Päivi Leino-Arjas

The effect of flexible work on mental health is not well known. The aim of this systematic review was to assess the effects of employee-oriented flexible work on mental health problems and associated disability. Literature searches were conducted in the PubMed, Scopus, Web of Sciences, Cochrane Library, PsycINFO, ProQuest and EconPapers databases from their inception through October-November 2020. Sixteen studies on the associations of worktime control, working from home, or flexible working arrangements with mental health related outcomes were included in the review: one cluster randomized controlled trial, two non-randomized controlled trials, two cross-over studies, and 11 prospective cohort studies. Three reviewers independently assessed the met-hodological quality of the included studies and extracted the data. The included studies differed in design, intervention/exposure, and outcome, so meta-analysis was not carried out and qualitative results were reported. A few prospective cohort studies found that low employees’ control over worktime increases the risk of depressive symptoms, psychological distress, burnout, and accumulated fatigue. One cross-over and a few cohort studies found small beneficial effects of working partly from home on depressive symptoms, stress, and emotional exhaustion. A small number of controlled trials, cross-over or cohort studies found that flexible working arrangements increase employees’ control over working hours, but have only modest beneficial effects on psychological distress, burnout, and emotional exhaustion. This systematic review suggests that employee-oriented flexible work may have small beneficial effects on mental health. However, randomized controlled trials and quasi-experimental studies are needed to identify the health effects of flexible work.

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Work disability may originate early during work history and involve sickness absences (SA) and eventually permanent disability. We studied this process over 15 years. Questionnaire data collected in 1981 on health, working conditions, and lifestyle of Finnish municipal employees aged 44–58 years (n = 6257) were linked with registers on SA (≥10 workdays), disability pension, and death from the period 1986–1995. Trajectory analysis was used to assess development in SA (days/year) over 5 years (1981–1985). We analyzed determinants of the trajectories with multinomial regression, while trajectory membership was used as a predictor of disability pension (DP) during the subsequent 10 years in survival analysis. Three SA trajectories emerged: increasing (women: 6.8%; men: 10.2%), moderate (21.2%; 22.7%), and low. In a mutually adjusted model, the increasing trajectory in women was associated with baseline musculoskeletal (MSD), mental and respiratory disorders, injuries, obesity, sleep problems, and low exercise (effect sizes OR > 2), and in men with MSD, sleep problems, smoking, low exercise, and non-satisfaction with management. The moderate trajectory associated with MSD, ‘other somatic disorders’, sleep problems, and awkward work postures in both genders; in women, also overweight, cardiovascular and respiratory morbidity, and (inversely) knowledge-intensive work, and in men, smoking and mental disorders were thus associated. Ten-year risks of DP contrasting increasing vs. low SA were more than 10-fold in both genders and contrasting moderate vs. low SA 3-fold in women and 2-fold in men. These findings emphasize the need for early identification of workers with short-term problems of work ability and interventions regarding lifestyle, health, and working conditions, to help prevent permanent disability.

The contribution of physically demanding work to the developmental trajectories of sickness absence (SA) has seldom been examined. We analyzed the associations of 12 physical work exposures, individually and in combination, with SA trajectories among the occupationally active in the Finnish nationally representative Health 2000 survey. We included 3814 participants aged 30–59 years at baseline, when exposure history to work-related factors was reported. The survey and interview responses were linked with the annual number of medically confirmed SA spells through 2002–2008 from national registries. Trajectory analyses identified three SA subgroups: 1 = low (54.6%), 2 = slowly increasing (33.7%), and 3 = high (11.7%). After adjustments, sitting or use of keyboard >1 year was inversely associated with the high SA trajectory (odds ratio, OR, 0.57; 95% 95% confidence interval, CI, 0.43–0.77). The odds of belonging to the trajectory of high SA increased with an increasing number of risk factors, and was highest for those with ≥4 physical workload factors (OR 2.71; 95% CI 1.99–3.69). In conclusion, these findings highlight the need to find ways to better maintain the work ability of those in physically loading work, particularly when there occurs exposure to several workload factors.

Objectives We aimed to investigate the long-term association of insomnia and fatigue due to shift work (with and without night shifts) in midlife and mobility limitations (ML) among initially middle-aged subjects followed over 28 years. Methods The Finnish Longitudinal Study on Ageing Municipal Employees (FLAME) was conducted by the Finnish Institute of Occupational Health from 1981 to 2009 among 6257 municipal workers. This study is based on the latest available response on ML questionnaires either from 1992 or 1997 or in 2009 (n=4704). International Classification of Functioning (ICF) was used to code the nine mobility tasks included in the ML. Insomnia and fatigue due to shift work were assessed using the yes/no questions in the baseline. The Incidence Rate Ratio (IRR) and 95% Confidence Interval (CI) for the association of insomnia and fatigue due to shift work and ML were assessed by using mixed Poisson regression. The results are presented separately for women and men in shift work with and without night shifts. Results After adjusting for age, smoking, alcohol use, BMI, physical exercise and chronic diseases, women engaged in shift work without night shifts in midlife had on average a 24% (due to shift work insomnia) and a 16% (due to shift work fatigue) higher risk for a unit increase in ML in old age than those without shiftwork insomnia and fatigue. Likewise, men engaged in shift work with night shifts in midlife had on average a 61% (insomnia) and a 66% (fatigue) higher risk for a unit increase in ML in old age. Furthermore, women in shift work with night shifts and men in shift work without night shifts had on average a higher risk of ML, but the risk was attenuated and remained insignificant after adjustment. Conclusions The findings of this prospective 28 year cohort study suggest that shift work related insomnia and fatigue in midlife have inverse effects on mobility functions in old age irrespective of gender and type of shift work, and indicates in the initiation of prevention of mobility decline in working life.

Osteoarthritis (OA) is the most common degenerative joint disease afflicting people in the Western world and has a strong genetic influence. The aim of this study was to examine the association of two known functional polymorphisms in the TGF-β inhibiting genes, asporin (ASPN) and cartilage intermediate layer protein (CILP), with hand OA and potential gene-occupational hand loading interaction. Statistically significant interaction of the CILP rs2073711 T and ASPN D15 alleles with hand OA was observed (OR = 2.48, 95% CI 1.27–4.85, p = 0.008) in a Finnish hand OA cohort of 543 women (aged 45–63). When stratified by variation in working tasks, low variation of working tasks increased the risk further (OR = 3.00, 95% CI 1.35–6.66, p = 0.007). Based on the analysis of ASPN and CILP protein-coding regions, functional studies were performed with one observed variant, rs41278695 in the ASPN gene. Analyses showed that bone morphogenetic protein 2 (BMP2) mediated expression of aggrecan (Agc1) and type II collagen (Col2a1) was significantly suppressed (p = 0.011 and p = 0.023, respectively) in a murine chondrocytic cell line (ATDC5) with cells stably expressing ASPN rs41278695. The carriage of either ASPN D15 or CILP rs2073711 TT is associated with increased risk of symmetrical hand OA, particularly in individuals with low variation in work tasks. ASPN rs41278695 SNP had an effect on Agc1 and Col2a1 gene expression when induced with BMP-2 suggesting an effect on the cartilage extracellular matrix composition.

Objective The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’. Methods A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations. Results 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability). Conclusions These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

Objectives We analyzed the work ability index (WAI) and its first item (work ability score, WAS) – and subsequent four-year changes thereof – as predictors of disability pension (DP). Methods We linked survey responses of 5251 Finnish municipal employees, aged 44–58 years, to pension and death register data until 2009. Job content (physical, mental, or mixed) was based on observation. Baseline (1981) WAI was divided into poor (37) and WAS into poor (0–5), moderate (6–7), and good/excellent (8–10). Four-year changes in these scores were classified as strong decline (<lowest 15th percentile), slight decline, and no change/improved. Cox regression and receiver operating characteristic (ROC) analysis were used. Results During follow-up, 2057 subjects were granted DP. Compared to those with good/excellent WAI, the hazard ratio (HR) for DP related to moderate and poor WAI, respectively, was 2.0 (95% CI 1.8–2.2) and 5.0 (95% CI 4.4–5.6), adjusted for sociodemographic variables and job content. For WAS, the HR were 1.8 (95% CI 1.6–2.0) and 3.4 (95% 3.0–3.8). Four-year decline in WAI/WAS further increased the risk. During the first four years of follow-up, the area under the curve (AUC) for WAI at cut-off point 27 was 0.66 (sensitivity 49.2% and specificity 82.9%) and 0.64 for cut-off point 36 (sensitivity 84.2% and specificity 44.3%). For WAS at cut-off point 5, the figures were AUC 0.63 (sensitivity 41.9% and specificity 85.0%) and AUC 0.65 for cut-off point 7 (sensitivity 78.2% and specificity 52.7%). Conclusion The single-item WAS can be considered a reasonable alternative to the seven-item WAI in describing the risk of DP and as a prognostic tool.

Aims Previously, among food industry workers, multisite pain predicted sickness absence (SA) only in those with low biomechanical workload. Here we studied among a wide range of occupations whether the relationship of pain with SA was modified by the level of physical or psychosocial workload. Methods A nationally representative sample (Health 2000 Survey) comprised 3420 occupationally active Finns aged 30–55 years. Baseline data on musculoskeletal pain during the preceding month, strenuous work history, current physical workload, job demands, job control, support at work, lifestyle, and chronic diseases were obtained in 2000/2001 by questionnaire, interview, and clinical examination. Musculoskeletal pain in 18 body locations was combined into four sites (neck, upper limbs, low back, and lower limbs) and classified as no pain, single-site pain, and multisite pain (2–4 sites). The data were linked with information from national registers on annual SA periods lasting ≥10 workdays for 2002–2008. Negative binomial regression analysis was used. Results At baseline, one-third of the study sample reported single-site and one-third multisite pain. Allowing for gender and age, the employees with multisite pain in strata with high physical workload and high job demands tended to have the highest risk of SA, but no statistically significant interactive effects between work factors and pain were observed. Further adjustment for health-related lifestyle and chronic diseases decreased the risk estimates in all strata. Conclusion We did not find evidence for significant modification by physical or psychosocial workload of the relationship between musculoskeletal pain and SA periods lasting ≥10 workdays.

Aim: Although multisite pain (MSP) often threatens work ability (WA), some of those with MSP retain good WA. Our aim was to identify factors associated with good WA among subjects with MSP. Methods: A nationally representative sample (the Health 2000-Study, response rate 87%) comprising 3884 occupationally active Finns aged 30–64 years. Data on WA, musculoskeletal pain, physical and psychosocial working conditions, chronic diseases, lifestyle and domestic situation were gathered by questionnaire, interview and clinical examination. Good current WA compared with the lifetime best was defined as ⩾9 on a 0–10 scale. Musculoskeletal pain in 18 body locations was combined into four sites, and thereafter pain in two or more sites was defined as MSP (N=1351). Poisson regression analysis was used to obtain prevalence rate ratios (PRR). Results: Good WA was reported by 48% of the women and 37% of the men with MSP. In a multivariable model good WA was associated with younger age, female gender, physically non-strenuous work (PRR 1.3, 95% CI 1.1–1.5), low job strain (1.2, 1.0–1.4), high supervisor support (1.2, 1.0–1.4), and not having musculoskeletal diseases (1.3, 1.1–1.5), mental disorders (1.4, 1.1–1.9), daytime tiredness (1.4, 1.2–1.7) or economic troubles (1.5, 1.1–1.9). Age-stratified analyses revealed also associations with high coworker support (1.2, 1.0–1.4) and strenuous leisure-time physical exercise (1.2, 1.0–1.4) in those aged 30–44 and low alcohol consumption (1.8, 1.2–2.6) in the age-group 45–64. Conclusions: Several potentially modifiable factors related to health, work, and lifestyle were associated with good WA among occupationally active subjects with MSP.