Search

Objectives: Our aim was to explore the predictive value of Return-to-Work-Readiness Questionnaire (RTW-RQ) among patients with mental disability. Material and Methods: The cohort consists of 129 patients undergoing psychiatric assessment for work ability. RTW-RQ was used to assess self-perceived functional capacity concerning return-to-work. The questionnaire comprises an equal appearing interval scale (0–10) and qualitative questions related to facilitating and hindering factors towards return-to-work. Work status was measured at one-year. Results: At one-year follow-up, 31 patients (24%) had returned to competitive employment (CE) and 81 (63%) were considered able to work. The mean score for RTW-RQ was 4.8 (SD 3.9) for patients having returned to CE, and 1.9 (2.7) for those having not returned. Medium and high RTW-RQ scores predicted return to CE compared to those with a low score (scores 2–4: OR 3.1, 95% 0.8–12.4; scores 5–10: OR 52.8, 95% 6.0–461.7). Health and work-related facilitating factors were positively associated with RTW-RQ and seemed to predict return to CE (OR 2.4, 95% CI 0.6–9.4, and OR 2.2, 95% CI 0.6–9.0, respectively). On the other hand, health-related hindering factors were negatively associated with RTW-RQ and seemed to predict return to CE (OR 0.6, 95% CI 0.1–3.3). Results were similar regarding work ability. Conclusions: RTW-RQ seem to predict return to competitive employment and work ability within one year among patients with mental disability. It also seems crucial to recognize facilitating and hindering factors in order to succeed in rehabilitation. [ABSTRACT FROM AUTHOR] more...

Background: With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation. Methods: A nationwide register-based follow-up was conducted. Data were analysed via cross-tabulations with chi-square statistics and t tests/ANOVAs. Multivariate analyses were performed via Cox regression, which accounts for differences in follow-up times. Results: Of the 1,359 subjects who had undergone hormonal GR in Finland from 1996 to 2019, 7.9% discontinued their established hormonal treatment during an average follow-up of 8.5 years. The risk for discontinuing hormonal GR was greater among later cohorts. The hazard ratio was 2.7 (95% confidence interval 1.1–6.1) among those who had accessed gender identity services from 2013 to 2019 compared with those who had come to contact from 1996 to 2005. Discontinuing also appeared to be emerging earlier among those who had entered the process in later years. Conclusions: The risk of discontinuing established medical GR has increased alongside the increase in the number of patients seeking and proceeding to medical GR. The threshold to initiate medical GR may have lowered, resulting in a greater risk of unbalanced treatment decisions. Trial registration number (TRN): Not applicable (the paper does not present a clinical trial). [ABSTRACT FROM AUTHOR] more...

Background: The COVID-19 pandemic strained healthcare workers but the individual challenges varied in relation to actual work and changes in work. We investigated changes in healthcare workers' mental health under prolonging COVID-19 pandemic conditions, and heterogeneity in the mental-health trajectories. Methods: A monthly survey over a full year was conducted for employees of the HUS Helsinki University Hospital (n = 4804) between 4th June 2020 to 28th May 2021. Pandemic-related potentially traumatic events (PTEs), work characteristics (e.g., contact to COVID-19 patients), local COVID-19 incidence, and demographic covariates were used to predict Mental Health Index-5 (MHI-5) and Insomnia Severity Index (ISI) in generalized multilevel and latent-class mixed model regressions. Results: Local COVID-19 log-incidence (odds ratio, OR = 1.21, with 95% CI = 1.10–1.60), directly caring for COVID-19 patients (OR = 1.33, CI = 1.10–1.60) and PTEs (OR = 4.57, CI = 3.85–5.43) were all independently associated with psychological distress, when (additionally) adjusting for age, sex, profession, and calendar time. Effects of COVID-19 incidence on mental health were dissociable from calendar time (i.e., evolved in time) whereas those on sleep were not. Latent mental-health trajectories were characterized by a large class of "stable mental health" (62% of employees) and minority classes for "early shock, improving" (14%) and "early resilience, deteriorating" mental health (24%). The minority classes, especially "early shock, improving", were more likely to live alone and be exposed to PTEs than the others. Conclusions: Healthcare workers faced changing and heterogeneous mental-health challenges as the COVID-19 pandemic prolonged. Adversity and mental ill-being may have accumulated in some employees, and factors like living arrangements may have played a role. Knowledge on employees' demographic and socioeconomic background, as well as further research on the factors affecting employees' resilience, may help in maintaining healthy and efficient workforce in the face of a prolonging pandemic. [ABSTRACT FROM AUTHOR] more...

Study Objectives: We set out to examine how chronotype (diurnal preference) is connected to ability to function in natural conditions where individuals cannot choose their sleep schedule. We conducted a cross-sectional study in military conscript service to test the hypothesis that sleep deprivation mediates the adverse effects of chronotype on cognitive functioning. We also examined the effects of time of day. Methods: One hundred forty participants (ages 18-24 years) completed an online survey, including the Morningness- Eveningness Questionnaire and a Cambridge Neuropsychological Test Automated Battery. Most (n = 106) underwent an actigraphy recording. After bivariate analyses, we created a mediation model (self-reported sleepiness and sleep deprivation mediating effect of chronotype on cognition) and a moderation model (synchrony between most alert time and testing time). Results: Reaction times in inhibition task correlated negatively with sleep efficiency and positively with sleep latency in actigraphy. There was no relation to ability to inhibit responses. More significantly, spatial working memory performance (especially strategicness of performance) correlated positively with morning preference and negatively with sleep deprivation before service. Synchrony with most alert time of the day did not moderate these connections. No other cognitive task correlated with morningness or sleep variables. Conclusions: In line with previous research, inhibitory control is maintained after insufficient sleep but with a tradeoff of slower performance. The connection between morning preference and working memory strategy is a novel finding. We suggest that diurnal preference could be seen as an adaptive strategy, as morningness has consistently been associated with better academic and health outcomes. [ABSTRACT FROM AUTHOR] more...

Aim: Mental disorders are the leading cause of work disability among young adults in the industrialized world. Factors predicting employment after long‐term psychiatric work disability are largely unknown. Methods: We linked personal and clinical information from the benefit applications and medical certificates of 1163 young adults (18‐34 years) with a new‐onset fixed‐term psychiatric disability pension in 2008 with employment records between 2005 and 2013. The outcomes were starting employment during and being employed at the end of follow‐up. Results: Of the participants, 48% had been employed during and 22% were employed at the end of follow‐up. Sustained employment history, university education (master's degree) and no recorded psychological symptoms in childhood were associated with both subsequent employment outcomes. Women and participants under 25 years were more likely to start employment. Depression and other mental disorders (vs psychotic diagnose) and having no comorbid mental disorders or substance abuse were associated with employment at the end of follow‐up. Conclusions: Sustained employment history, university education and no recorded psychological symptoms during childhood predict a return to employment among young adults after a fixed‐term psychiatric work disability pension. Pro‐active interventions in psychological problems during childhood could enhance employment after a period of work disability. [ABSTRACT FROM AUTHOR] more...

Purpose: To evaluate the association between two measurement tools (Social and Occupational Functioning Assessment Scale, SOFAS and Sheehan Disability Scale, SDS), returning to work (RTW) and their inter-correlation.Methods: 132 psychiatric patients referred to assessment of work ability participated. The association between SOFAS and SDS Work to RTW were assessed by logistic regression. Inter-correlations between SOFAS and SDS were assessed with the Spearman's rho correlation coefficient.Results: SOFAS and SDS Work scores were associated with a 1-year RTW and SOFAS and SDS were inter-correlated.Conclusions: When assigning the ability to work, both subjective and objective measures of function predict RTW. [ABSTRACT FROM AUTHOR] more...

Background: We examined the extent to which psychotherapeutic and work-oriented interventions were included in a medical treatment and rehabilitation plan and whether they predicted future employment among young adults with work disability due to a mental disorder. Methods: Data were obtained from the treatment and rehabilitation plans of 1163 young adults aged 18-34 years, who in 2008 were granted fixed-term work disability compensation due to a mental disorder and were followed for 5 years. Results: Forty-six percent had no proposal for psychotherapy or a work-oriented intervention in their treatment and rehabilitation plan, 22 % had a plan for only a psychotherapeutic intervention, 23 % had a plan for only a work- oriented intervention, and 10 % had both types of interventions planned. Having a planned psychotherapeutic intervention (HR = 1.35, 95 % CI 1.07-1.69) and of the work-oriented interventions, planned rehabilitative courses and training (HR = 1.34, 95 % CI 1.03-1.70) predicted quicker entry into competitive employment. Having a plan for both a psychotherapeutic and work-oriented intervention was associated with being employed at the end of the follow-up (OR = 1.77, 95 % CI 1.07-2.95). Conclusions: Young adults with a long-term psychiatric work disability episode rarely have a recorded plan for rehabilitation in their treatment and rehabilitation plan although psychotherapeutic interventions and a combination of a psychotherapeutic and work-oriented intervention might help them gain employment. [ABSTRACT FROM AUTHOR] more...

BACKGROUND: Occupational well-being in health care is essential for the quality of care and productivity. Some of the major challenges facing hospital nurses are the personnel turnover, emotional loading and health care reforms. After primary occupational safety and risk management, complementary positive health promotion approaches with cultural interventions can be experimented. OBJECTIVE: To examine the association between well-being indicators of hospital nurses and their participation in cultural events provided by the employer (theater, concerts, exhibitions, museums, sight-seeing, and musicals) during past 6 months. METHODS: Subjective well-being was measured by work engagement, workplace support for new ideas, work satisfaction and experienced stress. RESULTS: A dose-dependent association was found between participation in cultural events and positive psychology parameters of occupational well-being (support for new ideas and work engagement), but the experience of stress was unrelated to participation in cultural events. Collective participation has a positive covariant effect on work engagement and seems to mediate the innovative work climate measured by workplace support for new ideas. CONCLUSIONS: Collective cultural events for employees may promote positive aspects of occupational wellbeing. [ABSTRACT FROM AUTHOR] more...

This study explored the relationship between cultural leisure activities, recovery experiences and two outcomes among hospital workers. The differences in recovery experiences (detachment, relaxation, mastery and control) and outcomes (work engagement and subjective recovery state) among hospital personnel (N=769) were analysed by the type (receptive or creative) and frequency of cultural activities. The cross-sectional data were collected by a digital questionnaire. Employees who reported both receptive and creative cultural leisure activities on a weekly basis had the highest relaxation, mastery and control experiences during off-job time. In addition, those with weekly creative activities had beneficial mastery experiences. There were no differences in recovery outcomes after adjustment for age, except in work engagement. Cultural leisure activities, and creative activities in particular, play an important role in certain aspects of recovery. [ABSTRACT FROM AUTHOR] more...

The increasing mental demands of healthcare work call for developing complementary health promotion strategies. Cultural leisure activities have long been recognized as a source of wellbeing and coping for employees. Yet, little is known about implementation of employer-provided cultural activities--how they are encountered and experienced. In this study, a public sector hospital department offered monthly cultural events for personnel: Theater, concerts, musicals, dance-performances, museum visits and sight-seeing. A digital questionnaire was sent to hospital staff (N = 769) to ask about their participation in employer-provided cultural activities during the past 6 months. The motives and obstacles for participation, and the quality of experience of the cultural events, were explored quantitatively and qualitatively. The main motives for participation were related to well-being, content of cultural events and invitations from employer or colleagues. For some, the participation was hampered by work-shifts and missing information. The participants experienced recreation, relaxation and psychological detachment from strain, which is essential for recovery. Community participation was more common than individual participation. Shared cultural experiences among employees may increase the social capital at workplace, but equal access for all employees should be guaranteed. [ABSTRACT FROM AUTHOR] more...

Central dopamine regulation is involved in postural control and in the pathophysiology of restless legs syndrome (RLS) and Parkinson's disease (PD). Postural control abnormalities have been detected in PD, but there are no earlier studies with regard to RLS and postural control. Computerized force platform posturography was applied to measure the shift and the velocity (CPFV) of center point of forces (CPF) with eyes open (EO) and eyes closed (EC) in controls ( n = 12) and prior and after a single day intervention with pramipexole in RLS subjects ( n = 12). CPFV (EO) was significantly lower in the RLS group ( p < 0.05) than in controls. After pramipexole intake, the difference disappeared and the subjective symptom severity diminished. Pramipexole did not significantly influence CPFV (EC) or CPF shift direction. Subjects with RLS used extensively visual mechanisms to control vestibule-spinal reflexes to improve or compensate the postural stability. Further research is needed to clarify altered feedback in the central nervous system and involvement of dopamine and vision in the postural control in RLS. [ABSTRACT FROM AUTHOR] more...

Objective This study examined whether indicators of poor health and health risk behaviors among hospital staff differ between the ward specialties. Methods Across 21 hospitals in Finland, 8003 employees (mean age 42 years, 87% women, 86% nurses) working in internal medicine, surgery, obstetrics and gynecology, pediatrics, intensive care, and psychiatry responded to a baseline survey on health and health risk behaviors (response rate 70%). Responses were linked to records of sickness absence and medication over the following 12 months. Results Psychiatric staff had higher odds of smoking [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 2.14-3.12], high alcohol use (OR 1.55, 9 5% CI 1.21-1.99), physical inactivity (OR 1.30, 95% CI 1.11-1.53), chronic physical disease (OR 1.19, 95% CI 1.04-1.36), current or past mental disorders (OR 1.81, 95% CI 1.50-2.17), and co-occurring poor health indicators (OR 2 . 6 5, 9 5% CI 2.08-3.37) as compared to those working in other specialties. They also had higher odds of sickness absence due to mental disorders (OR 1.40, 95% CI 1.02-1.92) and depression (OR 1.61, 95% CI 1.02-2.55) at follow-up after adjustment for baseline health and covariates. Personnel in surgery had the lowest probability of morbidity. No major differences between specialties were found in the use of psychotropic medication. Conclusion The prevalence of hospital employees with an adverse health risk profile is higher in psychiatric wards than other specialties. [ABSTRACT FROM AUTHOR] more...

There is growing evidence of the beneficial effects of cultural activities on health and well-being at work. Employees facing job demands and changes at work might benefit from arts when recovering from mental strain, reflecting on their values and finding new perspectives. The aim of this study was to examine the association between the frequency and type of cultural leisure activities and well-being and creativity at work among health care professionals (N=336). We analysed the association of creative leisure activities (art-making or creative expression) and receptive cultural activities (consuming culture) with well-being at work in the following outcomes: creative working mode, personal achievement and work engagement. A higher frequency of cultural leisure activities was associated with well-being at work. Both types of cultural activities were associated with a sense of personal achievement at work, but only creative leisure activities were associated with the creative working mode. In contrast, only receptive cultural activities were associated with work engagement. Sense of coherence, a marker of individual resources for successfully coping with stress, and organizational support of a creative working climate were analysed as covariates. Neither of these explained the associations between cultural activities and well-being at work. Creative hobbies and consuming culture on a weekly basis are both related to well-being at work. In line with earlier studies, the results support cultural activities as a possible empowering factor in occupational well-being among health care professionals. [ABSTRACT FROM AUTHOR] more...

Objectives To examine the associations between socio-economic position (SEP) and the onset of psychiatric work disability, return to work and recurrence of disability. Methods Prospective observational cohort study (1997-2005) including register data on 141 917 public-sector employees in Finland. Information on International Classification of Diseases, 10th Revision diagnosis-specific psychiatric work disability (≥90 days) was obtained from national registers. Results During a mean follow-up of 6.3 years, 3938 (2.8%) participants experienced long-term psychiatric work disability. Of these, 2418 (61%) returned to work, and a further 743 (31%) experienced a recurrent episode. SEP was inversely associated with onset of disability owing to depressive disorders, anxiety disorders, personality disorders, schizophrenia and substance-use disorders. No association was found between SEP and disability owing to bipolar disorders or reaction to severe stress and adjustment disorders. High SEP was associated with a greater likelihood of a return to work following depressive disorders, personality disorders, schizophrenia and substance-use disorders, but not bipolar disorders, anxiety disorders or reaction to severe stress and adjustment disorders. Low SEP predicted recurrent episodes of work disability. Conclusions High SEP is associated with lower onset of work disability owing to mental disorders, as well as return to work and lower rates of recurrence. However, the socio-economic advantage is diagnosis-specific. SEP predicted neither the onset and recovery from disability owing to bipolar disorders and reaction to severe stress and adjustment disorders, nor recovery from disability owing to anxiety disorders. SEP should be taken into account in the attempts to reduce long-term work disability owing to mental disorders. [ABSTRACT FROM AUTHOR] more...

Background: Patient overcrowding and violent assaults by patients are two major problems in psychiatric healthcare. However, evidence of an association between overcrowding and aggressive behaviour among patients is mixed and limited to small-scale studies.Aims: This study examined the association between ward overcrowding and violent physical assaults in acute-care psychiatric in-patient hospital wards.Method: Longitudinal study using ward-level monthly records of bed occupancy and staff reports of the timing of violent acts during a 5-month period in 90 in-patient wards in 13 acute psychiatric hospitals in Finland. In total 1098 employees (physicians, ward head nurses, registered nurses, licensed practical nurses) participated in the study. The outcome measure was staff reports of the timing of physical assaults on both themselves and ward property.Results: We found that 46% of hospital staff were working in overcrowded wards, as indicated by >10 percentage units of excess bed occupancy, whereas only 30% of hospital personnel were working in a ward with no excess occupancy. An excess bed occupancy rate of >10 percentage units at the time of an event was associated with violent assaults towards employees (odds ratio (OR) = 1.72, 95% CI 1.05-2.80; OR = 3.04, 95% CI 1.51-6.13 in adult wards) after adjustment for confounding factors. No association was found with assaults on ward property (OR = 1.06, 95% CI 0.75-1.50).Conclusions: These findings suggest that patient overcrowding is highly prevalent in psychiatric hospitals and, importantly, may increase the risk of violence directed at staff. [ABSTRACT FROM AUTHOR] more...

Background: Neuroleptic-induced movement disorders (NIMDs) have overlapping co-morbidity. Earlier studies have described typical clinical movement patterns for individual NIMDs. This study aimed to identify specific movement patterns for each individual NIMD using actometry. Methods: A naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders -- Fourth Edition (DSM-IV). Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD. Results: The patterns of neuroleptic-induced akathisia (NIA) and pseudoakathisia (PsA) were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia. Conclusion: The present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting. [ABSTRACT FROM AUTHOR] more...

Background: Simpson-Angus Scale (SAS) is an established instrument for neuroleptic-induced parkinsonism (NIP), but its statistical properties have been studied insufficiently. Some shortcomings concerning its content have been suggested as well. According to a recent report, the widely used SAS mean score cut-off value 0.3 of for NIP detection may be too low. Our aim was to evaluate SAS against DSM-IV diagnostic criteria for NIP and objective motor assessment (actometry). Methods: Ninety-nine chronic institutionalised schizophrenia patients were evaluated during the same interview by standardised actometric recording and SAS. The diagnosis of NIP was based on DSM-IV criteria. Internal consistency measured by Cronbach's α, convergence to actometry and the capacity for NIP case detection were assessed. Results: Cronbach's α for the scale was 0.79. SAS discriminated between DSM-IV NIP and non- NIP patients. The actometric findings did not correlate with SAS. ROC-analysis yielded a good case detection power for SAS mean score. The optimal threshold value of SAS mean score was between 0.65 and 0.95, i.e. clearly higher than previously suggested threshold value. Conclusion: We conclude that SAS seems a reliable and valid instrument. The previously commonly used cut-off mean score of 0.3 has been too low resulting in low specificity, and we suggest a new cut-off value of 0.65, whereby specificity could be doubled without loosing sensitivity. [ABSTRACT FROM AUTHOR] more...

Objective: Since most of the world's schizophrenia patients are treated with conventional antipsychotics, the authors evaluated various methods for establishing the prevalence of neuroleptic-induced movement disorders in these patients. Method: DSM-IV criteria and established score thresholds on a movement disorder rating scale were used to identify cases of neuroleptic-induced movement disorder in a representative Estonian patient sample of 99 chronic institutionalized schizophrenia patients, 18-65 years old, treated with conventional neuroleptics (79.8%) or clozapine (20.2%). Results: Neuroleptic-induced movement disorders according to DSM-IV criteria were found in 61.6% of the group: 31.3% had neuroleptic-induced akathisia, 23.2% had neuroleptic-induced parkinsonism, and 32.3% had neuroleptic-induced tardive dyskinesia. Prevalence rates for akathisia and tardive dyskinesia were similar when either DSM-IV criteria or rating scale scores were used, but the prevalence rate for parkinsonism was much lower per DSM-IV criteria than according to rating scale score. Conclusions: Nearly two-thirds of chronic schizophrenia patients suffered from a neuroleptic-induced movement disorder. Globally, extrapyramidal adverse effects still impose a huge burden on the majority of neuroleptic-treated individuals with schizophrenia. The discrepancy between the standard identification methods for neuroleptic-induced movement disorder indicate the need for further research. [ABSTRACT FROM AUTHOR] more...

An objective marker of restless legs syndrome (RLS) is needed for developing diagnostic tools and monitoring symptoms. Actometric ambulatory monitoring of 15 RLS patients and 15 healthy controls was undertaken in order to differentiate between RLS-related motor symptoms and normal motor activity. Nocturnal lower-limb activity per minute differentiated and discriminated between groups with no overlap, whereas the periodic limb movement index and the controlled rest activity during sitting showed less discriminative power. The naturalistic recording of nocturnal activity by actometry may prove useful for assessing the severity of RLS and for finding an objective marker to support the diagnosis of RLS. © 2002 Movement Disorder Society [ABSTRACT FROM AUTHOR] more...

A letter to the editor is presented in response to an article on Asperger syndrome published in a previous issue of the periodical.

Background: Neuroleptic-induced movement disorders (NIMDs) have overlapping co-morbidity. Earlier studies have described typical clinical movement patterns for individual NIMDs. This study aimed to identify specific movement patterns for each individual NIMD using actometry.Methods: A naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders - Fourth Edition (DSM-IV).Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD.Results: The patterns of neuroleptic-induced akathisia (NIA) and pseudoakathisia (PsA) were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia.Conclusion: The present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting. [ABSTRACT FROM AUTHOR] more...