Finnish Institute of Occupational Health
Recent publications
Background Hypothesis-free studies applying advanced statistical analysis of objective working hour patterns and occupational accidents are lacking. This study aimed to identify patterns of working hours among hospital employees and to investigate the associations between the identified patterns and the risk of an occupational accident. Method In this cohort study of 4419 hospital employees, we collected electronic payroll-based working hour data (i.e., timing and duration) for each participant and linked them to records of occupational accident register between 2008 and 2018. We used optimal matching to assess similarity between individual working hour patterns for a period of 7 days preceding an accident or, for employees without an accident, a random pseudo-accident date. Using cluster analysis, we categorized employees into working hour pattern clusters. Log-binomial regression was used to examine risk ratios (RR) with 95 % confidence intervals (CI) of an occupational accident between cluster memberships. Results 1626 participants experienced an occupational accident which took place either at the workplace (65 %) or while commuting (35 %). Six clusters of working hour patterns were identified. Compared to the cluster with the fewest accidents, clusters with a higher proportion of accidents were characterized by late work shifts and a high proportion of quick returns (<11-hour shift interval,) and long work shifts (>12-hour shift), RR 1.31, 95 %CI 1.13–1.52 for the cluster with the most accidents. Conclusions This data-driven study suggests that working late and long with insufficient rest is associated with increased probability of occupational accidents. Working hour arrangements in 24/7 care of hospital merit attention to regularity and sufficient rest to support occupational safety.
Human Factors (HF) aims to improve system performance, safety, and well-being. However, to promote their application more widely in the future, more evidence is needed of the outcomes of HF practices. We studied HF outcomes between 2000 and 2019 in two aviation companies and one railway company via interviews (n = 21), observations and work-focused discussions (n = 13), and 11 organizational indicators. We evaluated the manifestations of HF practices at varying organizational levels. The HF outcomes were both explicitly and implicitly evident. At the most comprehensive level, the outcomes were reflected as an HF mindset, knowhow, and practical safety- and work- related applications. The shorter the time that the HF practices had been in use in an organization, the more the employees saw HF as practices of individuals. Conversely, the companies that had been using HF practices for a longer period exhibited a more systematic and comprehensive insight, i.e., HF practices were evident in work processes, were considered to affect well-being and involved group and organizational factors. HF knowledge and integration differed on the management, supervisor/expert and operational levels, indicating a need to implement HF practices more tangibly when planning and organizing work. This poses challenges for management, especially when an HF- informed, pragmatic approach to safety needs to be developed. The evaluation of HF practices clearly needed improvement in all the companies. The outcomes of the HF practices had not been monitored particularly closely, systematically or in the long term. However, the potential HF indicator data had increased in all the companies during the past years. We emphasize that the content and aims of HF for different tasks and organizational levels need to be concretely defined. HF practices must be applied systemically and systematically, in a participative and solution-based manner.
Per- and polyfluoroalkyl substances (PFASs) are a highly persistent, mobile, and bioaccumulative class of chemicals, of which emissions into the environment result in long-lasting contamination with high probability for causing adverse effects to human health and the environment. Within the European Biomonitoring Initiative HBM4EU, samples and data were collected in a harmonized way from human biomonitoring (HBM) studies in Europe to derive current exposure data across a geographic spread. We performed mixture risk assessments based on recent internal exposure data of PFASs in European teenagers generated in the HBM4EU Aligned Studies (dataset with N = 1957, sampling years 2014–2021). Mixture risk assessments were performed based on three hazard-based approaches: the Hazard Index (HI) approach, the sum value approach as used by the European Food Safety Authority (EFSA) and the Relative Potency Factor (RPF) approach. The HI approach resulted in the highest risk estimates, followed by the RPF approach and the sum value approach. The assessments indicate that PFAS exposure may result in a health risk in a considerable fraction of individuals in the HBM4EU teenager study sample, thereby confirming the conclusion drawn in the recent EFSA scientific opinion. This study underlines that HBM data are of added value in assessing the health risks of aggregate and cumulative exposure to PFASs, as such data are able to reflect exposure from different sources and via different routes.
Background Work in the health and social care services (HSS) is very stressful and sickness absences are high. Nevertheless, little is known about their work stressors and work ability. The first aim of this study is to describe the prevalence of different work stressors and their accumulation among eldercare workers compared to general HSS workers. Second aim is to analyze associations between different work stressors and work ability and thus provide information on factors that are important in enhancing work ability. Methods This cross-sectional survey examined HSS employees in Finland in 2020. The response rate was 67% ( N = 22,502). Descriptive analyses were used to describe the control variables and the differences between the work stressors of general HSS and eldercare employees. After this, multinomial logistic regression analysis revealed the association between work stressors and work ability. Results Eldercare employees experienced more often moral distress than HSS employees in general, and this further lowers their work ability. Single work stressors––Karasek’s strain, Siegrist’s ERI, organizational injustice and moral distress––increased the odds of low work ability (OR range 1.4–2.5) in comparison to no work stressors. However, the association with single stressors was roughly one third of that with the accumulation of all four work stressors (OR = 6.8). Thus, the accumulation of several stressors was most harmful for work ability. Conclusions This study provides novel information on the accumulation of work stressors in relation to work ability. The results suggest that in order to enhance work ability, HSS organizations should pay more attention to preventing several stressors from accumulating. Eldercare organizations in particular need to develop effective measures for lowering moral distress.
Aim To determine the extent to which change in (i.e., start and end of) workplace bullying can be predicted by employee responses to standard workplace surveys. Methods Responses to an 87-item survey from 48,537 Finnish public sector employees at T1 (2017–2018) and T2 (2019–2020) were analyzed with least-absolute-shrinkage-and-selection-operator (LASSO) regression. The predictors were modelled both at the individual- and the work unit level. Outcomes included both the start and the end of bullying. Predictive performance was evaluated with C-indices and density plots. Results The model with best predictive ability predicted the start of bullying with individual-level predictors, had a C-index of 0.68 and included 25 variables, of which 6 remained in a more parsimonious model: discrimination at work unit, unreasonably high workload, threat that some work tasks will be terminated, working in a work unit where everyone did not feel they are understood and accepted, having a supervisor who was not highly trusted, and a shorter time in current position. Other models performed even worse, either from the point of view of predictive performance, or practical useability. Discussion While many bivariate associations between socioeconomic characteristics, work characteristics, leadership, team climate, and job satisfaction were observed, reliable individualized detection of individuals at risk of becoming bullied at workplace was not successful. The predictive performance of the developed risk scores was suboptimal, and we do not recommend their use as an individual-level risk prediction tool. However, they might be useful tool to inform decision-making when planning the contents of interventions to prevent bullying at an organizational level.
COVID‐19 has highlighted the need for indoor risk‐reduction strategies. Our aim is to provide information about the virus dispersion and attempts to reduce the infection risk. Indoor transmission was studied simulating a dining situation in a restaurant. Aerosolized Phi6 viruses were detected with several methods. The aerosol dispersion was modeled by using the Large‐Eddy Simulation (LES) technique. Three risk‐reduction strategies were studied: (1) augmenting ventilation with air purifiers, (2) spatial partitioning with dividers, and (3) combination of 1 and 2. In all simulations infectious viruses were detected throughout the space proving the existence long‐distance aerosol transmission indoors. Experimental cumulative virus numbers and LES dispersion results were qualitatively similar. The LES results were further utilized to derive the evolution of infection probability. Air purifiers augmenting the effective ventilation rate by 65% reduced the spatially averaged infection probability by 30%–32%. This relative reduction manifests with approximately 15 min lag as aerosol dispersion only gradually reaches the purifier units. Both viral findings and LES results confirm that spatial partitioning has a negligible effect on the mean infection‐probability indoors, but may affect the local levels adversely. Exploitation of high‐resolution LES jointly with microbiological measurements enables an informative interpretation of the experimental results and facilitates a more complete risk assessment.
The aim of the study was to determine the exposure of workers within biodegradable waste processing facilities to bacteria and fungi to identify any exposures of potential concern to health. Occupational measurements were performed in six composting and three bioenergy (bioethanol or methane/biogas) producing facilities. Bioaerosols were measured from breathing zones with Button aerosol or open face cassette filter samplers, and swab specimens were taken from the nasal mucous membranes of the workers. Aspergillus fumigatus, Bacillus cereus group, Campylobacter spp., Salmonella spp., Streptomyces spp., and Yersinia spp. were determined by real-time polymerase chain reaction (qPCR). A. fumigatus , and mesophilic and thermophilic actinobacteria were also cultivated from filters. Bacterial airborne endotoxins collected by IOM samplers were analyzed using a Limulus assay. Bioaerosol levels were high, especially in composting compared to bioenergy producing facilities. Endotoxin concentrations in composting often exceeded the occupational exposure value of 90 EU/m ³ , which may be harmful to the health. In addition to endotoxins, the concentrations of A. fumigatus (up to 2.4 × 10 ⁵ copies/m ³ ) and actinobacteria/ Streptomyces spp. (up to 1.6 × 10 ⁶ copies/m ³ ) in the air of composting facilities were often high. Microbial and endotoxin concentrations were typically highest in waste reception and pre-treatment, equal or decreased during processing and handling of treated waste, and lowest in wheel loader cabins and control rooms/outdoors. Still, the parameters measured in wheel loader cabins were often higher than in the control sites, which suggests that the use of preventive measures could be improved. B. cereus group, Salmonella spp., and Yersinia spp. were rarely detected in bioaerosols or nasal swabs. Although Campylobacter spp. DNA was rarely detected in air, as a new finding, Campylobacter ureolyticus DNA was frequently detected in the nasal mucous membranes of workers, based on partial 16S rDNA sequencing. Moreover, especially A. fumigatus and C. ureolyticus spp. DNA concentrations in swabs after the work shift were significantly higher than before the shift, which indicates their inhalation or growth during the work shift. Microbial qPCR analysis of bioaerosols and swab samples of nasal mucosa allowed measuring exposure in various work operations and during the work shift, identifying problems for health risk assessment to improve working conditions, and evaluating the effectiveness of preventive measures and personal protection of workers.
Participatory shift scheduling for irregular working hours can influence shift schedules and sickness absence. We investigated the effects of using participatory shift scheduling and shift schedule evaluation tools on working hour characteristics and sickness absence. We utilized a panel data for 2015−2019 with 16,557 hospital employees (6143 in the intervention and 10,345 in the control group). Difference-in-differences regression with ward-level clustered standard errors was used to estimate the average treatment effect on the treated coefficients relative to timing of the intervention with 95% confidence intervals (CI). Using participatory scheduling tool increased long working hours and weekend work and had delayed effects on the short (1–3 days) sickness absences. Increased effects were observed: 0.2 [95% CI 0.0−0.4] days for the second, and 0.8 [95% CI 0.5−1.0] for the third year after the onset of intervention. An average increase of 0.5 [95% CI 0.1−0.9] episodes on all sickness absence episodes was observed for the third year. Using the shift schedule evaluation tool with the participatory shift scheduling tool attenuated the adverse effects. To conclude, participatory shift scheduling increased some potentially harmful working hour characteristics but its effects on sickness absence were negligible, and further attenuated by using the shift schedule evaluation tool.
Background and objectives: Clinical heterogeneity in sensitizer-induced occupational asthma (OA) and its relationship to airway inflammatory profiles remain poorly elucidated. To further characterize the interactions between induced sputum inflammatory patterns, asthma-related outcomes and the high- or low-molecular-weight category of causal agents in a large cohort of subjects with OA. Methods: This multicenter, retrospective, cross-sectional study was conducted among 296 subjects with OA ascertained by a positive specific inhalation challenge who completed induced sputum assessment before and 24 hours after challenge exposure. Results: Multivariate logistic regression analysis revealed that sputum eosinophilia ≥3% was significantly associated with a high dose of inhaled corticosteroid (odds ratio [95% confidence interval], 1.31 [1.11-1.55] for each 250-µg increment in daily dose), short-acting b2-agonist use less than once a day (3.54 [1.82-7.00]), and the level of baseline nonspecific bronchial hyperresponsiveness (mild: 2.48 [1.21-5.08]); moderate/severe: 3.40 [1.44-8.29]). Sputum neutrophilia ≥76% was associated with age (1.06 [1.01-1.11]), male gender (3.34 [1.29-9.99]), absence of corticosteroid use (5.47 [2.09-15.16]), short-acting b2-agonist use once or more a day (4.09 [1.71-10.01]), ≥2 severe exacerbations during the last 12 months at work (4.22 [1.14-14.99]), and isolated early reactions during the SIC (4.45 [1.85-11.59]). Conclusions: The findings indicate that sputum inflammatory patterns in subjects with OA are associated with distinct phenotypic characteristics and further highlight the differential effects of neutrophils and eosinophils on asthma-related outcomes. These associations between inflammatory patterns and clinical characteristics share broad similarities with what has been reported in nonoccupational asthma and are not related to the type of causal agent.
Aims: To assess the validity and completeness of the Care Register for Social Welfare among community-dwelling people with Alzheimer’s disease in Finland. Methods: The study was carried out in the Medication Use and Alzheimer’s disease (MEDALZ) study population, which includes 70,719 people who received a clinically verified diagnosis of Alzheimer’s disease between 2005 and 2011 and the people matched with them for comparison (n=282,862). The data were linked to the Care Register for Social Welfare, which contains data on care periods for nursing homes and sheltered housing with 24-h assistance during the time period 1994–2015. The validity of the Care Register for Social Welfare was analysed in relation to the Prescription Register among people with Alzheimer’s disease aged >65 years (n=25,640) who fulfilled the definitions of long-term care in certain inpatient care units (nursing homes, institutional care for people with dementia and rehabilitation institutions), although, in Finland, drug purchases should not be recorded in the register during long-term care. Results: The required level of assistance at discharge was recorded for 99.7% of people, diagnoses for 5.1% of the care periods and the discharge date for 100% of the completed care periods. Depending on the definition of long-term care, 6–10% of all long-term care periods included drug purchases during the study period. Conclusions: The validity of the Care Register for Social Welfare is high, but some limitations should be considered when using the data. Combining health and social care registers provides a potentially more comprehensive database on the utilisation and costs of services.
Background This study analysed the association between childhood socio-economic circumstances and the risk of dementia, and investigated the mediating role of potentially modifiable risk factors including adulthood socio-economic position and cardiovascular health. Methods We used a 10% sample of the 1950 Finnish population census linked with subsequent population and health registers (n = 95 381). Information of socio-economic characteristics, family structure and housing conditions at the age of 0–15 years was obtained from the 1950 census. We identified cohort members who developed dementia in 2000–2018 using national hospital, medication and death registers. Discrete time survival analysis using logistic regression and mediation analysis applying the Karlson–Holm–Breen (KHB) method were employed. Results An excess risk of dementia was observed for household crowding [odds ratio (OR) = 1.10; 95% CI 1.02–1.18 for 3 to <4 persons per heated room; OR = 1.19; 95% CI 1.11–1.27 for ≥4 persons], single-father family (OR = 1.27; 95% CI 1.07–1.51) and eastern and northern region of residence (OR = 1.19; 95% CI 1.10–1.28). The effects of single-father family and region of residence were mostly direct with adulthood characteristics mediating 14% and 29% of the total effect, respectively. The largest indirect effect was observed for household crowding mediated through adulthood socio-economic position (47–65%). Conclusions The study shows that childhood socio-economic circumstances are associated with dementia, and that the underlying mechanisms only partly relate to adulthood socio-economic position and cardiovascular health. Socio-economic and health interventions targeted at families with children may carry long-term benefits by contributing to a lower dementia risk in later life.
The aim was to investigate occurrence and duration of sickness absence (SA) among young employees with previous depression/anxiety in private and public sectors. This population-based prospective study included 11,519 Swedish twin individuals of age 19–29 years that were followed regarding SA during 2006–2016. Data on previous depression/anxiety came from two screening surveys in 2005. Data on SA and employment sector were received from national registries. Descriptive statistics and logistic regression were used, also controlling for familial factors. Proportion of employees with SA was significantly higher among those with, as compared to those without, previous depression/anxiety, regardless the employment sector. Individuals with previous depression/anxiety had increased risk for future SA, in both private (OR 2.25, 95% CI 1.90–2.66) and public sectors (OR 2.10, 95% CI 1.73–2.54). Familial factors played a role in the association among employees in the private sector. A higher proportion of long-term SA was observed among employees with previous depression/anxiety in the private as compared to the public sector. To conclude, previous depression/anxiety tends to increase risk for SA among young employees in both employment sectors, whereas long-term SA seemed to be more prevalent among those in the private as compared to the public sector.
Agriculture and food production are usually based on family farms or family enterprises. During the past decades, high job demands and mental health problems among farmers have been emerging issues. Lack of social support, high workload, ill health, and burnout among farmers may have serious direct and indirect negative consequences to the well-being of farmers and sustainability of farming. Our manuscript presents novel information about the relationships between farmers’ job demands, lack of resource, burnout, and ill health. We have tested the health impairment process of the Job Demands ─ Resources Model on a representative sample of Finnish dairy farmers. The data is based on a postal survey, and we utilized structural equation modelling to analyse the relationships. The aim was to find out whether two job demand factors, workload and societal demands, and lack of resource, loneliness, were related to the indicators of ill health via burnout. According to the results, two of the factors, workload and loneliness, were related to ill health indirectly via burnout. In addition, workload was directly connected with ill health. Based on our results, farmers could benefit from means to reduce workload, and there is also a need to develop tools and projects to alleviate loneliness among farmers.
Psychosocial job stressors increase the risk of mental health problems for the workers in health and social services (HSS). Although previous studies suggest that the accumulation of two or more stressors is detrimental to mental health, few studies have examined the synergistic interaction of accumulating job stressors. We examined survey responses from 9855 Finnish HSS workers in a cross-sectional study design from 2021. We conducted an interaction analysis of high job demands, low rewards and low workplace social capital on psychological distress, focusing on the relative excess risk due to interaction (RERI). Additionally, we analysed the interaction of job demands, low rewards and COVID-19 burden (extra workload and emotional load). Our analysis showed that the total RERI for the job stressors on psychological distress was considerable (6.27, 95% CI 3.14, 9.39). The total excess risk was caused by two-way interactions, especially between high demands and low rewards and by the three-way interaction of all stressors. The total RERI for job demands, low reward and COVID-19 burden (3.93, 95% CI 1.15, 6.72), however, was caused entirely by two-way interaction between high demands and low rewards. Mental health interventions tackling high demands, low rewards and low social capital are jointly needed.
Objectives Night work has been widely studied for the associations with diseases, sickness absence (SA) and disability pension (DP), but less for sustainable working life. We aimed to investigate the longitudinal changes in sustainable working life among those with or without baseline night work. Methods Using data from Swedish national registers, sustainable working life was defined as employment during follow-up without interruptions due to SA/DP, unemployment, and old-age pension. Survey data for two cohorts (i.e., born before or after 1959) were utilized to assess night work at baseline (yes/no) in 1998-2003 and 2004-2006, respectively. The final samples for the two cohorts were 34680 and 19637, respectively. Group-based trajectory models were applied. Results Among those born before 1959 (mean age 59 years, 13 years follow-up), a five-trajectory solution was best for those with and without night work. The trajectory groups were stable sustainable working life (38-42%), stable unsustainable working life (24-25%), early (13%) or later (13%) decreasing sustainable working life, and between sustainable and unsustainable working life (7%). Among those born after 1958 (mean age 37 years, follow-up 10 years), four trajectories were detected for those with night work: stable sustainable working life (81%), stable unsustainable working life (6%) and increasing (7%) and decreasing (5%) sustainable working life. For those without nightwork, a three-trajectory solution was best: stable sustainable working life (83%), stable unsustainable working life (6%) and between sustainable and unsustainable working life (11%). Conclusions Sustainable working life was similar across baseline night work statuses of older cohort but differed in younger cohort. The findings suggest that at least night work at one time point does not affect sustainable working life. However, night work at early stages of working life could be accompanied with lifestyle counselling for sleep and recovery. Key messages • Trajectories of sustainable working life seem similar for those with or without night work adding to the understanding of effects of such work to health. • From public health perspective, counselling employees with night work already at early stages of working life for health behaviours including sleep and recovery could support sustainable working life.
Introduction Mental disorders are a major cause of work disability among working age population. Psychotherapy has been shown to be an effective treatment for mental disorders, but the evidence mainly comes from small scale randomised trials with a relatively short follow-up. Objectives We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety related work disability using a quasi-experimental interrupted time series analysis. Methods All those who started rehabilitative psychotherapy in 2011-2014 comprised the study group. The study group included 10436 participants who were followed from three years prior to four years after the onset of rehabilitative psychotherapy, resulting in 83488 observations. Annual total number of mental health related work disability months was calculated based on total number of annual compensated sickness absence and disability pension days. Results The onset of rehabilitative psychotherapy marked a decline in depression or anxiety related work disability as compared to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76-0.85) as well as a 48% decrease in the slope (IRR 0.52; 95% CI 0.50-0.54) of work disability was detected. The decline was steepest in the oldest age-group Conclusions Providing statutory psychotherapy may decrease work disability at the population level. Further evidence for causal inference and the potential heterogeneity of the association is required.
Background Active labour market programmes, such as vocational training, have become widely adopted measures to increase job seekers’ employment opportunities, but evidence of their effectiveness in later employment is mixed. Individuals who enter training differ greatly in their socioeconomic background, health, and labour market history, which can affect the effectiveness of these programmes. There is still uncertainty, for example, on how vocational labour market training works for individuals with prior health problems. Methods We use nationally representative Finnish register data on 88,283 individuals aged 25-59 who participated in vocational labour market training in 2008-2013, 23,715 of whom had sickness absence lasting at least 10 weekdays (including Saturday) three years prior to the training and 64,568 of whom did not. To adjust for the differences in sociodemographic and work-related factors between these groups, we will conduct propensity score matching. We will analyze work participation three years before and after the training among those with sickness absence and those without using a difference-in-difference analysis. Results Our preliminary results show that before training the work participation rate was similar in those with sickness absence history (58.5 %) and those without (58.1 %). After training, those with a sickness absence history had slightly lower work participation than those without (54.6% versus 59.6 %). The differences in work participation between these groups increased slightly over time after training. Conclusions Vocational labour market training does not necessarily work equally well for everyone in terms of enhancing employment, and job seekers with work disability history should be offered either extra support or another type of unemployment service. However, these are our pre-matching results, and they cannot be causally interpreted. Next, we will conduct the propensity score matching and difference-in-difference analysis. Key messages • Having a sickness absence history prior to vocational labour market training is associated with lower work participation after training compared to participants without a sickness absence history. • The main advantage of the study is the use of a quasi-experimental study design to test the effectiveness of vocational training, using rich nationally representative register data with long follow-up.
Introduction The concept of health capital views health as a form of capital that produces healthy time to individual. This stock of capital - health that is - can decrease or increase. The potential of psychotherapy as individual's investment to (mental) health capital has been rarely studied in population level. Objectives The aim of our study is to shed light on the returns on individual-level investments in health capital. We consider the use of psychotherapy as an investment in health capital. This investment offers potential returns for individual as a higher level of subsequent income. However, these returns are potentially heterogenous: we aim to show to whom the use of psychotherapy is a sound investment in health capital. Methods We model the effects of mental health, and subsequent treatments such as the use of psychotropics and psychotherapy on income using two-way fixed effects regression. Results Preliminary results show that different parts of working-age population seem to have different potential returns related to the use of psychotherapy. These heterogenous effects are related to previously reported socioeconomic status related disparities: the level of human capital i.e. income and education play a role in the profitability of the individual level investment made in the health capital by the use of psychotherapy. Conclusions The use of psychotherapy has heterogenous effects on the income of individuals. The potential of this investment to produce health capital varies with education, the level of income prior to the use of psychotherapy.
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286 members
Kari Olavi Kurppa
  • Department of Epidemiology and Biostatistics
Eveliina Saari
  • Centre of Expertise for Work Organizations
Sirkka Rissanen
  • Occupational Safety
Päivi Husman
  • Work life and sociotechnical change
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