, 1.58 for men) but not among employees in low socioeconomic positions (hazard ratio 1.06 for women, 1.31 for men).
Psychologic distress has an independent effect on medically certified sickness absence. The identification of employees with high job strain and the improvement of their working conditions should be considered as an important target in the prevention of adverse consequences of psychologic distress.
To examine job strain, adverse life events, and their co-occurrence as predictors of sickness absence.
Random sample-based mail survey data on 1806 Finns in gainful employment were linked to sickness absence records (1987-1998) from national health registers. Generalized linear models with negative binomial distribution assumption were applied.
After adjustment for demographic characteristics and health behavior, job strain (rate ratio [RR] 1.73; 95% confidence interval [CI] = 1.21-2.48), but not life events, independently predicted increased rate of sickness absence among men. The opposite was true for women, (RR for life events 1.39; 95% CI = 1.10-1.75). No statistically significant interaction between job strain and life events was detected.
In addition to job strain, strain originating in private life should be kept in mind when the need for sickness absence of women employees is evaluated within health care.
Objectives The aim of this study was to investigate the association between the length of sickness absence and sustained return to work (SRTW) and the predictors of SRTW in depression, anxiety disorders, intervertebral disc disorders, and back pain in a population-based cohort of employees in the Finnish public sector. Methods We linked data from employers' registers and four national population registers. Cox proportional hazards regression analysis with a cluster option was applied. SRTW was defined as the end of the sickness benefit period not followed by a recurrent sickness benefit period in 30 days. Results For depression, the median time to SRTW was 46 and 38 days among men and women, respectively. For anxiety disorders, the figures were 24 and 22 days, for intervertebral disc disorders, 42 and 41 days, and, for back pain, 21 and 22 days among men and women respectively. Higher age and the persistence of the health problem predicted longer time to SRTW throughout the diagnostic categories. Comorbid conditions predicted longer time to SRTW in depression and back pain among women. Conclusions This large cohort study adds scientific evidence on the length of sickness absence and SRTW in four important diagnostic categories among public sector employees in Finland. Further research taking into account, eg, features of the work environment is suggested. Recommendations on the length of sickness absence at this point should be based on expert opinion and supplemented with research findings.
This study examined whether obstructive sleep apnoea syndrome (OSAS) is associated with increased risk of work disability during six years following the diagnosis.
Prospective follow-up study.
Ten municipalities and six hospital districts in Finland.
A total of 766 employees with OSAS (cases), and their control subjects (n=3,827) matched for age, gender, socioeconomic position, type of employment contract and type of organization.
Data on all (>9 days) or very long-term (>90 days) sickness absences and for disability pensions were obtained from national registers. Diagnosis of OSAS was determined according to the Hospital Discharge Register, which includes data on all hospital admissions.
According to the Cox proportional hazards models the hazard of the first sickness absence period (all sickness absences) during the follow-up was 1.7-fold (95% confidence interval (CI): 1.5-2.0) in male and 2.1-fold (95% CI: 1.8-2.4) in female sleep apnoea cases compared to controls after adjustments for sociodemographic factors. Both men and women with OSAS had a 2-fold increase in the risk for disability pension compared to controls. With regard to cause-specific work disability, employees with OSAS had a particularly pronounced risk of long-term work disability caused by injuries (HR 3.1 95% CI: 1.8-5.2) and mental disorders (HR: 2.8, CI 95%: 2.1-3.7).
These results suggest that OSAS is associated with an increased risk of both sickness absence and disability pension. They emphasize the need to identify the employees with this disorder and to improve general practitioners' knowledge about screening of sleep apnoea symptoms and indicators.