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Abstract Background Readmissions in psychiatric inpatient care may reflect problems in the provision of care, but the underlying factors are not well known. We examined the associations of patient characteristics (sociodemographic factors, diagnoses), treatment (duration, previous episodes, neuromodulation) and ward overload with psychiatric inpatient readmissions and multiple readmissions in Finland. Methods We used a routinely collected data pool from one hospital district and followed all 2052 hospitalizations that started in 2018. The outcomes were readmission within 30 days and one year, and among those with readmission, the number of readmissions. Results Of the patients, 11% had readmission within 30 days and 33% had readmission within one year. Women, those with previous hospitalizations, those with an ICD-10 diagnosis from the ‘behavioural syndromes associated with physiological disturbances and physical factors / disorders of adult personality and behaviour’ group, those with a diagnosis from the ‘neurotic, stress-related and somatoform disorders’ group, those with psychotic disorders, and those who received neuromodulation treatment were more likely to have readmissions. Having a diagnosis of ‘disorders of psychological development’ or ‘behavioural and emotional disorders with onset usually occurring in childhood and adolescence’ was associated with a lower likelihood of readmission. The duration of treatment and ward overload during the index period were not associated with readmission. Conclusions The findings of this study suggest possible risk factors for readmission and can be used to plan psychiatric care. To some degree, the risk factors varied between different readmission types. It is important to examine whether there are unmet treatment needs in psychiatric inpatient care for children and adolescents.

OBJECTIVE: This study aimed to compare the utility of risk estimation derived from questionnaires and administrative records in predicting long-term sickness absence among shift workers.METHODS: This prospective cohort study comprised 3197 shift-working hospital employees (mean age 44.5 years, 88.0% women) who responded to a brief 8-item questionnaire on work disability risk factors and were linked to 28 variables on their working hour and workplace characteristics obtained from administrative registries at study baseline. The primary outcome was the first sickness absence lasting ≥90 days during a 4-year follow-up.RESULTS: The C-index of 0.73 [95% confidence interval (CI) 0.70–0.77] for a questionnaire-only based prediction model, 0.71 (95% CI 0.67–0.75) for an administrative records-only model, and 0.79 (95% CI 0.76–0.82) for a model combining variables from both data sources indicated good discriminatory ability. For a 5%-estimated risk as a threshold for positive test results, the detection rates were 76%, 74%, and 75% and the false positive rates were 40%, 45% and 34% for the three models. For a 20%-risk threshold, the corresponding detection rates were 14%, 8%, and 27% and the false positive rates were 2%, 2%, and 4%. To detect one true positive case with these models, the number of false positive cases accompanied varied between 7 and 10 using the 5%-estimated risk, and between 2 and 3 using the 20%-estimated risk cut-off. The pattern of results was similar using 30-day sickness absence as the outcome.CONCLUSIONS: The best predictive performance was reached with a model including both questionnaire responses and administrative records. Prediction was almost as accurate with models using only variables from one of these data sources. Further research is needed to examine the generalizability of these findings.

This study examined the association between daily working hours and accelerometer-based sleep duration, sleep efficiency, and number of awakenings per hour of sleep on the following night among 800 older public sector employees in Finland (mean age 63 years in the first measurement they participated in, 87% women) with 4,818 measurement nights in total. Information on working hours was derived from daily logs and categorized into: 1) 6 h, 2) 7, hours 3) 8 h, 4) 9 h, and 5) 10 or more hours of work. The most common category (i.e. workdays with 8 h of work) was used as the reference category in the analyses. Nights followed by a workday and a free day were analyzed separately. No differences were observed in sleep duration between the reference group and the other working hour categories when the next day was a workday nor when the next day was a free day. After a 6-hour workday, sleep efficiency was on average 1.0 percentage points higher and there were on average 0.13 less awakenings per hour of sleep when compared with the reference category. When the next day was a free day, no differences in sleep quality were observed. Thus, no clear indication of a dose-response relationship between working hours and either duration or quality of sleep was found. Furthermore, future research should further examine the possibility that the association between working hours and sleep is somewhat different depending on whether the workday is followed by another workday or a free day.

Abstract Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study including people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes, comorbid depression and cardiometabolic disease. A total of 105 predictors were assessed at baseline. During a mean follow-up of 8.6 years, 6836 (7.7%) participants were granted a disability pension. C-statistics for the 8-item Finnish Institute of Occupational Health (FIOH) risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, exceeded 0.72 for all disease groups and was 0.80 (95% CI 0.80–0.81) for participants with musculoskeletal disorders, 0.83 (0.82–0.84) for those with migraine, and 0.82 (0.81–0.83) for individuals with respiratory disease. Predictive performance was not significantly improved in models with re-estimated coefficients or a new set of predictors. These findings suggest that the 8-item FIOH work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability.

Abstract Background In health care, the shift work is arranged as irregular work shifts to provide operational hours for 24/7 care. We aimed to investigate working hour trends and turnover in health care via identification of time-related sequences of work shifts and absences among health care employees. The transitions between the work shifts (i.e., morning, day, evening, and night shifts), and absences (days off and other leaves) over time were analyzed and the predictors of change in irregular shift work were quantified. Methods A longitudinal cohort study was conducted using employer-owned payroll-based register data of objective and day-to-day working hours and absences of one hospital district in Finland from 2014 to 2019 (n = 4931 employees). The working hour data included start and end of work shifts, any kind of absence from work (days off, sickness absence, parental leave), and employee’s age, and sex. Daily work shifts and absences in 2014 and 2019 were used in sequence analysis. Generalized linear model was used to estimate how each identified sequence cluster was associated with sex and age. Results We identified four sequence clusters: “Morning” (60% in 2014 and 56% in 2019), “Varying shift types” (22% both in 2014 and 2019), “Employee turnover” (13% in 2014 and 3% in 2019), and “Unstable employment (5% in 2014 and 19% in 2019). The analysis of transitions from one cluster to another between 2014 and 2019 indicated that most employees stayed in the same clusters, and most often in the “Varying shift types” (60%) and “Morning” (72%) clusters. The majority of those who moved, moved to the cluster “Morning” in 2019 from “Employee turnover” (43%), “Unstable employment” (46%) or “Varying shift types” (21%). Women were more often than men in the clusters “Employee turnover” and “Unstable employment”, whereas older employees were more often in “Morning” and less often in the other cluster groups. Conclusion Four clusters with different combinations of work shifts and absences were identified. The transition rates between work shifts and absences with five years in between indicated that most employees stayed in the same clusters. The likelihood of a working hour pattern characterized by “Morning” seems to increase with age.

Abstract While sunlight may influence cognitive function through several pathways, associations of residential sunlight exposure with cognitive function are not well known. We evaluated associations of long-term residential sunlight exposure with cognitive function among a representative cohort of 1838 Finnish adults residing in Finland who underwent comprehensive cognitive assessment in midlife. We linked daily recordings of global solar radiation to study participants using residential information and calculated the average daily residential exposure to sunlight for four exposure time intervals: 2 months, 1 year, 2 years and 5 years prior to the date of the cognition assessment. Associations of the residential sunlight exposure with cognitive function were assessed using linear regression analyses adjusting for season, sex, age, and individual- and neighborhood-level socioeconomic characteristics. Greater average residential sunlight exposure over 2 and 5 years prior to the cognitive function assessment was associated with better global cognitive function (b = 0.13, 95% CI = 0.01, 0.25; b = 0.17, 95% CI = 0.05, 0.29, per 1 MJ/m2 difference in sunlight exposure), while no associations with global cognitive function were observed at shorter exposure time intervals. In domain-specific analyses, greater residential exposure to sunlight over 1, 2 and 5 years prior to the cognitive function assessment was associated with better performance on new learning and visual memory (b = 0.10, 95% CI = 0.00, 0.20; b = 0.16, 95% CI = 0.04, 0.28; b = 0.19, 95% CI = 0.08, 0.31) and sustained attention (b = 0.15, 95% CI = 0.05, 0.25; b = 0.18, 95% CI = 0.06, 0.30; b = 0.17, 95% CI = 0.05, 0.29), but worse performance on reaction time (b = − 0.12, 95% CI = − 0.22, − 0.02; b = -0.15, 95% CI = − 0.28, − 0.02; b = − 0.18, 95% CI = − 0.30, − 0.05). Residential sunlight exposure was not associated with executive function. These findings suggest long-term residential sunlight exposure may be an environmental factor influencing cognitive function among a cognitively healthy cohort residing in Northern Europe. Further studies in populations residing in different geographical locations are needed.

OBJECTIVE: In terms of prevention, it is important to determine effects on cardiovascular disease (CVD) when some workplace psychosocial resources are high while others are low. The aim of the study was to assess the prospective relationship between clustering of workplace psychosocial resources and risk of CVD among employees. METHODS: We pooled data from three cohort studies of 135 669 employees (65% women, age 18–65 years and free of CVD) from Denmark, Finland and Sweden. Baseline horizontal resources (culture of collaboration and support from colleagues) and vertical resources (leadership quality and procedural justice) were measured using standard questionnaire items. Incident CVD, including coronary heart and cerebrovascular disease, was ascertained using linked electronic health records. We used latent class analysis to assess clustering (latent classes) of workplace psychosocial resources. Cox proportional hazard models were used to examine the association between these clusters and risk of CVD, adjusting for demographic and employment-related factors and pre-existing physical and mental disorders. RESULTS: We identified five clusters of workplace psychosocial resources from low on both vertical and horizontal resources (13%) to generally high resources (28%). High horizontal resources were combined with either intermediate [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.95] or high (HR 0.88, 95% CI 0.78–1.00) vertical resources were associated with lower risks of CVD compared to those with generally low resources. The association was most prominent for cerebrovascular disease (eg, general high resources: HR 0.80, 95% CI 0.67–0.96). CONCLUSIONS: Individuals with high levels of workplace psychosocial resources across horizontal and vertical dimensions have a lower risk of CVD, particularly cerebrovascular disease.

Objectives To develop a risk prediction algorithm for identifying work units with increased risk of violence in the workplace.Design Prospective cohort study.Setting Public sector employees in Finland.Participants 18 540 nurses, social and youth workers, and teachers from 4276 work units who completed a survey on work characteristics, including prevalence and frequency of workplace violence/threat of violence at baseline in 2018–2019 and at follow-up in 2020–2021. Those who reported daily or weekly exposure to violence or threat of violence daily at baseline were excluded.Exposures Mean scores of responses to 87 survey items at baseline were calculated for each work unit, and those scores were then assigned to each employee within that work unit. The scores measured sociodemographic characteristics and work characteristics of the work unit.Primary outcome measure Increase in workplace violence between baseline and follow-up (0=no increase, 1=increase).Results A total of 7% (323/4487) of the registered nurses, 15% (457/3109) of the practical nurses, 5% of the social and youth workers (162/3442) and 5% of the teachers (360/7502) reported more frequent violence/threat of violence at follow-up than at baseline. The area under the curve values estimating the prediction accuracy of the prediction models were 0.72 for social and youth workers, 0.67 for nurses, and 0.63 for teachers. The risk prediction model for registered nurses included five work unit characteristics associated with more frequent violence at follow-up. The model for practical nurses included six characteristics, the model for social and youth workers seven characteristics and the model for teachers included four characteristics statistically significantly associated with higher likelihood of increased violence.Conclusions The generated risk prediction models identified employees working in work units with high likelihood of future workplace violence with reasonable accuracy. These survey-based algorithms can be used to target interventions to prevent workplace violence.

The COVID-19 pandemic led to permanent and temporary job losses but the mental health consequences of different types of employment transitions are not well-understood. In particular, knowledge is scarce concerning furloughs, which was a common job protection strategy in many high- and upper middle-income countries during this crisis. This study focuses on how different types of job instability and job loss during the pandemic influences depression and anxiety in the context of Sweden.A subset of participants from the Swedish Longitudinal Occupational Survey of Health were contacted in February 2021 and again in February 2022. A total of 1558 individuals participated in either or both waves and worked before the pandemic. We examined whether i) workplace downsizing, ii) furlough, or iii) unemployment/job loss were associated with depression and anxiety over this one-year period during the pandemic. Logistic regression models with cluster-robust standard errors were estimated, adjusting for sociodemographic factors and prior mental health problems. Effect modification by sex and prior mental health problems was also examined.In comparison to stable employment, being furloughed was unrelated to mental health, while experiencing workplace downsizing during the pandemic was associated with an increased risk of anxiety (adjusted Odds Ratio (OR) = 2.09, 95% Confidence interval (CI) = 1.08–4.05). Job loss/unemployment increased the risk of depression (OR = 1.91, 95% CI = 1.02–3.57) compared to being stably employed, but the risk estimate crossed unity when considering prior mental health status. No effect modification by sex or by prior mental health problems was found.This study found that while job loss and downsizing during the COVID-19 pandemic were associated with depression and anxiety, respectively, being furloughed was not. These findings thus suggest that job retention schemes in the form of short-time work allowances, as implemented in Sweden during the COVID-19 pandemic, may prevent mental health problems among employees during economic crises.

Abstract While characteristics of psychosocial work environment have traditionally been studied separately, we propose an alternative approach that treats psychosocial factors as interacting elements in networks where they all potentially affect each other. In this network analysis, we used data from a prospective occupational cohort including 10,892 participants (85% women; mean age 47 years) and repeated measurements of seven psychosocial work characteristics (job demands, job control, job uncertainty, team climate, effort-reward imbalance, procedural justice and interactional justice) assessed in 2000, 2004, 2008 and 2012. Results from multilevel longitudinal vector autoregressive models indicated that job demands as well as interactional and procedural justice were most broadly associated with the subsequent perceptions of the work-related psychosocial factors (high out-Strength), suggesting these factors might be potentially efficient targets of workplace interventions. The results also suggest that modifying almost any of the studied psychosocial factors might be relevant to subsequent perceptions of effort-reward imbalance and interactional justice at the workplace.

Administrative data accumulating daily from hospitals would provide new possibilities to assess work shifts and patient care. We aimed to investigate associations of work unit level average work shift length and length of patient in-hospital stay, and to examine the role of nurse-patient-ratio, year, night work, age, work units and working hours at the work units for these estimations. The data for this study were based on combined administrative day-to-day patient and pay-roll based objective working hour data of employees of one hospital district in Finland for 2013-2019. Three patient measures were calculated: the overall length of in-hospital stay, the length of in-hospital stay before a medical procedure and the length of in-hospital stay after a medical procedure. A Generalized Linear Mixed Model (GLMM) with multivariate normal random effects was used with Penalized Quasi-Likelihood for relative risk ratios (RR) with 95% confidence intervals (CI). The results showed that compared to 10 hours work shifts were associated with a decreased likelihood of the overall length of in-hospital stay (RR 0.94, 95% CI 0.94, 0.95) and length of in-hospital stay after a medical procedure among all occupations (RR 0.94, 95% CI 0.92, 0.97). These associations retained the magnitude and direction in the models additionally adjusted for work, employee, and patient characteristics, and the associations were weaker for nurses than among all occupations. To conclude, compared with the standard work shifts, 8-10 hours work shifts seem to be associated with longer, and >10 hours work shifts with shorter length of in-hospital stay. Administrative data provides feasible possibilities to investigate working hours and length of in-hospital stay.

OBJECTIVE: Whether perceived job insecurity increases the risk of suicidal behaviors is unclear. Improved understanding in this area could inform efforts to reduce suicide risk among those experiencing elevated job insecurity during the COVID-19 pandemic as well as post-pandemic. We aimed to investigate if perceived job insecurity predicted increased risk of suicide mortality and suicide attempts. METHOD: Employees (N=65 571), representative of the Swedish working population who participated in the Swedish Work Environment Survey in 1991–2003, were followed up through 2016 in the National Inpatient and Death Registers. Suicide deaths and suicide attempts were defined according to International Classification of Diseases (ICD) 10 and ICD-8/9 codes of underlying cause of death and in-/outpatient care. Job insecurity and subsequent risk of suicide and suicide attempt were investigated with marginal structural Cox regression analyses and inverse probability of treatment weighting to control for confounding. RESULTS: Perceived job insecurity was associated with an elevated risk of suicide [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.03–2.20], but not with incident suicide attempts (HR 1.03, CI 0.86–1.24). Estimates remained similar after considering prevalent/previous poor mental health, other work factors, and when restricting the follow up time to ten years. CONCLUSION: The study suggests that job insecurity is associated with an increased risk of suicide mortality. Concerns about elevated job insecurity and suicide levels in the wake of the current pandemic could thus be considered in strategies to reduce the population health impact job insecurity both during and following the COVID-19 pandemic.

Objectives To investigate working life courses in women and men and possible associations with socioeconomic, health-, and work-related factors. Methods A 15-year prospective cohort study of individuals aged 18–50 in paid work at baseline and answering the Swedish Living Conditions Surveys (2000–2003, N = 9269) and their annual economic activity, using nationwide registers. We used sequence and cluster analyses to identify and group similar working life sequences. Multinomial logistic regression was used to examine associations of sex, socioeconomic, health-, and work-related factors with sequence cluster memberships. Results We identified 1284 working life sequences, of which 65% represented continuous active (in paid work/studying) states. We then identified five sequence clusters, the largest one with individuals who were continuously active (n = 6034, 65% of the participants; 54% of women and 76% of men) and smaller ones with interruptions of the active state by long-term parental-leave, unemployment, and/or sickness absence/disability pension (SA/DP), or retirement. Women were more likely than men to belong to the “Parental-leave periods” (odds ratio [OR]: 33.2; 95% confidence intervals [CI]: 25.6, 43.1) and the “SA/DP periods” sequence clusters (OR: 1.8; 95% CI: 1.4, 2.1), also after adjustment for covariates. In both sexes, low education and poor health were the strongest predictors of belonging to the sequence cluster “Unemployment & SA/DP periods”. Predictors of the “Parental-leave periods” sequence cluster differed between women and men. Conclusions In a cohort of individuals in paid work at baseline, the majority of women and men worked most of each year although women were more likely to have some interruptions characterized by long-term parental-leave or SA/DP periods than men, independently of socioeconomic, health-, and work-related factors.

There is limited knowledge on the characteristics of employees who engage in catch-up sleep, the extension of sleep duration on free days to compensate for sleep loss accumulating during workdays. This study examined associations of accelerometer-measured free day catch-up sleep with sleep duration, sleep timing, and socio-demographic, health and lifestyle factors among older employees. We measured sleep repeatedly with accelerometers among 824 public sector employees in Finland (mean age 63 years; 86% women). On average, the participants provided 1.7 annual accelerometer measurements and 1,437 person-observations in total. Catch-up sleep was defined as longer average sleep duration on free days compared with average sleep duration on workdays. Prevalence of catch-up sleep was 78%. On average, the catch-up sleep group extended their sleep on free days by 1 hour 22 min (95% confidence interval [CI] 1 h 19 min – 1 h 26 min), whereas the non-catch-up sleep group reduced their sleep duration by 45 min (95% CI -50 min – -40 min). Catch-up sleep was mainly associated with delayed awakening time on free days (by 1 h 57 min, 95% CI 1 h 52 min – 2 h 2 min). We also observed a greater social jetlag in the catch-up sleep group in comparison to the non-catch-up sleep group, whereas no differences were observed in chronotype, self-reported sleep, or other individual characteristic. In conclusion, accelerometer-measured catch-up sleep is common among older employees in Finland and major differences in duration and timing of sleep occur between those with and without catch-up sleep.

Abstract Background There is inconsistent evidence that long working hours and night work are risk factors for sickness absence, but few studies have considered variation in the length of exposure time window as a potential source of mixed findings. We examined whether the association of long working hours and night work with sickness absence is dependent on the length of exposure to the working hour characteristics. Methods We analysed records of working hours, night work and sickness absence for a cohort of 9226 employees in one hospital district in Finland between 2008 and 2019. The exposure time windows ranged from 10 to 180 days, and we used Cox’s proportional hazards models with time-dependent exposures to analyse the associations between working-hour characteristics and subsequent sickness absence. Results Longer working hours for a period of 10 to 30 days was not associated with the risk of sickness absence whereas longer working hours for a period of 40 to 180 days was associated with a lower risk of sickness absence. Irrespective of exposure time window, night work was not associated with sickness absence. Conclusions It is important to consider the length of exposure time window when examining associations between long working hours and sickness absence, whereas the association between night work and sickness absence is not similarly sensitive to exposure times.

BackgroundThe association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working

OBJECTIVES: Data mining can complement traditional hypothesis-based approaches in characterizing unhealthy work exposures. We used it to derive a hypothesis-free characterization of working hour patterns in shift work and their associations with sickness absence (SA). METHODS: In this prospective cohort study, complete payroll-based work hours and SA dates were extracted from a shift-scheduling register from 2008 to 2019 on 6029 employees from a hospital district in Southwestern Finland. We applied permutation distribution clustering to time series of successive shift lengths, between-shift rest periods, and shift starting times to identify clusters of similar working hour patterns over time. We examined associations of clusters spanning on average 23 months with SA during the following 23 months. RESULTS: We identified eight distinct working hour patterns in shift work: (i) regular morning (M)/evening (E) work, weekends off; (ii) irregular M work; (iii) irregular M/E/night (N) work; (iv) regular M work, weekends off; (v) irregular, interrupted M/E/N work; (vi) variable M work, weekends off; (vii) quickly rotating M/E work, non-standard weeks; and (viii) slowly rotating M/E work, non-standard weeks. The associations of these eight working-hour clusters with risk of future SA varied. The cluster of irregular, interrupted M/E/N work was the strongest predictor of increased SA (days per year) with an incidence rate ratio of 1.77 (95% confidence interval 1.74–1.80) compared to regular M/E work, weekends off. CONCLUSIONS: This data-mining suggests that hypothesis-free approaches can contribute to scientific understanding of healthy working hour characteristics and complement traditional hypothesis-driven approaches.

Summary: Background: Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use. Methods: In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines – non-drinking (never or former drinkers); moderate consumption (1–14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study. Findings: During 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9–30·8) years, women 29·8 (29·2–30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4–29·0) years, women 29·6 (29·4–29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9–26·0) years, women 24·0 (21·4–26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3–26·8), women 27·5 (26·4–28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less. Interpretation: Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller. Funding: Medical Research Council, National Institute on Aging, NordForsk, Academy of Finland, Finnish Work Environment Fund.

OBJECTIVES: This study aimed to examine the contribution of shift work, work time control (WTC) and informal caregiving, separately and in combination, to sleep disturbances in ageing employees. METHODS: Survey data were obtained from two prospective cohort studies with repeated measurements of working conditions, informal caregiving, and sleep disturbances. We used fixed-effect conditional logistic regression analysis to examine whether within-individual changes in shift work, WTC and informal caregiving were associated with changes in sleep. Secondary analyses included between-individuals comparison using standard logistic regression models. Results from the two cohorts were pooled using meta-analysis. RESULTS: Low WTC and informal caregiving were associated with sleep disturbances in within-individual analyses [odds ratios (OR) ranging between 1.13 (95% confidence interval 1.01–1.27) and 1.48 (95% CI 1.29–1.68)] and in between-individuals analyses [OR 1.14 (95% CI 1.03–1.26) to 1.33 (1.19–1.49)]. Shift work alone was not associated with sleep disturbances, but accumulated exposure to shift work, low WTC and informal caregiving was associated with higher risk of sleep disturbances (OR range 1.21–1.76). For some of the sleep outcomes, informal caregiving was related to a higher risk of sleep disturbances when WTC was low and a lower risk when WTC was high. CONCLUSIONS: Informal caregiving and low WTC are associated with risk of sleep disturbances among ageing employees. The findings also suggest that low WTC in combination with informal caregiving may increase the risk of sleep disturbances whereas high WTC may alleviate the adverse impact of informal caregiving on sleep.

OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and learning disabilities (LD) have an early onset and often persist into adulthood, although their relative contribution to incapacity for work is unclear. We examined this issue among young adults with ADHD, ASD or LD taking into account socioeconomic factors and comorbid mental disorders. METHODS: Recorded diagnoses between the ages of 10–35 years between 2001 and 2010 were derived from nationwide inpatient and specialized outpatient hospital registers in Sweden. We identified 15 632 individuals with a main diagnosis of ADHD, 8238 with ASD, and 1038 with LD, and the matched control group without recorded mental disorders (N=124 536). The outcome was the number of register-based sickness absence and work disability pension (SA-DP) days during a maximum of three years follow-up. RESULTS: Among men, the rate ratio (RR) of SA-DP was 11.17 [95% confidence interval (CI) 9.89–12.60] for ADHD, 35.59 (95% CI 30.30–41.81) for ASD, and 9.20 (95% CI 5.76–14.70) for LD, in comparison to those in the reference group. The corresponding risks among women were RR 12.05 (95% CI 10.30–14.09) for ADHD, RR 28.36 (95% CI 22.96–35.02) for ASD, and RR 9.60 (95% CI 5.83–15.81) for LD. The findings were, to a large extent, similar when individuals on DP at baseline were excluded. Comorbid mental disorders further increased the risk of SA-DP. Educational differences were smaller among the patients than in the reference group. CONCLUSIONS: Early-onset neurodevelopmental disorders, particularly with comorbidity, have a far-reaching impact on adult life in terms of SA and DP.

SUMMARY: Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints. Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers. Findings: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality. Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality. Funding: NordForsk, the Medical Research Council, the National Institute on Aging, the Wellcome Trust, Academy of Finland, and Finnish Work Environment Fund.

Abstract Background Co-occurrence of mental and somatic symptoms is common, and recent longitudinal studies have identified single trajectories of these symptoms, but it is poorly known whether the symptom trajectories can also co-occur and change across the lifespan. We aimed to examine co-occurring symptoms and their joint trajectories from adolescence to midlife. Methods Longitudinal data were derived from Northern Sweden, where 506 girls and 577 boys aged 16 years participated at baseline in 1981 (99.7% of those initially invited), and have been followed up in four waves until the age of 43. Survey data were collected about depressive, anxiety, and somatic symptoms. Potential joint development of this three-component symptom set was examined with multiple response trajectory analysis, a method that has not been previously used to study co-occurrence of these symptoms. Results We identified a five trajectory solution as the best: “very low” (19%), “low” (31%), “high” (22%), “late sharply increasing” (16%) and a “very high increasing” (12%). In the “late sharply increasing” and “very high increasing” groups the scores tended to increase with age, while in the other groups the levels were more stable. Overall, the results indicated that depressive, anxiety, and somatic symptoms co-exist from adolescence to midlife. Conclusions The multiple response trajectory analysis confirmed high stability in the co-occurrence of depressive, anxiety, and somatic symptoms from adolescence to midlife. Clinicians should consider these findings to detect symptoms in their earliest phase in order to prevent the development of co-occurring high levels of symptoms.

OBJECTIVES: We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index ≥ 25kg/m^2). METHODS: We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (≥90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption. RESULTS: The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35–1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31–1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70–0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar. CONCLUSIONS: These findings suggest that the excess risk of work disability among overweight individuals would drop by 3–4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.

OBJECTIVES: Bi-directional associations between perceived effort‒reward imbalance (ERI) at work and neck-shoulder pain have been reported. There is also evidence of associations between ERI and depressive symptoms, and between depressive symptoms and pain while the links between ERI, depressive symptoms and pain have not been tested. We aimed to assess whether depressive symptoms mediate the association between ERI and neck-shoulder pain, as well as the association between neck-shoulder pain and ERI. METHODS: We used prospective data from three consecutive surveys of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. ERI was assessed with a short version of the ERI questionnaire, and pain was defined as having had neck-shoulder pain that affected daily life during the past three months. Depressive symptoms were assessed with a continuous scale based on six-items of the (Hopkins) Symptom Checklist. Counterfactual mediation analyses were applied using exposure measures from 2010/2012 (T1), depressive symptoms from 2012/2014 (T2), and outcomes from 2014/2016 (T3), and including only those free of outcome at T1 and T2 (N=2876‒3239). RESULTS: ERI was associated with a higher risk of neck-shoulder pain [risk ratio (RR) for total effect 1.22, 95% confidence interval (CI) 1.00–1.48] and 41% of this total effect was mediated through depressive symptoms. Corresponding RR for association between neck-shoulder pain and ERI was 1.34 (95% CI 1.09–1.64), but the mediating role of depressive symptoms was less consistent. CONCLUSIONS: Depressive symptoms appear to be an intermediate factor in the relationship between ERI and neck-shoulder pain.

Working hours is a ubiquitous exposure given that most adults are employed, and one that is modifiable via legislative change if not always through individual-level choice. According to a recent report from the World Health Organization (WHO) and International Labour Organization (ILO), there is currently sufficient evidence to conclude that long working hours (i.e., ≥55 h per week) elevate the risk of fatal and non-fatal ischaemic heart disease to a clinically meaningful extent. After assessing the data used by the ILO/WHO, we feel that the expert group has not correctly applied their own framework for assessing the strength of the evidence. In the meta-analysis of observational studies in the report, the association between long working hours and incident heart disease appeared stronger in lower quality cohort studies with a high risk of bias (minimally-adjusted hazard ratio 1.20, 95% CI 1.01–1.41, compared to standard 35–40 weekly hours) than in the superior-quality studies with a lower risk of bias for which the estimate was not significantly different from the null (1.08, 95% CI 0.93–1.25). There was also marked effect modification, such that there was no increase in ischaemic heart disease for those working long hours in high socioeconomic status occupations, a finding also reported in analyses of a recent census-based cohort study which was not included in the report. Our meta-analysis of all these studies confirm that the findings are not consistent but differ between subgroups and that the summary age- and sex-adjusted hazard ratio for long working hours in high socioeconomic status occupations does not support excess risk: 0.85, 95% CI 0.63–1.13 (Pinteraction = 0.005, total N = 451,982). For these and other reasons detailed in this commentary, we advance a more cautious interpretation of the existing evidence. The conclusions should be restricted to low socioeconomic status occupations only and more research is still needed to confirm or refute harmfulness and determine clinical relevance.

Background Job strain is implicated in many atherosclerotic diseases, but its role in peripheral artery disease (PAD) is unclear. We investigated the association of job strain with hospital records of PAD, using individual‐level data from 11 prospective cohort studies from Finland, Sweden, Denmark, and the United Kingdom. Methods and Results Job strain (high demands and low control at work) was self‐reported at baseline (1985–2008). PAD records were ascertained from national hospitalization data. We used Cox regression to examine the associations of job strain with PAD in each study, and combined the study‐specific estimates in random effects meta‐analyses. We used τ2, I2, and subgroup analyses to examine heterogeneity. Of the 139 132 participants with no previous hospitalization with PAD, 32 489 (23.4%) reported job strain at baseline. During 1 718 132 person‐years at risk (mean follow‐up 12.8 years), 667 individuals had a hospital record of PAD (3.88 per 10 000 person‐years). Job strain was associated with a 1.41‐fold (95% CI, 1.11–1.80) increased average risk of hospitalization with PAD. The study‐specific estimates were moderately heterogeneous (τ2=0.0427, I2: 26.9%). Despite variation in their magnitude, the estimates were consistent in both sexes, across the socioeconomic hierarchy and by baseline smoking status. Additional adjustment for baseline diabetes mellitus did not change the direction or magnitude of the observed associations. Conclusions Job strain was associated with small but consistent increase in the risk of hospitalization with PAD, with the relative risks on par with those for coronary heart disease and ischemic stroke.

Summary: Background: Socioeconomic disadvantage is a risk factor for many diseases. We characterised cascades of these conditions by using a data-driven approach to examine the association between socioeconomic status and temporal sequences in the development of 56 common diseases and health conditions. Methods: In this multi-cohort study, we used data from two Finnish prospective cohort studies: the Health and Social Support study and the Finnish Public Sector study. Our pooled prospective primary analysis data comprised 109 246 Finnish adults aged 17–77 years at study entry. We captured socioeconomic status using area deprivation and education at baseline (1998–2013). Participants were followed up for health conditions diagnosed according to the WHO International Classification of Diseases until 2016 using linkage to national health records. We tested the generalisability of our findings with an independent UK cohort study—the Whitehall II study (9838 people, baseline in 1997, follow-up to 2017)—using a further socioeconomic status indicator, occupational position. Findings: During 1 110 831 person-years at risk, we recorded 245 573 hospitalisations in the Finnish cohorts; the corresponding numbers in the UK study were 60 946 hospitalisations in 186 572 person-years. Across the three socioeconomic position indicators and after adjustment for lifestyle factors, compared with more advantaged groups, low socioeconomic status was associated with increased risk for 18 (32·1%) of the 56 conditions. 16 diseases formed a cascade of inter-related health conditions with a hazard ratio greater than 5. This sequence began with psychiatric disorders, substance abuse, and self-harm, which were associated with later liver and renal diseases, ischaemic heart disease, cerebral infarction, chronic obstructive bronchitis, lung cancer, and dementia. Interpretation: Our findings highlight the importance of mental health and behavioural problems in setting in motion the development of a range of socioeconomically patterned physical illnesses. Policy and health-care practice addressing psychological health issues in social context and early in the life course could be effective strategies for reducing health inequalities. Funding: UK Medical Research Council, US National Institute on Aging, NordForsk, British Heart Foundation, Academy of Finland, and Helsinki Institute of Life Science.

OBJECTIVES: The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension. METHODS: The work stressors job strain, effort−reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models. RESULTS: Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61–0.81), 17.7% to two stressors (O/E=0.91–1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9–2.1-fold [95% confidence interval (CI) 1.7–2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0–1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4–4.7-fold (95% CI 2.4–8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9–2.5-fold (95% CI 1.1–4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6–1.9-fold (95% CI 1.3–2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0–1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings. CONCLUSIONS: Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors.

OBJECTIVES: This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. METHODS: We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. RESULTS: We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1–5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03–1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I^2=45.1%, P=0.004). A moderate association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13–2.01), a weaker association in Europe (1.11, 95% CI 1.00–1.22), and no association in North America (0.97, 95% CI 0.70–1.34) or Australia (0.95, 95% CI 0.70–1.29). Differences by other characteristics were small. CONCLUSIONS: This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.

OBJECTIVES: This study aimed to develop and validate a risk prediction model for long-term sickness absence. METHODS: Survey responses on work- and lifestyle-related questions from 65 775 public-sector employees were linked to sickness absence records to develop a prediction score for medically-certified sickness absence lasting >9 days and ≥90 days. The score was externally validated using data from an independent population-based cohort of 13 527 employees. For both sickness absence outcomes, a full model including 46 candidate predictors was reduced to a parsimonious model using least-absolute-shrinkage-and-selection-operator (LASSO) regression. Predictive performance of the model was evaluated using C-index and calibration plots. RESULTS: Variance explained in ≥90-day sickness absence by the full model was 12.5%. In the parsimonious model, the predictors included self-rated health (linear and quadratic term), depression, sex, age (linear and quadratic), socioeconomic position, previous sickness absences, number of chronic diseases, smoking, shift work, working night shift, and quadratic terms for body mass index and Jenkins sleep scale. The discriminative ability of the score was good (C-index 0.74 in internal and 0.73 in external validation). Calibration plots confirmed high correspondence between the predicted and observed risk. In >9-day sickness absence, the full model explained 15.2% of the variance explained, but the C-index of the parsimonious model was poor (

Abstract Background Previous studies have not distinguished between different alcohol-use histories, which could have contributed to the current inconsistent evidence regarding the relationship between alcohol use and subsequent sickness absence. We thus examined alcohol use and subsequent diagnosis-specific sickness absence in groups with different levels of alcohol use, as well as in lifelong abstainers, former drinkers, and people with clinical alcohol use disorders. Methods The data of the population-based Health 2000 Survey (BRIF8901) of 3666 Finns aged 30–55 were linked with national registers on medically certified sickness absences lasting for > 10 working days (long-term) for all causes (2000 − 2010) and for mental or musculoskeletal disorders (2004-2010), as well as with registers on pensions and death (2000-2010). Alcohol use was assessed by questionnaire. Chronic somatic diseases were evaluated at baseline in a clinical examination, and common mental and alcohol use disorders using the Composite International Diagnostic Interview (CIDI). Cox regression analyses were conducted with censoring for death and retirement from work. Results During an average 10-year follow-up, 56.0% of the participants had at least one long-term sickness absence period. Compared with light drinkers, those having an alcohol use disorder had increased risk of all-cause sickness absence (HR = 1.27; 95% CI = 1.04 − 1.54) and sickness absence due to mental disorders (HR = 2.16; 95% CI = 1.39 − 3.35), when somatic and mental disorders as well as demographic, lifestyle-related and occupational factors at baseline were accounted for. Lifelong abstainers did not differ from light drinkers. Also high-volume drinking (HR = 1.52; 95% CI 1.03 − 2.25) and former drinking (HR = 1.57; 95% CI = 1.15 − 2.15) were associated with long-term sickness absence due to mental disorders. Alcohol use was not predictive of sickness absence due to musculoskeletal disorders. Conclusions These results highlight the need to distinguish between former drinking and lifelong abstinence, as only former drinking was associated with sickness absence. Alcohol use disorder and high-volume drinking were strongly predictive of sickness absence due to mental disorders. Identifying people with excessive alcohol use e.g. in occupational health care, and mapping and supporting their mental health may help in preventing sickness absences.

Past decades have been characterized by technological changes and globalization of the economy, which has led to a change in employment conditions worldwide. Flexible labor markets and decreased impact of trade unions have contributed to the increase and emergence of insecure ‘non-standard’ forms of employment, such as temporary agency jobs and zero-hour job contracts. During the past ten years, there has been an increase, albeit slight, in precariousness of work in developed countries (1). Although precarious employment is a societal issue with potential adverse effects on health, the majority of research activity has focused on proximal psychosocial working conditions within the workplace, which however, represents a small aspect of a complex system involving labor markets, employment and working conditions, psychosocial working conditions, and the relationship with health. While an internationally accepted scientific definition is lacking, precarious employment can be conceptualized as accumulated unfavorable aspects of employment (contract) quality. These unfavorable aspects may include temporary job contracts, job insecurity, vulnerability, lack of control and employee rights, nonstandard or substandard working time arrangements, limited training and employability opportunities, and low salary (2). The point is that while any single dimension does not necessarily indicate precariousness, accumulating adversities result in precarious employment (3). Young people in particular seem to be at risk of health problems when exposed to precarious employment (4). A recent systematic review also concluded that some dimensions of precarious employment were associated with occupational injuries and accidents (5). In this issue of the Scandinavian Journal of Work, Environment & Health, Rönnblad et al (6) present the first systematic review and meta-analysis on the relationship between precarious employment and mental health. They found 16 studies that met their inclusion criteria: prospective studies with data on working age active labor market participants from European Economic Area, Switzerland, Australia, New Zealand, Canada, and the US during 2000‒2017. In the included studies, the assessed exposure was single or multiple dimensions of precarious employment, and workers exposed were compared to those not exposed. Outcomes that were related to mental health were included. Of the included studies, only five studies used multidimensional exposure (ie, measured more than one dimension of precariousness). The review was carefully conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocol (PRISMA-P) guidelines. The authors conclude that moderate quality evidence was found for adverse effect of job insecurity on mental health. Evidence of very low quality was found for single dimensions of temporary job contracts and unpredictable working hours on mental health. The quality problems in these studies included inconsistent evidence and limited total number of studies. No quality rating was conducted for the five studies using multidimensional measure of precariousness. However, a meta-analysis was performed, which gave a summary odds ratio of 2.01 (95% CI 1.60-2.53) for the association between precarious employment and poor mental health. This was interpreted as representing “an indication of where the effect sizes would probably disperse when studying more than one dimension of precarity simultaneously” (6). The authors give a clear recommendation that observational studies with single exposures, particularly overly broad category of temporary employment and general job insecurity, should not be prioritised in future studies. Rather, high-quality studies using multidimensional exposure to precarious employment were found to be scarce, and the authors had to exclude many studies due to poor or inadequate study designs. It thus seems clear that we need to develop a common measure for precarious employment which is of high quality and widely used in the scientific community. This means development, testing, and validation studies for measuring precariousness, and theoretical discussions on the concept. The Employment Precariousness Scale is a step towards this goal (7, 8). However, as the response rates to questionnaire data are decreasing internationally, and there are widely known biases in self-reported data such as ‘common method bias’ (9, 10), we may need additional data sources. Moreover, as Rönnblad et al note, precarious employees are almost by definition, difficult to follow longitudinally. Here, register data and secondary use of digital data sources (‘big data’) may provide additional information. For example, objective information on employment contracts, salaries, unionisation, and working hours are available through employers’ registers, at least in the Nordic countries. The level of worker organization (union representation) and training are available through national registers (in Finland: Statistics Finland). In fact, Van Aerden and her colleagues (11) have used latent class cluster analysis of survey data and found that it is empirically possible to identify separate clusters of employment quality based on information on employment contract, income level, uncompensated work, long working hours, schedule unpredictability, involuntary part-time employment, training opportunities, information on occupational health and safety issues, and employee involvement. The majority of these measures could be identified through register databases. Rönnblad and his colleagues (6) further suggest that job insecurity should be studied as an outcome or mediator between other labor market exposures and health outcomes. This suggestion could be expanded to other indicators of precarious employment as well. For example, the model of sustainable employability by van der Klink et al (12) considers opportunities to develop new knowledge and skills (capabilities) as core element of sustainable employability. The model postulates a process where a worker can convert his/her resources into opportunities to achieve valuable goals. The major point of the model is that people are more likely to be sustainably employable if their work does not merely represent a means to earn a living. Precarious employees have a poor labor market status and, by definition (dimension of precarious employment), poor opportunities to develop their capabilities. Future research could thus investigate whether precarious employment, or dimensions of precariousness, mediate or moderate the relationship between work and labor market exposures and health-related outcomes. The independent effect of precarious employment from adversity related to low income should be addressed. Furthermore, to date, research on precarious employment has been based on data with assessment of precarious employment at one time point only (1). However, the dynamic nature of the labor market sets requirements to future research so that we need to consider changes of employment relationships over time, across the individual’s working life course. New methods, such as trajectory analyses and multi-state models would give valuable information on employment trajectories and dynamic intersections between precarious employment and other work and employment related characteristics across the working life course. References 1. Benach J, Vives A, Tarafa G, Delclos C, Muntaner C. What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research. Int J Epidemiol. 2016 Feb;45(1):232-8. https://doi.org/10.1093/ije/dyv342 2. Julia M, Vanroelen C, Bosmans K, Van Aerden K, Benach J. Precarious employment and quality of employment in relation to health and well-being in Europe. Int J Health Serv. 2017 Jul;47(3):389-409. https://doi.org/10.1177/0020731417707491 3. Koranyi I, Jonsson J, Ronnblad T, Stockfelt L, Bodin T. Authors’ response to “Multiple-job holding is not a type of precarious employment”. Scand J Work Environ Health. 2019 Jan 1;45(1):100. https://doi.org/10.5271/sjweh.3789 4. Vancea M, Utzet M. How unemployment and precarious employment affect the health of young people: A scoping study on social determinants. Scand J Public Health. 2017 Feb;45(1):73-84. https://doi.org/10.1177/1403494816679555 5. Koranyi I, Jonsson J, Ronnblad T, Stockfelt L, Bodin T. Precarious employment and occupational accidents and injuries - a systematic review. Scand J Work Environ Health. 2018 Jul 1;44(4):341-50. https://doi.org/10.5271/sjweh.3720 6. Rönnblad T, Grönholm E, Jonsson J, Koranyi I, Orellana C, Kreshpaj B, et al. Precarious employment and mental health: a systematic review and meta-analysis of longitudinal studies. Scand J Work, Environ Health - online first. https://doi.org/10.5271/sjweh.3797 7. Vives A, Amable M, Ferrer M, Moncada S, Llorens C, Muntaner C, et al. The Employment Precariousness Scale (EPRES): psychometric properties of a new tool for epidemiological studies among waged and salaried workers. Occup Environ Med. 2010 Aug;67(8):548-55. https://doi.org/10.1136/oem.2009.048967 8. Vives A, Gonzalez F, Moncada S, Llorens C, Benach J. Measuring precarious employment in times of crisis: the revised Employment Precariousness Scale (EPRES) in Spain. Gac Sanit. 2015 Sep-Oct;29(5):379-82. https://doi.org/10.1016/j.gaceta.2015.06.008 9. Thorsen SV, Flyvholm MA, Bultmann U. Self-reported or register-based? A comparison of sickness absence data among 8110 public and private employees in Denmark. Scand J Work Environ Health. 2018 Nov 1;44(6):631-8. https://doi.org/10.5271/sjweh.3747 10. Gupta N, Heiden M, Mathiassen SE, Holtermann A. Is self-reported time spent sedentary and in physical activity differentially biased by age, gender, body mass index, and low-back pain? Scand J Work Environ Health. 2018 Mar 1;44(2):163-70. https://doi.org/10.5271/sjweh.3693 11. Van Aerden K, Moors G, Levecque K, Vanroelen C. Measuring employment arrangements in the European labor force: A typological approach. Social Indicators Research. 2014 May 01;116(3):771-91. https://doi.org/10.1007/s11205-013-0312-0 12. van der Klink JJ, Bultmann U, Burdorf A, Schaufeli WB, Zijlstra FR, Abma FI, et al. Sustainable employability--definition, conceptualization, and implications: A perspective based on the capability approach. Scand J Work Environ Health. 2016 Jan;42(1):71-9. https://doi.org/10.5271/sjweh.3531

OBJECTIVES: The aim of this study was to examine occupational class differences in working more than six months beyond the mandatory retirement age and factors that may contribute to these differences. METHODS: The study comprised a prospective cohort study of a total of 5331 Finnish municipal employees (73% women) who were not on work disability pension and reached the age eligible for old-age pension in 2005–2011. Occupational class included four categories: managers and professionals, lower grade non-manual, skilled manual, and elementary occupations. Survey responses while at work were linked to national health and pension registers. RESULTS: A total of 921 participants (17.3%) worked beyond the pensionable age. Compared with elementary workers, skilled manual workers had a similar probability [gender-adjusted risk ratio (RR) 0.95, 95% confidence interval (95% CI) 0.72–1.23] while lower grade non-manual workers had a 2.03-fold (95% CI 1.59–2.58), and managers and professionals had a 1.79-fold (95% CI 1.41–2.27) probability of working beyond the pensionable age. Adjustment for physical workload (32.0% in lower non-manual, 36.7% in managers and professionals), work time control (20.4% and 11.4%) and perceived work ability (16.5% and 29.1%) contributed to the largest attenuation for these associations. Analyses using a counterfactual approach suggested greater mediated effects for physical workload and work time control than those observed in traditional mediation analyses. CONCLUSIONS: Employees with higher occupational classes are two times more likely to continue working beyond the retirement age compared to those with lower occupational classes. A large proportion of these differences were explained by having physically light job, better work time control, and better self-rated work ability among employees with high occupational class.

OBJECTIVES: The aim of this study was to investigate the association between the length of sickness absence and sustained return to work (SRTW) and the predictors of SRTW in depression, anxiety disorders, intervertebral disc disorders, and back pain in a population-based cohort of employees in the Finnish public sector. METHODS: We linked data from employers’ registers and four national population registers. Cox proportional hazards regression analysis with a cluster option was applied. SRTW was defined as the end of the sickness benefit period not followed by a recurrent sickness benefit period in 30 days. RESULTS: For depression, the median time to SRTW was 46 and 38 days among men and women, respectively. For anxiety disorders, the figures were 24 and 22 days, for intervertebral disc disorders, 42 and 41 days, and, for back pain, 21 and 22 days among men and women respectively. Higher age and the persistence of the health problem predicted longer time to SRTW throughout the diagnostic categories. Comorbid conditions predicted longer time to SRTW in depression and back pain among women. CONCLUSIONS: This large cohort study adds scientific evidence on the length of sickness absence and SRTW in four important diagnostic categories among public sector employees in Finland. Further research taking into account, eg, features of the work environment is suggested. Recommendations on the length of sickness absence at this point should be based on expert opinion and supplemented with research findings.

Abstract We examined the trajectories of work disability before and after IHD and stroke events. New IHD (n = 13521) and stroke (n = 7162) cases in 2006–2008 were retrieved from nationwide Swedish hospital records and their annual work disability days five years before and after the date of diagnosis were retrieved from a nationwide disability register. There was no pre-event differences in disability days between the IHD and stroke cases and five years prior to the event, they were close to those observed in the general population. In the first post-event year, the adjusted mean days increased to 83.9 (95% CI 80.6–86.5) in IHD; to 179.5 (95% CI 172.4–186.8) in stroke, a six-fold increase in IHD and 14-fold in stroke. Work disability leveled off among the IHD cases but not among those who had stroke. The highest disability levels for the fifth post-event year after a stroke event was associated with pre-existing diabetes (146.9), mental disorder (141.2), non-employment (137.0), and immigrant status (117.9). In a working-age population, the increase in work disability after a cardiovascular event decreases close to the pre-event level in IHD but remains particularly high after stroke; among patients with comorbid depression or diabetes, immigrants, and those not in employment.

Cumulative contributions of social and health-related determinants to long-term unemployment during early working life among young adults are poorly understood. Therefore, we used four cumulative indices of both parental and own social and health-related determinants of such unemployment among a cohort which comprised a complete census of children born in Finland in 1987. The cohort participants were registered in the Medical Birth Register, and they were followed-up through 2015 (N = 46 521). We calculated predicted probabilities for long-term unemployment (> 12 months) when participants were 25–28 years. Moreover, we examined whether the associations differed by unemployment at the municipal level.During the follow-up, 4.5% of women and 7.1% of men experienced long-term unemployment. All cumulative indices of parental and own social and health-related determinants predicted the probability of long-term unemployment. The greatest probabilities were observed for own social determinants, both in municipalities with high and low unemployment although the probabilities were higher in the high-unemployment municipalities. Of the individual determinants, poor school performance showed the strongest association with long-term unemployment among women (OR 6.65, 95% CI 5.21–8.55) and men (OR 3.70, 95% CI 2.96–4.67), after adjusting for other own social determinants. The results highlight the importance of life course social equality in the prevention of long-term unemployment in early adulthood. Keywords: Social determinants, Psychiatric diagnoses, Teen-age pregnancies, School performance, Register-based, Child protection action

OBJECTIVES: Work-related stress has been linked to increased risk of disability pensioning, but the association between perceived justice of managerial behavior and decision-making processes at the workplace (ie, organizational justice) and risk of disability pensioning remains unknown. We examined the associations of organizational justice and its relational and procedural components with all-cause and diagnosis-specific disability pensions with repeated measures of justice. METHODS: Data from 24 895 employees responding to repeated surveys on organizational justice in 2000–2002 and 2004 were linked to the records of a national register for disability pensions from 2005–2011. Associations of long-term organizational justice (average score from two surveys) with disability pensions were studied with Cox proportional hazard regression adjusted for demographics, socioeconomic status, baseline health and health risk behavior, stratified by sex. RESULTS: During a mean follow-up of 6.4 years, 1658 (7%) employees were granted disability pension (282 due to depression; 816 due to musculoskeletal diseases). Higher organizational justice was associated with a lower risk of disability pensioning [hazard ratio (HR) per one-unit increase in 5-point justice scale 0.87 (95% CI 0.81–0.94)]. For disability pension due to depression and musculoskeletal diseases, the corresponding HR were 0.77 (95% CI 0.65–0.91) and 0.87 (95% CI 0.79–0.97), respectively. Adjustment for job strain and effort–reward imbalance attenuated the HR by 20–80%. CONCLUSIONS: Supervisors` fair treatment of employees and fair decision-making in the organizations are associated with a decreased risk of disability pensioning from all-causes, depression and musculoskeletal diseases. These associations may be attributable to a wider range of favorable work characteristics.

OBJECTIVES: Using Swedish population-based register data, we examined the extent to which comorbid conditions contribute to the risk of disability pension among people with diabetes. METHODS: We carried out Cox proportional hazard analyses with comorbid conditions as time-dependent covariates among 14 198 people with newly diagnosed diabetes in 2006, and 39 204 people free from diabetes during the follow-up from 2007–2010. The average follow-up times were 46 and 48 months for those with and without diabetes, respectively. RESULTS: For those with diabetes only, the incidence of all-cause disability pension was 9.5 per 1000 person-years. The highest incidence of disability pension were for those with: diabetes and depression (23.6); diabetes and musculoskeletal disorder (30.6), and those with diabetes and more than one comorbid condition (36.5). The incidence rate was 5.8 for those without diabetes. Diabetes was associated with a 2.30 times [95% confidence interval (95% CI) 2.09–2.54] higher risk of disability pension (adjusted for sociodemographic factors). This association attenuated by 41% after further adjustment for comorbid chronic conditions. While diabetes was a risk factor for disability pension due to musculoskeletal disorders and diseases of the circulatory system, even after accounting for the above-mentioned conditions, the association between disability pension due to mental disorders and diabetes was diluted after adjustment for mental disorders. CONCLUSIONS: Although diabetes is an independent risk factor for disability pension, comorbid conditions contribute to this risk to a large degree.

Summary: Background: Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence. Methods: We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAFexternal). Findings: For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70·9 days per 10 person-years), depressive disorders (26·5 days per 10 person-years), and external causes (such as injuries and poisonings; 12·8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1·30, 95% CI 1·21–1·40; PAFexternal 8·9%) and low physical activity (1·23, 1·14–1·34; 7·8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1·90, 1·41–2·56; 15·2%), smoking (1·70, 1·42–2·03; 11·8%), low physical activity (1·67, 1·42–1·96; 19·8%), and obesity (1·38, 1·11–1·71; 5·6%) were associated with absences due to depressive disorders; heavy episodic drinking (1·64, 1·33–2·03; 11·3%), obesity (1·48, 1·27–1·72; 6·6%), smoking (1·35, 1·20–1·53; 6·3%), and being overweight (1·20, 1·08–1·33; 6·2%) were associated with absences due to external causes; obesity (1·82, 1·40–2·36; 11·0%) and smoking (1·60, 1·30–1·98; 10·3%) were associated with absences due to circulatory diseases; low physical activity (1·37, 1·25–1·49; 12·0%) and smoking (1·27, 1·16–1·40; 4·9%) were associated with absences due to respiratory diseases; and obesity (1·67, 1·34–2·07; 9·7%) was associated with absences due to digestive diseases. Interpretation: Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk. Funding: NordForsk, British Medical Research Council, Academy of Finland, Helsinki Institute of Life Sciences, and Economic and Social Research Council.

Summary: Background: Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight. Methods: We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991–2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI

BackgroundAlthough a stroke event often leads to work disability, diagnoses behind work disability before and after stroke are largely unknown. We examined the pre‐event and postevent trends in diagnosis‐specific work disability among patients of working age. Methods and ResultsWe included all new nonfatal stroke events in 2006–2008 from population‐based hospital registers in Sweden among women and men aged 25 to 60 years (n=12 972). Annual days of diagnosis‐specific work disability were followed for 4 years before and after stroke. Repeated measures negative binomial regression models using the generalized estimating equations method were fitted to examine trends in diagnosis‐specific work disability before and after the event. Already during the 4 pre‐event years, work disability attributed to circulatory diseases increased among women (rate ratio, 1.99; 95% confidence interval, 1.68–2.36) and men (rate ratio, 2.20; 95% confidence interval, 1.88–2.57). Increasing trends before stroke were also found for work disability attributed to mental disorders, musculoskeletal diseases, neoplasms, diseases of the nervous, respiratory, and digestive systems, injuries, and diabetes mellitus. As expected, a sharp increase in work disability days attributed to circulatory diseases was found during the first year after the event among both sexes. Overall, during 4 years after the stroke, there was a decreasing trend for circulatory diseases and injuries, whereas the trend was increasing for nervous diseases and diabetes mellitus. ConclusionsWork disability attributed to several mental and somatic diagnoses is higher already before a stroke event.

Established in 2008 and comprising over 60 researchers, the IPD-Work (individual-participant data meta-analysis in working populations) consortium is a collaborative research project that uses pre-defined meta-analyses of individual-participant data from multiple cohort studies representing a range of countries. The aim of the consortium is to estimate reliably the associations of work-related psychosocial factors with chronic diseases, disability, and mortality. Our findings are highly cited by the occupational health, epidemiology, and clinical medicine research community. However, some of the IPD-Work’s findings have also generated disagreement as they challenge the importance of job strain as a major target for coronary heart disease (CHD) prevention, this is reflected in the critical discussion paper by Choi et al (1). In this invited reply to Choi et al, we aim to (i) describe how IPD-Work seeks to advance research on associations between work-related psychosocial risk factors and health; (ii) demonstrate as unfounded Choi et al’s assertion that IPD-Work has underestimated associations between job strain and health endpoints; these include the dichotomous measurement of job strain, potential underestimation of the population attributable risk (PAR) of job strain for CHD, and policy implications arising from the findings of the IPD-Work consortium; and (iii) outline general principles for designing evidence-based policy and prevention from good-quality evidence, including future directions for research on psychosocial factors at work and health. In addition, we highlight some problems with Choi et al’s approach.

Summary: Background: Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. Methods: We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m2), overweight (25·0–29·9 kg/m2), class I (mild) obesity (30·0–34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (

Summary: Background: The associations of social isolation and loneliness with premature mortality are well known, but the risk factors linking them remain unclear. We sought to identify risk factors that might explain the increased mortality in socially isolated and lonely individuals. Methods: We used prospective follow-up data from the UK Biobank cohort study to assess self-reported isolation (a three-item scale) and loneliness (two questions). The main outcomes were all-cause and cause-specific mortality. We calculated the percentage of excess risk mediated by risk factors to assess the extent to which the associations of social isolation and loneliness with mortality were attributable to differences between isolated and lonely individuals and others in biological (body-mass index, systolic and diastolic blood pressure, and handgrip strength), behavioural (smoking, alcohol consumption, and physical activity), socioeconomic (education, neighbourhood deprivation, and household income), and psychological (depressive symptoms and cognitive capacity) risk factors. Findings: 466 901 men and women (mean age at baseline 56·5 years [SD 8·1]) were included in the analyses, with a mean follow-up of 6·5 years (SD 0·8). The hazard ratio for all-cause mortality for social isolation compared with no social isolation was 1·73 (95% CI 1·65–1·82) after adjustment for age, sex, ethnic origin, and chronic disease (ie, minimally adjusted), and was 1·26 (95% CI 1·20–1·33) after further adjustment for socioeconomic factors, health-related behaviours, depressive symptoms, biological factors, cognitive performance, and self-rated health (ie, fully adjusted). The minimally adjusted hazard ratio for mortality risk related to loneliness was 1·38 (95% CI 1·30–1·47), which reduced to 0·99 (95% CI 0·93–1·06) after full adjustment for baseline risks. Interpretation: Isolated and lonely people are at increased risk of death. Health policies addressing risk factors such as adverse socioeconomic conditions, unhealthy lifestyle, and lower mental wellbeing might reduce excess mortality among the isolated and the lonely. Funding: Academy of Finland, NordForsk, and the UK Medical Research Council.

The association between cognitive decline and the ability to recognise emotions in interpersonal communication is not well understood. We aimed to investigate the association between cognitive function and the ability to recognise emotions in other people's facial expressions across the full continuum of cognitive capacity.Cross-sectional analysis of 4039 participants (3016 men, 1023 women aged 59 to 82 years) in the Whitehall II study. Cognitive function was assessed using a 30-item Mini-Mental State Examination (MMSE), further classified into 8 groups: 30, 29, 28, 27, 26, 25, 24, and

OBJECTIVES: Research on temporary employment as a risk factor for work disability due to depression is mixed, and few studies have measured work disability outcome in detail. We separately examined the associations of temporary employment with (i) the onset of work disability due to depression, (ii) the length of disability episodes, and (iii) the recurrence of work disability, taking into account the possible effect modification of sociodemographic factors. METHODS: We linked the prospective cohort study data of 107 828 Finnish public sector employees to national registers on work disability (>9 days) due to depression from January 2005 to December 2011. RESULTS: Disability episodes were longer among temporary than permanent employees after adjustment for age, sex, level of education, chronic somatic disease, and history of mental/behavioral disorders [cumulative odds ratio (COR) 1.37, 95% confidence interval (95% CI) 1.25–51). The association between temporary employment and the length of depression-related disability episodes was more pronounced among participants with a low educational level (COR 1.95, 95% CI 1.54–2.48) and older employees (>52 years; COR 3.67, 95% CI 2.83–4.76). The association was weaker in a subgroup of employees employed for ≥50% of the follow-up period (95% of the original sample). Temporary employment was not associated with the onset or recurrence of depression-related work disability. CONCLUSIONS: Temporary employment is associated with slower return to work, indicated by longer depression-related disability episodes, especially among older workers and those with a low level of education. Continuous employment might protect temporary employees from prolonged work disability.

OBJECTIVES: Job strain has previously been shown to predict disability pension, but it is unknown whether effort-reward imbalance (ERI), another major stress model, is also associated with disability pension. METHODS: We examined ERI as a risk factor for diagnosis-specific disability pension in a cohort of 51 874 public-sector employees in Finland. To control for reporting bias, work unit-level scores of ERI (based on the survey responses of 35 260 employees in 2000–2002) were constructed and linked to all eligible employees. A sub-cohort of the respondents was analyzed also with individual-level ERI. Disability pension data were derived from national pension registers with no loss to follow-up. The outcomes were all-cause disability pension and disability pension due to depression, musculoskeletal diseases, and ischemic heart diseases (IHD). Multivariate Cox proportional hazard models (adjusted for sociodemographic factors, baseline health, and work-related characteristics) were used for analyses. RESULTS: During a mean 8.9 years of follow-up, 4542 participants were granted disability pension. An increased risk for disability pension due to depression was detected for both high work unit- and individual-level ERI [hazard ratio (HR) 1.63, 95% confidence interval (95% CI) 1.31–2.04 and HR 1.90, 95% CI 1.51–2.40, respectively]. High individual-level ERI increased the risk of disability pension due to musculoskeletal diseases (HR 1.32, 95% CI 1.13–1.53), but no association was observed for work unit-level ERI (HR 1.02, 95% CI 0.88–1.19). ERI was not associated with disability pension due to IHD. CONCLUSION: The present study showed a consistent association between high ERI and an increased risk of disability pension due to depression.

OBJECTIVES: Associations between psychosocial work environment and excess weight have not been systematically addressed. The aim of this systematic review was to summarize the published evidence for the associations of psychosocial factors at work and long work hours with weight-related outcomes . Methods We conducted a search of Medline and Embase for all original articles published up to September 2012 using predefined keywords. After excluding studies with a definite selection bias, we included 39 articles. RESULTS: About 60% of the studies reported at least one positive association between psychosocial factors at work and a weight-related outcome. However, 76% of the tested associations were found to be non-significant. Furthermore, the associations were rather weak. Studies of higher quality tended to observe associations more often than those of lower quality. Positive associations were found more frequently (i) among women versus men, (ii) in cross-sectional versus longitudinal studies, and (iii) for overweight or obesity versus other outcomes. About 70% of the studies reported positive associations between long work hours and weight-related outcomes. All four studies that evaluated the association between working overtime and weight gain (three longitudinal and one cross-sectional), showed a positive association among men and two of them also observed associations among women. CONCLUSIONS: We found evidence for weak associations between psychosocial factors at work and excess weight. Associations were observed between long work hours, working overtime, and weight gain, especially among men. More cohort studies among non-obese baseline participants using appropriate analytical methods based on an elaborated hypothetical model are needed.