Leena Ala-Mursula

• MD Professor
• Professor (Full) at University of Oulu

Objectives This study aimed to investigate the effect of a brief training intervention for occupational health services (OHS) professionals on multiprofessional resource utilization and the costs of biopsychosocial management of patients with low-back pain (LBP) compared to usual care among all participants and those in work disability-based risk g...

Background Both the symptoms and diagnoses of mental health disorders affect individuals’ occupational status and income. However, studies that compare the impact of differences between symptoms and diagnoses on occupational outcomes are lacking. Aims This study aimed to compare labour market attachment and income until midlife between individuals...

In return-to-work (RTW) negotiations after sickness absence, the work ability of an individual employee becomes a shared interest for the multiple stakeholders representing both the healthcare sector and working life. In practice, the employee, employer and occupational health professionals need to reach a shared understanding of the employee’s wor...

Job strain is a major concern in the workplace. Work-related stress is an increasing challenge worldwide as it is the leading cause of long-term sickness absences, disability pensions and lower productivity. Rarely studied simultaneously, both leisure-time physical activity (LTPA) and physical fitness (PF), which comprises cardiorespiratory fitness...

Background and Aims The incidence of cerebrovascular disease (CVD) is rising among young adults (<55 years). The risk for CVD starts to form in early childhood and is comprised of genetic and environmental risk factors. The aim of this study is to investigate the relationship between early family socioeconomic status (SES), inherited risk, and CVD...

Objective To study the association between an advanced climacteric status at 46 years of age and current perceived work ability, the consequent 2-year accumulation of disability and unemployment days, and the 7-year incidence of disability pensions. Methods Study participants (n = 2,661) were recruited from the Northern Finland Birth Cohort 1966 s...

Objectives To investigate the role of chronotype for work engagement in middle age. Methods We used data from the Northern Finland Birth Cohort 1966 study (n = 5,341) to analyze associations of self-reported chronotype (morning, intermediate, and evening type) with work engagement and its dimensions (vigor, dedication, absorption). We conducted mu...

Insufficient sleep has been linked to the accumulation of cardiometabolic risks while physical activity acts as a protective factor. Also, sleep regularity may play a critical role in maintaining optimal cardiometabolic health. This cross-sectional study examined the association between device-based sleep regularity, waking activity behaviors, and...

Introduction Urinary incontinence is a common ailment in women and is likely to affect their work ability. We investigated the associations between the different subtypes of urinary incontinence and several dimensions of perceived work ability in middle‐aged general population. Material and methods Cross‐sectional survey at age 46 among participan...

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-ps...

Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals' implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored ver...

Sleep has been shown to affect economic outcomes, including wages. The mechanisms by which sleep affects wages remain unclear. We examine the relationship between chronotype - morning larks, evening owls - and wages at mid-age. We propose a novel model relating chronotype to wages in consideration of human, social, and health capital constructs. Em...

Background: The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) was developed to identify psychological and functioning-related risk factors among individuals with musculoskeletal pain at risk of work disability. This study aimed to examine whether the short version of the ÖMPSQ (ÖMPSQ-SF) can be used for this purpose, using registry-ba...

Background: The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia a...

Objective: To evaluate how glucose metabolism in midlife is related to preceding 30-year-long employment trajectories. Methods: In the Northern Finland Birth Cohort 1966 we compared glucose metabolism at 46 to employment trajectories (previously defined for men and women and named as high-educated, traditional, self-employed, delayed, and flound...

Occupation-related stress and work characteristics are possible determinants of social inequalities in epigenetic aging but have been little investigated. Here, we investigate the association of several work characteristics with epigenetic age acceleration (AA) biomarkers. The study population included employed and unemployed men and women (n = 631...

Background Severe health events may lead to reduced income among survivors. Importantly, individuals’ risks for both severe health events and for lower income are shaped by early life course. Our aim was to consider early-life factors in determining lost individual income after stroke, heart attack and cancer between ages 18 and 50. Methods A popu...

This paper explores individuals’ economic preferences and temperament traits among different categories of business leaders (i.e., managers, self-employed with employees, self-employed without employees) and paid employees. We assume that these quite stable preferences and traits play a role in predicting occupational choice toward leadership roles...

Purpose Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals' working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individual...

Objective: Polycystic ovary syndrome (PCOS) presents with multiple comorbidities potentially affecting functioning. This was the first general population-based study to evaluate work ability, participation in working life, and disability retirement in middle-aged women with and without PCOS. Design: Cohort study. Methods: Women with PCOS (n=280) an...

Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) identifies factors that are facilitators of or barriers to professionals´ change of behavior after evidence-based training. The original English DIBQ consists of 93 items covering 18 domains. The DIBQ is built upon the Theoretical Domains Framework and the Behavioral Chang...

Objective: To examine the role of physical activity (PA) and sedentary behavior (SED) for work engagement. Methods: We used data from Northern Finland Birth Cohort 1966 Study (n = 3046 to 4356) to analyze self-reported weekly leisure-time physical activity (LTPA), daily leisure-time sitting time (LTST) and work engagement. PA and SED 24-hour wer...

Recent evidence indicates consistent association of low socioeconomic status with epigenetic age acceleration, measured from DNA methylation. As work characteristics and job stressors are crucial components of socioeconomic status, we investigated their association with various measures of epigenetic age acceleration. The study population included...

Family's socioeconomic profile collected prenatally is known to predict offspring mortality during early life, but it remains unclear whether it has the potential to predict offspring mortality until later life. In this study, 12,063 individuals belonging to the Northern Finland Birth Cohort 1966 were followed up from mid-pregnancy for 52 years (57...

PurposeThe prospects and predictors of returning to the labour market after long-term work disability in psychoses are unclear. Our aim was to study the proportion and characteristics of persons with schizophrenia and other psychoses who return to the labour market after receiving a disability pension.Methods In this 50-year follow-up study in the...

Background: Multisite pain is commonly chronic and often lacks its initial role as a potential tissue damage signal. Chronic pain among working-age individuals is a risk for disability and imposes a major burden on health care systems and society. As effective treatments for chronic pain are largely lacking, better identification of the factors ass...

Introduction: Endometriosis may cause a deterioration of daily functioning due to related symptoms such as pain, fatigue and psychological distress. Accordingly, endometriosis may jeopardize work ability, as suggested in mainly survey-based case-control studies, including clinically established cases at fertile age. This is the first general popul...

Background Productivity costs result from loss of paid and unpaid work and replacements due to morbidity and mortality. They are usually assessed in health economic evaluations with human capital method (HCM) or friction cost method (FCM). The methodology for estimating lost productivity is an area of considerable debate. Objective To compare trad...

Objectives This is the first general population study to evaluate whether evening chronotypes (E) have poorer work ability (WA) and higher probability for early disability pensions (DPs) than morning types (M) in middle age. Methods Among non-retired individuals (n=5831; 2672 men, 3159 women) of the Northern Finland Birth Cohort 1966, chronotype w...

Applying social investment theory (SIT), we examined whether employment trajectories until midlife, with differential investments in education and employment, are associated with social investments during early life and with work-related well-being in midlife, with a special reference to potential differences between self-employment and paid work....

We apply neoclassical economic modelling augmented with behavioral aspects to provide a detailed empirical investigation into indicators of socio-economic status (SES) as determinants of leisure-time physical activity. We utilize the data from the Northern Finland Birth Cohort 1966 obtained at the most recent time point during 2012-2014 (response r...

Morning, day or evening chronotypes differ by the circadian timing of alertness and the preferred timing of sleep. It has been suggested that evening chronotype is associated with low physical activity (PA) and high sedentary time (SED). Our aim was to investigate whether such an association is confirmed by objectively measured PA and SED. In 46‐ye...

Background There are various maternal prenatal biopsychosocial (BPS) predictors of birth weight, making it difficult to quantify their cumulative relationship. Methods We studied two birth cohorts: Northern Finland Birth Cohort 1986 (NFBC1986) born in 1985–1986 and the Generation R Study (from the Netherlands) born in 2002–2006. In NFBC1986, we se...

Background: The relevance of health-related behaviors to exclusion from the labor market in early adulthood remains poorly studied in relation to the magnitude of the problem. We explored whether adolescents' accumulated unhealthy behaviors and psychosocial problems are associated with later labor market exclusion, and whether multisite musculoske...

Background: The study aimed to explore the association between early life and life-course exposure to social disadvantage and later life body mass index (BMI) accounting for genetic predisposition and maternal BMI. Methods: We studied participants of Helsinki Birth Cohort Study born in 1934-1944 (HBCS1934-1944, n = 1277) and Northern Finland Bir...

Background People with psychotic disorders typically have the poorest rate of employment compared to other mental disorders. However, the chances of returning back to labour market and work after long-term work disability is unclear. Aim of this study was to study proportion of persons who can return to labour market after they have received disabi...

So far, the relationship between the various dimensions of social support and work engagement has not been widely examined in the literature. In this study, we examined the relationship of social support at work (from a colleague or supervisor) and social support in one’s private life (from a spouse,relative or friend) with various dimensions of wo...

Objective To evaluate how clinically measured glucose metabolism categories predict registered participation in working life. Methods In the 46-year follow-up of Northern Finland Birth Cohort 1966 (n=5328, 2342 men and 2986 women), we used oral glucose tolerance tests, surveys and glycated haemoglobin to determine glucose metabolism categorised as...

Background: The prevention of the risk of type 2 diabetes (T2D) is complicated by multidimensional interplays between biological and psychosocial factors acting at the individual level. To address the challenge we took a systematic approach, to explore the bio-psychosocial predictors of blood glucose in mid-age. Methods: Based on the 31-year and...

Objectives To examine the relationships of late-career physical heaviness of work and sitting at work with mortality. A national-level job exposure matrix was used to determine the occupation-specific level of physical heaviness and sitting. Design Prospective cohort study between years 1990 and 2015. Setting Community. Participants 5210 men and...

Purpose To investigate the association between personal meaning of work and perceived work ability among middle-aged workers with physically strenuous or light work. We evaluated the course of perceived work ability from 31 to 46 years and examined the possible differences in the association between personal meaning of work and perceived work abili...

Objective: To examine associations between temperament traits and early retirement intentions. Methods: In the Northern Finland Birth Cohort 1966, we analyzed early retirement intentions at the age 46 according to Cloninger's temperament traits at the age 46 (n = 4409) and at the age 31 (n = 3226). Ordinal logistic regression analyses were used....

Background: Most studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, a...

Background Alexithymia, a difficulty in identifying and expressing emotions, has been associated with obesity and eating disorders in small-scale cross-sectional studies. Here, we assess the relationship between body mass index (BMI) and alexithymia in a large cohort of free-living Finnish adults over a 15-year period. Methods Participants were dr...

Descriptive statistics by sex of the longitudinal set at both 31-year and 46-year time points (n = 3274). (DOCX)

Background Temperament is theorized to be an important factor contributing to the development of alcohol use disorder, but longitudinal studies on how temperament is related to alcohol use among general population in mid‐life are scarce. Our aims were to investigate potentially reciprocal associations between temperament and changes in alcohol use...

Objectives Unemployment has been linked with poor health. We hypothesized that being unemployed is associated with disorders of glucose metabolism and performed a systematic review and meta-analysis of the literature to ascertain the relationship. Methods We searched the databases of Scopus, Medline Ovid and Web of Science for population-based orig...

Aims: We explored whether registered unemployment is associated with impaired glucose metabolism in general population. Methods: Based on Northern Finland Birth Cohort 1966 at 46 years, we analyzed the oral glucose tolerance tests of 1970 men and 2544 women in relation to their preceding three-year employment records in three categories of unemp...

Objectives: The vertebral cross-sectional area (CSA) is a major determinant of vertebral strength. Since leisure-time physical activity (LTPA) is known to affect vertebral CSA, we hypothesised that engagement in physical activity at work might have similar effects on vertebral size. We aimed to examine the association between various adulthood occ...

Objective: Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Design: Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Setting: Paltamo, Finland. Participants: Unem...

Background: Little is known about whether factors during the first years of life predict later outcomes in schizophrenia spectrum disorder (SSD). As part of the Northern Finland Birth Cohort 1966, we examined if prospectively collected early parenthood-related and developmental factors predict employment and hospitalization in individuals with and...

Introduction Personality traits have been associated with risk for depressive disorders. Studies with premorbid measures on personality are uncommon. Objective Estimate effect of premorbid personality as a predictor for remission in depressive disorders. Aim To study premorbid personality as a predictor for remission in depression in a population...

Background Longitudinal studies on how temperament is related to alcohol use in general population are scarce. Objectives Finding relations with temperament and problematic alcohol use using prospective birth cohort data. Aims To investigate trends in self-reported alcohol consumption in adulthood. Methods In the Northern Finland Birth Cohort 19...

This study aims to research the impact of impersonal and interpersonal trust on communication among virtual teams. A multi-method case study was conducted, with data provided by 94 organisation members in a global telecommunication company with a long history of virtual ways of working. The case study consisted of semi-structured interviews, an ele...

Objective: To describe changes in alcohol use in relation to employment, education and relationship statuses in a general population sample in early midlife using prospective birth cohort data. Materials and methods: In the Northern Finland Birth Cohort 1966 (N=5621) alcohol use was studied in participants at two time points: ages 31 and 46. The...

Objective: To investigate the effect of adulthood obesity on work ability in early midlife during a 15-year follow-up. Methods: The study population included men and women (n = 5470), born in northern Finland in 1966. Participants evaluated their current perceived work ability compared with their lifetime best at the age of 46. Participants' wei...

Background Most of the few studies that exist on the longitudinal associations between health behaviors and work ability target to single health behaviors. Purpose To investigate how lifetime clusters of unhealthy behaviors associate with perceived work ability in early midlife. Methods The study population consisted of 46-year-old men and women (n...

Introduction Employment is important from the point of view of social inclusion and quality of life in individuals with schizophrenia. Objectives To explore employment status in individuals with schizophrenia. Aims To examine register based employment and disability pension in average 20 years after onset of schizophrenia and compare those to pop...

Background Longitudinal alcohol consumption in early adulthood has been studied, but reports from later adulthood are scarce. Objectives Finding longitudinal trends in alcohol consumption using prospective birth cohort data. Aims To investigate trends in self-reported alcohol consumption in adulthood. Methods In the Northern Finland Birth Cohort...

In virtual operating environments for new product development (NPD) increase the need to manage communication efficiently. The goal of communication is to reach a shared understanding; however, this is often challenging due to barriers that harm the communication process. Communication barriers typically cause misunderstandings and conflicts and hi...

Virtual teams are increasingly common in global businesses, and it is easy to establish a team of experts located across the globe, collaborating by email, tele-and web-conferencing, and other information and communication technology (ICT). However, it is clear that information processing in global companies is vulnerable to misunderstandings. Find...

Objectives: Employee control over work times has been associated with favorable psychosocial and health-related outcomes, but the evidence regarding sleep quality remains inconclusive. We examined cross-sectional and prospective associations between work time control and sleep disturbances in a large working population, taking into account total h...

BACKGROUND. Doctors assess an individual's work ability by comparing the diagnoses and findings to the demands of work. The accuracy of this disease-based orientation has recently been challenged. METHODS. A case study was conducted to compare a disease-based and a multidimensional functioning -based work ability assessment, illustrated through an...

In response to the economic consequences of ageing of the population, governments are seeking ways with which people might work into older age. We examined the association of working conditions and health with extended employment (defined as >6 months beyond the pensionable age) in a cohort of older, non-disabled employees who have reached old-age...

To develop a theoretical model of hospital nurses' wellbeing at work. The concept of wellbeing at work is presented without an exact definition and without considering different contents. A model was developed in a deductive manner and empirical data collected from nurses (n = 233) working in a university hospital. Explorative factor analysis was u...

Life stress resulting from early-life experiences and domestic stress is linked with shorter leukocyte telomere length (LTL), but evidence on employment-related stress is scarce. We explored whether unemployment in early adulthood is associated with shorter LTL, a potential biomarker of premature aging. We used data from 5620 men and women belongin...

This study examined the previously unexplored occupational grade-specific relationships of domestic responsibilities, the age of children, and work-family spillover, with registered sickness absence (>3 days' sick leave episodes, a mean follow-up of 17 months; n = 18,366 municipal employees; 76% women). The results showed that negative spillover fr...

The objective of this study was to explore the association between job strain and the co-occurrence of adverse health behaviors; smoking, heavy drinking, obesity, and physical inactivity. The authors studied cross-sectional data of 34,058 female and 8154 male public sector employees. Multinomial logistic regression models adjusted for sex, age, bas...

To explore the associations of working hours (paid, domestic, commuting, and total) with sickness absence, and to examine whether these associations vary according to the level of employee control over daily working hours. Prospective cohort study among 25 703 full-time public sector employees in 10 towns in Finland. A survey of working hours and c...

We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires des...

To examine whether the effects of work stress on sickness absence vary by the level of control the employees have over their working times. Prospective cohort study. A survey of job strain, effort-reward imbalance, and control over daily working hours and days off was carried out in 2000-01. The survey responses were linked with registered data on...

To investigate the health effects of employee worktime control. Prospective cohort study among 4218 permanent full time municipal employees linking questionnaire data from 1997 and 2000 with sickness absence records from 1997 and 2001. Worktime control was considered high for the highest tertile in both 1997 and 2000, low for the lowest tertile for...

The objective of the study was to determine whether the double burden of and negative spillover between domestic and full-time paid work are associated with an increase in health problems. Survey responses were linked with sickness absence records in a cross-sectional study of 6442 full-time municipal employees. Women and men experiencing severe wo...

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 certi...

To investigate the impact of employees' worktime control on health, taking into account other aspects of job control. Analysis of questionnaire data in 1997 and register data on sickness absence during 1996-1998. Eight towns in Finland. 6442 municipal employees (1490 men and 4952 women) representing the staff of the towns studied. Follow up was 17...