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Purpose: This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. Methods: A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes. Results: A main theme was identified "the workplace and healthcare hold different organizational value logics" and four sub-themes: "the PSI-WPI challenged the organizational goals and values of the workplace and healthcare", "the PSI-WPI challenged organizational values on fairness", "the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators" and "the PSI-WPI introduced a need for the employee to juggle the employee and patient roles". Conclusion: Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders' roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders. [ABSTRACT FROM AUTHOR]

Research exploring relationships between leadership behaviors and sickness absence is scarce. Grounded in self‐determination theory (SDT), the present study examined: (i) the relationship between need‐supportive leadership and sickness absence; and (ii) whether satisfaction of the basic psychological needs mediates the relationship between need‐supportive leadership and sickness absence. Municipal employees (n = 347, 78% women, age span = 19–66 years) provided baseline data on perceived need‐supportive leadership and reported their need satisfaction at work 8 weeks later. Sickness absence data were obtained from municipality records. Two‐part regression models showed that need‐supportive leadership was negatively associated with sick days (b = −0.28, 95% CI [−0.45, −0.11]). Need‐supportive leadership had an indirect effect on the number of sick days through a composite score of need satisfaction (ab = −1.96, 95% CI [−5.11, −0.12]). Mediation models with each need separately indicated that autonomy (ab = −2.12, 95% CI [−5.33, −0.23]) and relatedness (ab = −1.33, 95% CI [−3.41, −0.11]) mediated the relationship between need‐supportive leadership and number of sick days. Need‐supportive leadership and need satisfaction at work may function as protective factors that provide followers with opportunities to deal with symptoms of ill health and reduce the risk of prolonged sickness absence. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed to examine (i) if work-to-family conflicts (WtFC) and family-to-work conflicts (FtWC) are associated with sickness absence due to mental disorders and (ii) whether these associations are different among health and social care (HSC) employees compared to other municipal employee sectors. METHODS: The Helsinki Health Study survey data collected in 2017 among 19–39-year-old female municipal employees (N=2557) were prospectively linked to administrative Social Insurance Institution of Finland register data on long-term sickness absence due to mental disorders (SA-MD) covering a follow-up of up to five years. The associations of WtFC and FtWC and SA-MD were analyzed using Cox regression models stratified by employment sector (HSC, education, other), adjusting for sociodemographic and health-related covariates. RESULTS: Of HSC employees, 16% had SA-MD during the follow-up, which surpassed the figures for employees in education (12%) and other (11%) sectors. In the HSC sector, the youngest employees had the highest prevalence of SA-MD and, among HSC employees, prior SA-MD was the most common. In Kaplan–Meier curves, the steepest increase in SA-MD was observed for HSC employees. WtFC [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.39–2.45] and FtWC (HR 1.78, 95% CI 1.32–2.40) were associated with SA-MD among HSC employees. The associations were rather similar for employees in education and other sectors. Adjusting for work-related factors and health history somewhat attenuated the associations. CONCLUSIONS: Better possibilities to combine work and family life might aid in preventing SA-MD in all employment sectors.

OBJECTIVES: Return to work (RTW) of workers with mental disorders is often a process of gradually increasing work hours over time, resulting in a RTW trajectory. This study aimed to investigate 2-year RTW trajectories by mental disorder diagnosis, examining the distribution of age, sex and contracted work hours across the diagnosis-specific RTW trajectories. METHODS: Sickness absence episodes diagnosed within the ICD-10 chapter V (mental and behavioral disorders) and ICD-10 Z73.0 (burnout) were retrieved from a Dutch occupational health service register, together with age, sex and contracted work hours. Sickness absence episodes due to adjustment disorders (N=25 075), anxiety disorders (N=1335), burnout (N=3644), mood disorders (N=5076), and post-traumatic stress disorders (N=2393) were most prevalent and included in latent class growth analysis (LCGA) to estimate 23-month RTW trajectories. RESULTS: Four main RTW trajectories were identified for all mental disorder diagnoses: fast full RTW [range 82.4% (mood disorders) to 92.0% (adjustment disorders) of the study population], slow full RTW [3.5% (burnout) to 6.1% (mood disorders)], slow partial RTW [0.6% (adjustment disorders) to 1.6% (mood disorders)] and no RTW [2.2% (adjustment disorders) to 9.7% (mood disorders)]. Trajectories with a late onset of fast full RTW included higher percentages of women and lower percentages of full-time workers. CONCLUSIONS: RTW trajectories were similar for different mental disorder diagnoses although the distribution differed across diagnoses, with more partial and no RTW trajectories among workers with mood disorders. To better guide workers back to work, more knowledge is needed of factors associated with late, partial, or no RTW.

Abstract Purpose The purpose of this study is to explore line managers’ perspectives on data as tool in the management of sickness absence in public sector workplaces in Denmark. Methods The study is a qualitative study based on 19 semi-structured interviews with line managers from four public sector workplaces characterized by high levels of sickness absence or poor work environment. The interviews were analysed inductively using thematic analysis. Results The findings show that line managers primarily use data to identify employees at risk of sickness absence. The experiences highlighted related to how and when data are perceived as a valuable tool by the line managers, and that nuances in the data, accessibility of the data and how data are presented are important factors to ensure appropriate follow-up on sickness absence. Conclusions The findings suggest that for line managers to use data to manage sickness absence appropriately, the data must be easily accessible, simple for line managers to understand and provide line managers with a sufficient overview of sickness absence in their work units. It is also important to consider other factors affecting sickness absence, such as the work environment, when aiming to reduce sickness absence.

OBJECTIVE: This study aimed to investigate (i) the risk of work disability (>10-day sickness absence spell or disability pension) due to common mental disorders (CMD) among social workers compared with other health and social care, education, and non-human service professionals and (ii) whether the risk was mediated by job stress. METHODS: A cohort of 16 306 public sector professionals in Finland was followed using survey data from baseline (2004 or if not available, 2008) on job stress [job strain or effort-reward imbalance (ERI)] and register data on work disability due to CMD from baseline through 2011. A Cox proportional hazards model was used to analyze the risk of work disability due to CMD between three occupation-pairs in a counterfactual setting, controlling for age, sex, job contract, body mass index, alcohol risk use, smoking, and physical inactivity. RESULTS: Social workers’ job stress was at higher level only when compared to education professionals. Thus, the mediation hypothesis was analyzed comparing social workers to education professionals. Social workers had a higher risk of work disability due to CMD compared with education professionals [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.58–2.74]. This HR was partly mediated by job strain (24%) and ERI (12%). Social workers had a higher risk of work disability than non-human service professionals (HR 1.54, 95% CI 1.13–2.09), but not compared with other health and social care professionals. CONCLUSIONS: Job stress partly mediated the excess risk of work disability among social workers only in comparison with education professionals.

OBJECTIVES: Several studies have found higher sickness absence in shared and open workspaces than in private offices, but little is known about why these differences occur. We propose and test job control as a potential mechanism underlying observed differences in the risk of physician-certified sickness absence between private offices and shared and open workspaces. METHODS: We conducted a counterfactual mediation analysis using observational survey data from a nationally representative sample of Norwegian employees merged with prospective data from national registries (N=5512). The registry data included information about whether participants had any physician-certified sickness absence the year following the survey. Models were adjusted for age, sex, education level, occupation group, executive/leadership responsibility, and time spent on office work. RESULTS: We found significantly higher sickness absence risk in conventional [risk ratio (RR) 1.12, 95% confidence interval (CI) 1.01‒1.25] and non-territorial (RR 1.20, 95% 1.04‒1.37) open-plan and non-territorial shared-room offices (RR 1.29, 95% CI 1.13‒1.48) compared to private offices. Natural indirect effects due to job control were statistically significant in all contrasts and accounted for 19–34% of total effects depending on contrast. CONCLUSIONS: Findings were in line with hypothesized relationships and suggest that job control may be a mechanism underlying observed differences in sickness absence across office concepts. Future studies should continue to explore potential mechanisms linking shared and open workspaces to higher sickness absence and other unfavorable outcomes in the workplace, particularly with study designs that provide stronger basis for causal inference.

Abstract Background High rates of sickness absence is a challenge within the healthcare sector, highlighting the need for effective interventions. Despite this, limited research has been conducted on the impact of such interventions within the healthcare context. This study evaluates an intervention aimed at improving the work environment influences sickness absence rates in Norwegian hospital units. The intervention is a comprehensive framework for discovering and tailoring solutions to each units’ specific needs, with a focus on employee involvement and collaboration between leader, union representatives and safety delegates. Methods We employed two methodological approaches. Method 1 involved using HR-registered sickness absence data to track changes in sickness absence across all intervention units and matched control groups over a three-year period. In Method 2, we used a pre- and post-survey design in 14 intervention units, focusing on employees’ job satisfaction and self-reported health. Results The results of the intervention were mixed. There was a significant decrease in total sickness absence in the intervention units the first year after the intervention, and a significant decrease in long-term sickness absence both in the first and second year after the intervention, measured with HR registries. However, we did not see a significant larger decrease in total sickness absence in the intervention units compared to the control units and only partial support for a larger decrease in long-term absence in the intervention units. In the subsample of units that also participated in the survey, we observed significant improvements in employee job satisfaction post intervention. Conclusions There is a need for research on effective interventions to reduce sickness absence in the healthcare sector. “Where the shoe pinches” provides a potential methodological framework for reducing sickness absence by addressing challenges in the work environment, however with uncertain results. Further exploration is warranted to refine strategies for effectively managing sickness absence within healthcare organizations.

Abstract Background This study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees’ wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied. Methods The research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model. Results Wards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (ORcrude: 0.20, 95% CI: 0.05–0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (ORcrude: 0.08, 95% CI: 0.01–0.49). Overall, the results showed a clear data trend, although not all results were statistically significant. Conclusion Higher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management.

Purpose: The purpose of this study is to explore line managers' perspectives on data as tool in the management of sickness absence in public sector workplaces in Denmark. Methods: The study is a qualitative study based on 19 semi-structured interviews with line managers from four public sector workplaces characterized by high levels of sickness absence or poor work environment. The interviews were analysed inductively using thematic analysis. Results: The findings show that line managers primarily use data to identify employees at risk of sickness absence. The experiences highlighted related to how and when data are perceived as a valuable tool by the line managers, and that nuances in the data, accessibility of the data and how data are presented are important factors to ensure appropriate follow-up on sickness absence. Conclusions: The findings suggest that for line managers to use data to manage sickness absence appropriately, the data must be easily accessible, simple for line managers to understand and provide line managers with a sufficient overview of sickness absence in their work units. It is also important to consider other factors affecting sickness absence, such as the work environment, when aiming to reduce sickness absence. [ABSTRACT FROM AUTHOR]

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Background: High rates of sickness absence is a challenge within the healthcare sector, highlighting the need for effective interventions. Despite this, limited research has been conducted on the impact of such interventions within the healthcare context. This study evaluates an intervention aimed at improving the work environment influences sickness absence rates in Norwegian hospital units. The intervention is a comprehensive framework for discovering and tailoring solutions to each units' specific needs, with a focus on employee involvement and collaboration between leader, union representatives and safety delegates. Methods: We employed two methodological approaches. Method 1 involved using HR-registered sickness absence data to track changes in sickness absence across all intervention units and matched control groups over a three-year period. In Method 2, we used a pre- and post-survey design in 14 intervention units, focusing on employees' job satisfaction and self-reported health. Results: The results of the intervention were mixed. There was a significant decrease in total sickness absence in the intervention units the first year after the intervention, and a significant decrease in long-term sickness absence both in the first and second year after the intervention, measured with HR registries. However, we did not see a significant larger decrease in total sickness absence in the intervention units compared to the control units and only partial support for a larger decrease in long-term absence in the intervention units. In the subsample of units that also participated in the survey, we observed significant improvements in employee job satisfaction post intervention. Conclusions: There is a need for research on effective interventions to reduce sickness absence in the healthcare sector. "Where the shoe pinches" provides a potential methodological framework for reducing sickness absence by addressing challenges in the work environment, however with uncertain results. Further exploration is warranted to refine strategies for effectively managing sickness absence within healthcare organizations. [ABSTRACT FROM AUTHOR]

Background: Emerging issues in the management of major depressive disorder (MDD) comprise a nonadherence to treatment and treatment failures, depressive recurrence and relapses, misidentification of incoming exacerbated phases and consequently, a chronification of depression. While antidepressant drugs constitute the standard of care for MDD, effective psychosocial interventions are needed to reduce rehospitalizations and other adverse events. The present study primarily investigated the effects and impact of implementing a structured psychoeducational intervention on the clinical course of MDD. Methods: A non-randomized comparative, pragmatic, pilot, single-center study of adults with nonpsychotic moderate or severe episode of MDD recently discharged from a psychiatric hospitalization. The consecutive subjects were allocated either to the intervention group (N=49) or to the attention control group (N=47), based on their preference. The psychoeducational intervention was based on a modified Munoz's Depression Prevention Course. Subjects were followed up prospectively for two years. Results: The absolute changes in Beck anxiety inventory scale, Zung's depression questionnaire, and Montgomery and Äsberg depression rating scale (MADRS) total scores at 6-month follow-up were comparable between the two groups. There were lower rates of the rehospitalization within one year (2.1% vs. 16.7%; P<0.001) and less rehospitalizations after one year (6.3% vs. 25%; P<0.001), lower rates of the ongoing sickness absence (11.5% vs. 29.2%; P<0.001), less persons with disability due to MDD at 1-year follow-up (1% vs. 11.5%; P=0.002), and less nonadherent subjects who self-discontinued treatment (6.3% vs. 28.1%; P<0.001) among participants in the intervention group compared to the control group. The disability due to MDD at 1-year follow-up was predicted by the absence of the psychoeducational intervention (P=0.002) and by the MADRS total score at 6-month follow-up (OR 1.10; 95% CI 1.003-1.195; P=0.044). Qualitative data indicated the intervention was desired and appreciated by the participants, as well as being practical to implement in Slovakian clinical settings. Conclusion: The results suggest the psychoeducational intervention based on a modified Munoz's Depression Prevention Course has beneficial effects in adults with MDD recently discharged from a psychiatric hospitalization. The findings implicate the psychoeducational intervention may offer a new approach to the prevention of depressive relapses. [ABSTRACT FROM AUTHOR]

Background: This study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees' wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied. Methods: The research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model. Results: Wards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (ORcrude: 0.20, 95% CI: 0.05–0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (ORcrude: 0.08, 95% CI: 0.01–0.49). Overall, the results showed a clear data trend, although not all results were statistically significant. Conclusion: Higher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management. [ABSTRACT FROM AUTHOR]

Over recent decades, sickness absence due to common mental disorders has increased among young workers. The phenomenon is mostly understood on the basis of epidemiological research, and knowledge regarding the viewpoints of young workers themselves is lacking. Our study explored the explanations for mental health‐related sickness absence in the narrative accounts of young workers in high‐risk health and social care occupations. Semi‐structured narrative interviews were conducted with 23 Finnish young workers (aged 21–34), with self‐reported sickness absence related to common mental disorders over the previous year. Our analysis identified three narrative explanations for the onset of mental health problems leading to sick leave: work as the sole cause, work as an additional cause and work as a trigger. These findings indicate that mental health‐related sickness absences form a complex phenomenon related to various life and work‐related circumstances. More comprehensive preventive measures are needed in the health and social care sector to help tackle mental health problems among young workers. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to compare the sickness absence (SA; over 10 days) rates of migrant and non-migrant care workers in Finland. Methods: Two cohorts were randomly sampled from nationwide registers and analysed together in a three-year follow-up design (2011–2013, 2014–2016). The pooled data consisted of 78,476 care workers, of whom 5% had a migrant background. Statistical methods included cross-tabulations and Poisson regression modelling. Results: Thirty-five percent of the Finnish-born care workers had at least one SA during the follow-up. Care workers from the post-2004 EU countries (30%, at least one SA), Russia, the Former Soviet Union and the Balkan states (25%) and the Global South and East (21%) had fewer episodes of SA than the Finnish-born care workers. The two latter groups also had lower SA rates after we controlled for occupation, gender, age, income and region of residence. Care workers from Western Europe and the Global North (36%) had higher SA rates than the Finnish-born care workers. Conclusions: The following explanations were discussed: population-level health differences – migrants from lower-income non-EU countries are generally healthier than the Finnish-born population (due to, e.g., the 'healthy migrant effect'); discrimination in recruitment and employment – migrants from lower-income non-EU countries need to be healthier than Finnish-born jobseekers to gain employment (in the care sector or more broadly); and sickness presenteeism – migrants from lower-income non-EU countries underuse their right to sickness allowance (due to, e.g., job insecurity). It is likely that these mechanisms affect migrants differently depending on, for example, their countries of origin and social status in Finland. [ABSTRACT FROM AUTHOR]

Information and Communication Technology (ICT) at work can cause distress and frustration, commonly labeled ”technostress”. Nevertheless, few, if any, studies have examined the impact of ICT factors on sickness absence due to mental distress. We investigated effects of ”ICT-hassles” - disruption of work due to ICT-problems - on low or medium-level and high level sickness absence due to psychological diagnoses (LMSA-P/HSA-P). We also determined the mitigating influences of ICT-training and ICT-support. We surveyed 8620 workers in Norway, linking responses to official registry data of medically certified absence due to psychological complaints during 12 months following the survey. We used Bayesian multilevel multinomial logistic regression and analyzed ICT-variables at the individual level as well as averaged over employees within work-units. Moderated regressions determined whether effects of ICT-hassles varied with levels of support and training. Individual level ICT-hassles predicted HSA-P (OR 1.20, 95% CI 1.01,1.42) and work-unit level hassles LMSA-P (OR 1.47, 95% CI 1.11,1.94). ICT-support at both levels predicted lower risk of LMSA-P (individual: OR 0.84, 95% CI 0.74,0.97, work-unit: OR 0.63, 95% CI 0.50,0.80). Insufficient training appeared to have the most marked effects, with ORs ranging from 1.66 to 5.12. Effects were strongest at the work-unit level and persisted after adjustment for job demands and -control. No moderation of the effect of hassles by training and support was observed. In conclusion, ICT-hassles may promote absence whereas support and training prevent it. However, offering support after hassles have occurred may not be sufficient, suggesting that prevention is more effective than repair.

Purpose This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. Methods A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes. Results A main theme was identified “the workplace and healthcare hold different organizational value logics” and four sub-themes: “the PSI-WPI challenged the organizational goals and values of the workplace and healthcare”, “the PSI-WPI challenged organizational values on fairness”, “the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators” and “the PSI-WPI introduced a need for the employee to juggle the employee and patient roles”. Conclusion Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders’ roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.

Objective: To examine the relevance of questions on psychosocial working conditions and depressive symptoms, as used in a screening questionnaire in preventive occupational health care, to predict repetitive short or long sickness absences. Methods: The participants were 11,495 employees of various occupations in Finnish companies. The data were prospectively collected by one occupational healthcare service provider (Finla) and included register data of sickness absences and responses to a questionnaire used in pre-employment and periodic health examinations between 2011 and 2019. Long sickness absences of > 30 days and repetitive short sickness absences of one to ten days in a 24-month follow-up were used as outcome variables for multiple logistic regression analysis. Results: Strong associations were found between repetitive short and long sickness absences, and the questions on depressive symptoms “felt hopeless about the future”, “felt melancholic”, “felt everything was an effort”, and “feelings of worthlessness”. Among questions on psychosocial working conditions, strong associations were found between sickness absences and questions on decision authority, self-reformation opportunities, job versatility, and appreciation for their work. Conclusions: Questionnaires on depressive symptoms and psychosocial work environment can help identify patients with an increased risk of sickness absence. Data accumulating in occupational health care should be used more systematically to reduce the risk of work disability through targeted occupational health interventions.

Abstract Objectives The aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account. Methods The study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses. Results Exposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52–2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10–2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52–2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism. Conclusions Exposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes.Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants.The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078–0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms.The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.Early identification of at-risk patients and team-based rehabilitation within primary care to prevent sickness absence and long-term problems due to acute/subacute musculoskeletal disorders has been scarcely studied.The PREVSAM model provides a framework for team-based interventions in primary care rehabilitation.The PREVSAM model may be used in the management of acute/subacute musculoskeletal disorders in the prevention of sickness absence.Early identification of at-risk patients and team-based rehabilitation within primary care to prevent sickness absence and long-term problems due to acute/subacute musculoskeletal disorders has been scarcely studied.The PREVSAM model provides a framework for team-based interventions in primary care rehabilitation.The PREVSAM model may be used in the management of acute/subacute musculoskeletal disorders in the prevention of sickness absence. [ABSTRACT FROM AUTHOR]

Introduction: The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD‐related work disability and the change in psychotropic drug purchases is scarce. Methods: We used a register‐based cohort representing 33% of the Finnish population. The participants included working‐age individuals (N = 12,047, 76% women, mean age = 36) who initiated long‐term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration‐dependent changes in CMD‐related work disability (primary outcome, operationalized as depression or anxiety‐related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes). Results: There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the <1‐year duration group (88% decline for SA and 43%–44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases). Conclusion: Work disability outcomes and duration varied among individuals, even with similar initial mental health‐related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to compare work disability duration of intraprovincially and interprovincially mobile workers with nonmobile workers in British Columbia, Canada. Methods: Workers' compensation claims were extracted for workers injured between 2010 and 2019. Employer and residential postal codes were converted to economic regions to define nonmobile, intraprovincially, and interprovincially mobile workers. Quantile regression models using matched cohorts were used to estimate differences in work disability days at different percentiles of the distribution. Results: Compared with nonmobile workers, both mobile worker groups had longer work disability durations, particularly interprovincially mobile workers. Differences persisted in injury-stratified models and were partially or fully attenuated in some industry-stratified models. Conclusions:Workers' compensation systems, employers, and healthcare providers may need to tailor specific interventions for mobile workers who are from out-of-province as well as traveling between regions in the province. [ABSTRACT FROM AUTHOR]

Objective: Return to work and permanence in employment of women who survive breast cancer are topics that become important as incidence and survival rates increase. Self-efficacy as a modifiable element is of special interest in this process. The objective of this study is to measure the level of self-efficacy in female breast cancer survivors, according to sociodemographic, work and treatment characteristics and their relationship with return to work. Methods: This was a cross-sectional study, based on a survey of breast cancer patients about their demographic and work characteristics, the return to work process, permanence in the same job and the level of work self-efficacy. Differences in the level of self-efficacy with respect to characteristics were evaluated using bivariate analyses and hypothesis statistical testing. A value of p<0.05 was considered statistically significant. Results: One hundred and twenty-four women were included, 87.9% had returned to work, the majority (56.4%) between one and six months after treatment, 67.7% remained in the same job. Higher levels of work self-efficacy were related to a higher probability of returning to work and staying there, and a shorter time to return to work; these differences were statistically significant. Conclusion: Occupational health and risk prevention services must consider and strengthen work self-efficacy and organizational support in breast cancer survivors to achieve a successful return to work [ABSTRACT FROM AUTHOR]

Background: To date, hand eczema (HE)‐related presenteeism has never been assessed within the general population, and general population‐based studies on HE‐related sickness absence are limited. Objectives: To assess the prevalence of HE‐related presenteeism and sickness absence, and factors associated with HE‐related presenteeism, within the Dutch general population. Methods: Within the Lifelines Cohort Study, participants with HE in the last year (aged 18–65 in 2020), were identified by a questionnaire including questions regarding HE‐related presenteeism and sickness absence. Socio‐demographic factors were collected from 2006 to 2020. Results: Out of the 3.703 included participants with HE, 2.7% (n = 100) reported HE‐related presenteeism, with 19.8% (n = 57) among those with severe‐to‐very‐severe HE. HE‐related sickness absence was reported by 0.5% (n = 20) and 5.9% (n = 17), respectively. Logistic regression analyses, adjusted for age and sex, showed negative associations between HE‐related presenteeism and higher educational attainment, higher income (>€2500) and higher occupational skill level, and positive associations for high‐risk occupations, chronic HE, moderate and severe‐to‐very‐severe HE (compared to almost clear), atopic dermatitis and occupational wet exposure. Conclusions: A high prevalence of HE‐related presenteeism was found among participants with severe‐to‐very‐severe HE. Future studies should focus on longitudinal associations with the clinical course of HE, as HE‐related presenteeism might aggravate symptoms of HE. [ABSTRACT FROM AUTHOR]

Although absenteeism is a key concern in most western societies, research on reducing absenteeism in public sector organizations is scarce, particularly regarding the impact of organizational relationships. By building on the concept of workplace social capital (WSC) and using a large longitudinal cohort of Danish municipal employees, this study shows that three types of WSC (bridging, direct-leader-linking, and top-level-linking WSC) reduce absenteeism, while there is no significant effect of bonding WSC. Our empirical results further suggest that the relationships with the immediate leader and the top management (direct-leader-linking and top-level-linking WSC) are most important for employees' absenteeism. [ABSTRACT FROM AUTHOR]

BackgroundEmerging issues in the management of major depressive disorder (MDD) comprise a nonadherence to treatment and treatment failures, depressive recurrence and relapses, misidentification of incoming exacerbated phases and consequently, a chronification of depression. While antidepressant drugs constitute the standard of care for MDD, effective psychosocial interventions are needed to reduce rehospitalizations and other adverse events. The present study primarily investigated the effects and impact of implementing a structured psychoeducational intervention on the clinical course of MDD.MethodsA non-randomized comparative, pragmatic, pilot, single-center study of adults with nonpsychotic moderate or severe episode of MDD recently discharged from a psychiatric hospitalization. The consecutive subjects were allocated either to the intervention group (N=49) or to the attention control group (N=47), based on their preference. The psychoeducational intervention was based on a modified Munoz’s Depression Prevention Course. Subjects were followed up prospectively for two years.ResultsThe absolute changes in Beck anxiety inventory scale, Zung’s depression questionnaire, and Montgomery and Äsberg depression rating scale (MADRS) total scores at 6-month follow-up were comparable between the two groups. There were lower rates of the rehospitalization within one year (2.1% vs. 16.7%; P

Abstract Background The Norwegian home care services experience a high level of sick leave, a large proportion of which is due to common mental disorders. A substantial number of such cases can be attributed to psychosocial factors at work, but more knowledge about occupation-specific risk factors is needed to develop targeted preventive measures to reduce sick leave levels. The aim of this study is to identify the most prominent psychosocial work factors influencing the risk of sick leave spells due to common mental disorders. Methods Employees from a random sample of 130 Norwegian home care services (N = 1.819) completed a baseline survey on 15 psychosocial work factors. Participants were subsequently followed up for 26 months using registry data on sick leave. The outcome measure was the number of medically certified sick leave spells due to common mental disorders during follow-up in the Norwegian social insurance database. Incidence risk ratios (IRR) and 95% confidence intervals (CIs) were calculated using negative binomial regression with robust standard errors. Results Emotional dissonance (IRR 1.30, 95% CI 1.05–1.60) and emotional demands (IRR 1.35, 95% CI 1.14–1.58) were associated with an excess risk of sick leave, while control over work pacing (IRR 0.78, 95% CI 0.62–0.98) was associated with a reduced risk. An estimated 30% (95% CI 8.73–48.82) of sick leave cases were attributable to emotional dissonance and 27% (95% CI 4.80-46.33) were attributable to emotional demands. Control over work pacing was estimated to have prevented 20% (95% CI 1.32–37.78) of the sick leave cases. Conclusions This study found that emotional dissonance and emotional demands were robust risk factors for sick leave due to common mental disorders, and that control of work pacing constituted a robust protective factor against sick leave.

Background: Diabetes and prediabetes have been linked with morbidity or mortality from cardiovascular disease, cancer, or other physical disorders among working-age populations, but less is known about outcomes directly related to labor loss (eg, Tlong-term sickness absence [LTSA] or pre-retirement death due to physical disorders). This prospective study aimed to examine the association of diabetes and prediabetes with the risk of a composite outcome of LTSA and pre-retirement death due to physical disorders. The present study also examined the associations of severe outcomes (LTSA or death) due to specific physical disorders or injuries/external causes in relation to diabetes and prediabetes. Methods: Data were derived from the Japan Epidemiology Collaboration on Occupational Health study. A total of 60,519 workers from 12 companies were followed for 8 years. Diabetes and prediabetes were defined based on the American Diabetes Association criteria. A Cox proportional hazards regression model was used to examine the association between diabetes/prediabetes and severe outcomes due to physical disorders or injuries/external causes. Results: The adjusted hazard ratios of severe outcomes due to all physical disorders were 1.22 (95% confidence interval [CI], 1.02–1.45) and 2.32 (95% CI, 2.04–2.64) for prediabetes and diabetes, respectively. In cause-specific analyses, an increased risk was observed for severe outcomes due to cancers, cardiovascular diseases, diseases of the musculoskeletal system, and injuries/external causes in relation to either or both diabetes and prediabetes. Conclusion: Diabetes and prediabetes were associated with an increased risk of severe outcomes due to physical disorders or injuries/external causes among Japanese workers.

At the Scandinavian Journal of Work, Environment & Health, it is our fundamental conviction that workers’ health is a value in itself. To put it simply, work must not be health-hazardous, and work must not make the worker neither physically nor mentally sick. In our minds, there is no need for any further rationale for healthy and safe work. That said, it would be naïve to think that, in a bottom-line world, the bottom-line would not count with regard to work and health. It does count at individual, company, and societal level. At individual level, a worker may worry about reduced payment during sickness absence. At company level, the phrase “is there a business case?” is often heard. At societal level, all economic consequences, rather than a partial interest, are considered. Therefore, there is a broad need to know the magnitude of the economic loss that comes with a health-hazardous work environment and, vice-versa, the magnitude of the economic benefit that comes with improving the work environment. For example, when the World Health Organization (WHO) published in 2022 its landmark guidelines on mental health at work using a societal perspective (1), a lot of attention was paid to the WHO`s estimation that the global economic costs of the most prevalent mental health conditions totalled USD1 trillion per year (2, 3). There is, thus, a great demand for work environment economics, for analyses that quantify the economic costs of a poor work environment and the economic benefits of a good work environment. However, this demand is yet not being met by the research community. As van Dongen & van der Beek (4) delineated in an editorial in this Journal in May 2022, there are two types of work environment economic studies: (i) observational studies that examine the economic costs of work-related ill-health among workers, the so-called `cost of illness` studies and (ii) economic evaluation studies that examine cost-effectiveness and return-on-investment of occupational health interventions. With regard to the latter, van Dongen & van der Beek point to a couple of recent promising evaluation studies (5, 6), however, they conclude that the methodological quality of economic evaluations of occupational health interventions leaves in general a lot to be desired (4). With regard to the former, observational studies on the economic costs of work-related ill-health among workers, Russo et al (5) recently published in this Journal a cost-estimation model for work-related stress that was tested in two case studies in Italy – in healthcare and public administration. Costs were estimated as loss of productivity due to sickness absence attributable to work-related stress. The authors showed that across different work organizations, the proportion of sickness absence attributable to work-related stress varied strongly, and that methodological choices influenced the cost estimations largely. In this issue of the Journal, Pedersen and colleagues (7) go a step further and present a paper that aims to estimate the effect of work-related stress on labor market costs at the societal level. Linking survey data from Denmark on indicators of self-reported work-related stress to register data on labor market affiliation, they first calculated the two-year prospective association between exposure to work stress and days of recurrent (being at work, sickness absence, unemployment, being temporarily out of the labor market for other reasons) and absorbing (retirement, disability pension, death) labor market states. Absorbing states occurred only rarely in their sample. Next, they calculated the costs incurred by the recurrent labor market states, ie, the costs associated with days lost due to all work absenteeism combined and work absenteeism stratified by sickness absence, unemployment, and being temporarily out of the labor market. Based on these calculations, the authors estimated an average annual work absenteeism loss per employee of €1903 for men and €3909 for women. For the Danish workforce, this corresponds to annual expenses of €305 million among men and €868 million among women, a total expense of €1.17 billion or 0.3% of the Danish gross domestic product in 2022. The results of this article caused a lot of interest in the Danish media and among unions and employer organizations (8, 9). We commend the authors for their bold approach to estimate the costs of an assumed work-environment-induced health condition at the societal level, taking advantage of the excellent Danish health and labor market registers and using multi-state modeling that takes recurrence of events into consideration. There are, though, also important challenges in the article, relating both to the outcome and health condition under study. Regarding the outcome, there are two major labor market costs to consider: (i) costs related to absenteeism, ie, costs due to not being at work, and (ii) costs related to loss of productivity, ie, costs due to being at work but with reduced work capacity. Pederson and colleagues limited their analyses to the former and did not analyze the latter. This is understandable, as absenteeism can be closely monitored in Danish national registers, whereas no national register is available for monitoring the productivity of workers. In terms of internal validity, it was therefore likely a wise decision by the authors to limit the analyses to an outcome where good data is available. However, as a consequence, an important part of the labor market costs of work-related stress – the loss in productivity among those who are present at work with reduced work capacity – could not be addressed in the article. Regarding the health condition under study, the authors analyzed work-related stress. On the one hand, this is laudable, stress at work is topical and a major point of public debate in many countries, including Denmark. On the other hand, the authors could hardly have chosen a more difficult health condition. Stress is on many accounts an intricate, some would say, hopeless concept in research. Since the early days of stress research by Walter B Cannon (1871–1945) and Hans Selye (1907–1982), the concept of stress has been plagued with ambiguities (10, 11). Today, there is no lack of elaborated stress models (stimulus-based models, reaction-based models, the transactional model, the allostatic load model, the cognitive-activation theory of stress, to name just a few) (12–14). However, there is no common definition of stress, and there is no agreement on basic questions, such as if stress research should focus on the environmental conditions (often called “stressors”) that may cause cognitive, emotional, behavioral, and physiological changes in the individual (often called “stress reactions”) or if the focus should be on these stress reactions of the individual and how these different types of reactions are related to each other. To make things further complicated, Pedersen and colleagues not only analyzed “stress”, but they analyzed “work-related stress”, thus, they based their analyses on the assumption that the stress condition reported by the participants were, to a considerable extent, caused by the work environment. To ensure the work-relatedness of their stress concept, Pedersen and colleagues combined three very different measures into one index. The three measures included (i) a kind of self-labeling method, where the definition of stress and the attribution to work or none-work related causes were solely at the discretion of the respondents; (ii) the measurement of a psychosocial work environment condition, job strain, that has been conceptualized as a stressor, ie, as an entity that is assumed to elicit stress reactions (15); and (iii) four items of Cohen’s Perceived Stress Scale (PSS-4), which is probably the most widely used questionnaire for assessing stress (16, 17), however, in a modified version that included references to work in three of the four items. When taking a closer look at the three stress measures, one cannot help but to wonder whether the stress index by Pedersen and colleagues is rather a measure of poor psychosocial working conditions than a measure of stress. One of the three measures, job strain, obviously, is conceptualized as a measure of psychosocial working conditions, defined by the simultaneous exposure of high job demands and low job control (15). But also the modified PSS-4 items that asked, for example, about feeling that difficulties at work were piling up or feeling confident about handling problems at work, may have captured important parts of the psychosocial work environment. Thus, it could be argued that the article is first and foremost about the labor market costs of poor psychosocial working conditions. To summarize, Pedersen and colleagues provided us with a thought-provoking paper on two hot but also very challenging topics in occupational health research, work-related stress and work environment economics. Both topics are likely strongly shaped by macro-level structural conditions that vary greatly between countries(18, 19). We look forward to further analyses and papers on these topics from other regions of the world. Conflict of interest statement Reiner Rugulies is employed at the same research institution as the authors of the article by Pedersen et al, and he collaborates closely with the last author (Ida EH Madsen). Dr Rugulies was neither involved in the design, analysis or writing of the article nor in the decision by the journal to accept the article for publication. References 1. World Health Organization. WHO guidelines on mental health at work. Geneva: World Health Organization, 2022. Available from: https://www.who.int/publications/i/item/9789240053052 (Accessed: 28 September 2022). 2. World Health Organization and International Labour Organization. Mental health at work: Policy brief. Geneva: World Health Organization and International Labour Organization, 2022. Available from: https://www.who.int/publications/i/item/9789240057944 (Accessed: 28 September 2022). 3. Ghebreyesus TA. Tackling the trillion dollar taboo [LinkedIn post]. 2022. Available from: https://www.linkedin.com/pulse/tackling-trillion-dollar-taboo-tedros-adhanom-ghebreyesus. (Accessed: 27 January 2024). 4. van Dongen JM, van der Beek AJ. Economic evaluations in occupational health: what brings the best bang for the buck? Scand J Work Environ Health. 2022;48(4):249-252. https://doi.org/10.5271/sjweh.4026 5. Russo S, Ronchetti M, Di Tecco C, Valenti A, Jain A, Mennini FS, et al. Developing a cost-estimation model for work-related stress: An absence-based estimation using data from two Italian case studies. Scand J Work Environ Health. 2021;47(4):318-327. https://doi.org/10.5271/sjweh.3948 6. Finnes A, Hoch JS, Enebrink P, Dahl J, Ghaderi A, Nager A, et al. Economic evaluation of return-to-work interventions for mental disorder-related sickness absence: two years follow-up of a randomized clinical trial. Scand J Work Environ Health. 2022;48(4):264-272. https://doi.org/10.5271/sjweh.4012 7. Pedersen J, Graversen BK, Hansen KS, Madsen IEH. The labor market costs of work-related stress: A longitudinal study of 52 763 Danish employees using multi-state modeling. Scand J Work Environ Health. 2024;50(2):61–72. https://doi.org/10.5271/sjweh.4131 8. Fagbevægelsens Hovedorganisation. FH: Underprioriteret forebyggelse af stress koster dyrt for alle [Internet Blog: Underprioritised prevention of stress is costly for everyone]. 2023. Available from: https://fho.dk/blog/2023/11/16/fh-underprioriteret-forebyggelse-af-stress-koster-dyrt-for-alle. (Accessed: 27 January 2024). 9. Dansk Industri. Stresssygemeldinger har menneskelige og økonomiske omkostninger [Internet News: Sickness absenteeisms due to stress have human and financial costs]. 2023. Available from: https://www.danskindustri.dk/vi-radgiver-dig/personale/nyhedsarkiver---personaleforhold/nyheder-om-arbejdsmiljo/2023/11/stresssygemeldinger-har-menneskelige-og-okonomiske-omkostninger. (Accessed: 27 January 2024). 10. Cannon WB. Bodily changes in pain, hunger, fear and rage. An account of recent researchers into the function of emotional excitement. New York: D. Appleton and Company; 1915. https://doi.org/10.1037/10013-000 11. Selye H. Stress: the physiology and pathology of a exposure to stress. Montreal: Acta Medica; 1950. 12. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer; 1984. 13. McEwen BS. Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33-44. https://doi.org/10.1111/j.1749-6632.1998.tb09546.x 14. Ursin H, Eriksen HR. Cognitive activation theory of stress (CATS). Neurosci Biobehav Rev. 2010;34(6):877-881. https://doi.org/10.1016/j.neubiorev.2009.03.001 15. Theorell T, Karasek R. Current issues relating to psychological job strain and cardiovascular disease research. J Occup Health Psychol. 1996;1(1):9-26. https://doi.org/10.1037/1076-8998.1.1.9 16. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-396. https://doi.org/10.2307/2136404 17. Eskildsen A, Dalgaard VL, Nielsen KJ, Andersen JH, Zachariae R, Olsen LR, et al. Cross-cultural adaptation and validation of the Danish consensus version of the 10-item Perceived Stress Scale. Scand J Work Environ Health. 2015;41(5):486-490. https://doi.org/10.5271/sjweh.3510 18. Lunau T, Siegrist J, Dragano N, Wahrendorf M. The association between education and work stress: does the policy context matter? PLoS One. 2015;10(3):e0121573. https://doi.org/10.1371/journal.pone.0121573 19. Frank J, Mustard C, Smith P, Siddiqi A, Cheng Y, Burdorf A, et al. Work as a social determinant of health in high-income countries: past, present, and future. Lancet. 2023;402(10410):1357-1367. https://doi.org/10.1016/S0140-6736(23)00871-1

OBJECTIVE: Work-related stress is an important public health concern in all industrialized countries and is linked to reduced labor market affiliation and an increased disease burden. We aimed to quantify the labor market costs of work-related stress for a large sample of Danish employees. METHODS: We linked four consecutive survey waves on occupational health and five national longitudinal registers with date-based information on wage and social benefits payments. From 2012 to 2020, we followed survey participants for two year-periods, yielding 110 559 person-years. We identified work stress by combining three dichotomous stress indicators: (i) self-perceived work stress, (ii) Cohen 4-level perceived stress scale, and (iii) job strain. Using the multi-state expected labor market affiliation (ELMA) method, we estimated the labor market expenses associated with work-related stress. RESULTS: Of the employees, 26–37% had at least one work-stress indicator. Men aged 35–64 years and women aged 18–64 years with work-related stress had up to 81.6 fewer workdays and up to 50.7 more days of sickness absence during follow-up than similarly aged men without work stress. The average annual work absenteeism loss per employee linked to work-related stress was €1903 for men and €3909 for women, corresponding to 3.3% of men’s average annual wages and 9.0% of women’s average annual wages, respectively. The total annual expenses were €305.2 million for men and €868.5 million for women. CONCLUSION: Work-related stress was associated with significant labor market costs due to increased sickness absence and unemployment. The prevention of work-related stress is an important occupational health concern, and the development of effective interventions should be given high priority.

Abstract Background General practitioners (GPs) have an important gatekeeping role in the Norwegian sickness insurance system. This role includes limiting access to paid sick leave when this is not justified according to sick leave criteria. 85% of GPs in Norway operate within a fee-for-service system that incentivises short consultations and high service provision. In this qualitative study, we explore how GPs practise the gatekeeping role in sickness absence certification. Methods Qualitative data was collected through six focus group interviews with 33 GPs, working in practices with a minimum of four practising GPs, in different geographical regions across Norway, including both urban and rural areas. Data was analysed using Braune and Clarke’s thematic analysis approach. Results Our results indicate that GPs’ sick-listing decisions are largely driven by patient demand and preferences for sick leave. GPs reported that they rarely overrule patient requests for sickness absence, including in cases where such requests conflict with the GPs’ opinion of whether sick leave is justified or benefits the patient. The degree of effort made to limit unjustified or non-beneficial sick leave seems to depend on the GPs’ available time and perceived risk of conflict with the patient. GPs generally expressed dissatisfaction with their role as certifiers of sickness absence. Conclusion Our study suggests that GPs’ decisions about sickness certification is largely driven by patient preferences. The GPs’ gatekeeping function is limited to negotiations about grade and duration of absence spells.

The tendency to abuse sickness absence is a complex problem conditioned by many factors, that can be divided, depending on the level of impact, into three groups: micro (related to personal characteristics), meso (related to the work environment), and macro (related to the broader environment). The subject of interest in the article is the first level (micro). The aim is to evaluate the impact of various personal factors on the declared abuse of sickness leave in Poland.

Abstract Background Exposure to dust in textile mills adversely affects workers’ health. We collected epidemiological data on textile workers suffering from respiratory diseases and assessed work absence associated with illnesses in Faisalabad, Pakistan. Methods We recruited 206 workers using multistage sampling from 11 spinning mills in Faisalabad, Pakistan. The data were collected using 2-week health diaries and face-to-face interviews. The data pertains to socio-demographics, occupational exposures, the state of the workers’ health, and other attributes. A theoretical framework of the health production function was used to estimate the relationship between cotton dust exposure and respiratory illnesses. We also estimated functional limitations (e.g., work absence) associated with dust exposure. STATA 12 was used to calculate descriptive statistics, an ordered probit for byssinosis, a probit model for chronic cough, and three complementary log-log models for blood phlegm, bronchitis, and asthma to measure dose–response functions. A Tobit model was used to measure the sickness absence function. Results We found that cotton dust exposure causes a significant health burden to workers, such as cough (35%), bronchitis (17%), and different grades of byssinosis symptoms (22%). The regression analysis showed that smoking cigarettes and working in dusty sections were the main determinants of respiratory diseases. Dusty work sections also cause illness-related work absences. However, the probability of work absence decreases with the increased use of face masks. Conclusion The study’s findings imply the significance of promoting occupational safety and health culture through training and awareness among workers or implementing the use of safety gadgets. Promulgating appropriate dust standards in textile mills is also a need of the hour.

OBJECTIVE: This study aimed to determine the effects of the Labor Inspection Authority’s regulatory tools on physician-certified sick leave and self-reported health outcomes among employees in municipal home-care services in Norway. METHODS: We conducted a cluster-randomized controlled trial in the home-care service sector, and 96 eligible municipalities were randomly assigned to one of three groups: (i) labor inspection visits, based on the Labor Inspection Authority’s standard inspections; (ii) guidance-through-workshops, where participants from home-care services met with labor inspectors to receive information and discuss relevant topics; and (iii) the control group. Data on employee self-reported health (N=1669) were collected at baseline and 6 and 12 months after the interventions. Additionally, registry data (N=1202) on diagnosis specific physician-certified sick leave were collected for 18 months after the interventions. RESULTS: We found no statistically significant effects of either intervention on self-reported health outcomes. There was, for both interventions, a pattern of decrease in days and periods of physician-certified sick leave due to musculoskeletal diagnoses and increase in days and periods of physician-certified sick leave due to psychological diagnoses, but these were not statistically significant. CONCLUSION: Labor inspections and guidance-through-workshops had no statistically significant effect on self-reported health and physician-certified sick leave. The results should be interpreted with caution given the low response rate and subsequent attrition, and in the context of the COVID-19 pandemic. Future studies, in various industries, should further elucidate whether regulatory tools influence employee health and sick leave due to musculoskeletal and mental disorders.

Abstract Background Our objective was to quantify the prospective associations between work factors across chemical, physical, mechanical, and psychosocial domains and the onset of medically certified sick leave. Methods Eligible respondents were interviewed in 2009, 2013, or 2016 and were registered in the national sick leave register with an employee relationship lasting more than 50 working days during the year of the survey interviews and the following year (n = 15,294 observations). To focus on the onset of high-level sick leave (HLSL; >16 days a year), we excluded individuals with HLSL during the survey year (baseline). We then used mixed-effect logistic regression models to assess prospective associations between self-reported work conditions and the occurrence of doctor-certified HLSL in the following year. Results The average occurrence of HLSL was 13.1%. After adjusting for sex, age, level of education, chronic health problems, and smoking, we observed an exposure-response relationship between cumulative exposure to work factors within all domains and the occurrence of HLSL. When evaluating the impact of combined exposures, predicted odds ratios (OR) for employees exposed to 1, 2, and 3 or more work factors within all domains were 1.60 (95%CI 1.32 − 1.94), 2.56 (95%CI 1.73 − 3.74) and 4.09 (95%CI 2.28 − 7.25), compared to those not exposed. Conclusions The results support the notion that exposure to multiple work factors in various domains, including psychosocial, mechanical, chemical, and physical work conditions, is associated with an increased risk of high-level sick leave. Employers and occupational health professionals should consider the joint impact of these domains when designing interventions.

BACKGROUND: There is need for more knowledge about the relationship between work and cognitive functioning in sick-listed individuals. OBJECTIVE: This study investigated whether the degree of work participation is relevant for recovery of cognitive functioning in sick-listed individuals. METHODS: 177 occupational rehabilitation participants and 70 controls participated in a non-randomised, longitudinal study. Participants completed computerised cognitive tests targeting sustained attention and working memory at start and end of rehabilitation and 3 and 12 months after rehabilitation. The change score performance in attention and memory between start and end, start and 3 months and 12 months was compared in individuals on sick leave 100–75%, 74–40% and 39–0% (three sick leave groups) of the time in the year after rehabilitation, and a control group not being on sick leave. Fixed effect analysis of covariance adjusting for education and work ability was used. RESULTS: The sick leave group 100–75% had significantly lower score on work ability compared to the other groups at baseline. The main findings indicated that the sick leave group 39–0% improved significantly more in sustained attention compared to the sick leave group 100–75% between start and end of rehabilitation and from start of rehabilitation to 3 and 12 months after. CONCLUSION: The degree of work participation seems relevant to recovery of the cognitive function sustained attention in sick-listed individuals. These findings encourage work rehabilitation clinicians, work consultants and employers to develop RTW plans which take into account that graded employment influence cognitive functioning. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of work-related stress on labor market outcomes such as sickness absence, return to work probability, and early retirement, highlighting the scarcity of studies considering multiple labor outcomes and their interconnectivity, which could provide crucial insights into the relationship between recurrent sickness absence and decreased work participation.

The article focuses on the importance of prioritizing workers' health and safety, acknowledging the economic impact of poor work environments on individuals, companies, and society, highlighting the need for research to quantify these costs and benefits. Topics include the economic costs of work-related ill-health and the methodological quality of economic evaluations of occupational health interventions.

Background: Exposure to dust in textile mills adversely affects workers' health. We collected epidemiological data on textile workers suffering from respiratory diseases and assessed work absence associated with illnesses in Faisalabad, Pakistan. Methods: We recruited 206 workers using multistage sampling from 11 spinning mills in Faisalabad, Pakistan. The data were collected using 2-week health diaries and face-to-face interviews. The data pertains to socio-demographics, occupational exposures, the state of the workers' health, and other attributes. A theoretical framework of the health production function was used to estimate the relationship between cotton dust exposure and respiratory illnesses. We also estimated functional limitations (e.g., work absence) associated with dust exposure. STATA 12 was used to calculate descriptive statistics, an ordered probit for byssinosis, a probit model for chronic cough, and three complementary log-log models for blood phlegm, bronchitis, and asthma to measure dose–response functions. A Tobit model was used to measure the sickness absence function. Results: We found that cotton dust exposure causes a significant health burden to workers, such as cough (35%), bronchitis (17%), and different grades of byssinosis symptoms (22%). The regression analysis showed that smoking cigarettes and working in dusty sections were the main determinants of respiratory diseases. Dusty work sections also cause illness-related work absences. However, the probability of work absence decreases with the increased use of face masks. Conclusion: The study's findings imply the significance of promoting occupational safety and health culture through training and awareness among workers or implementing the use of safety gadgets. Promulgating appropriate dust standards in textile mills is also a need of the hour. [ABSTRACT FROM AUTHOR]

Purpose. This study aims to analyze and compare data on sickness absence in the EU and Croatia and to estimate the costs associated with sickness absence in Croatia, with a specific focus on the hospitality industry. Design/methodology/approach. Utilizing the Human Capital Approach (HCA), we quantify the economic impact of sickness absenteeism before, during and after the COVID-19 crisis by calculating the monetary value of lost productivity due to employee absences caused by illness. Additionally, we conducted a comparison of the effects of sickness absence on Gross Value Added (GVA) between the hospitality industry and the overall Croatian economy. Findings. The study found a significant increase in sickness absences and productivity losses due to sickness absenteeism in Croatia from 2018 to 2023, with peaks during the COVID-19 crisis (2020-2022), particularly in the hospitality industry. These results highlight the need for effective support mechanisms, for both policymakers and organizations, that can be adapted and applied to other sectors, in order to reduce absenteeism and its negative consequences. Originality. This is the first known study of sickness absence that encompasses the extent of this behavior across the periods before, during, and after the COVID-19 crisis at a state level. No previous studies have been found that also focus on the post-COVID-19 period. The findings provide valuable insights for policymakers, and employers aiming to enhance productivity and absenteeism management. [ABSTRACT FROM AUTHOR]

The article investigates the association between Parkinson's disease (PD) and occupational exposure to organic solvents, particularly chlorinated hydrocarbons (CHC), in Finland. Topics include exploring the association between PD and exposure to organic solvents, with a focus on CHC; utilizing a case-control study design involving 17,187 cases and 35,738 controls in Finland; and addressing potential biases in exposure measurement through probabilistic bias analysis (PBA).

This study analyses sickness absence in selected European countries. We suggested and applied three sick‑leave measures: global sickness absence rate, frequency rate, and absolute crude absence rate. To calculate the rates, open access data from Eurostat, the OECD, and the WHO were used. On the one hand, assessing sickness absence is a challenge in spite of accessible numbers of people and days of absence in public and employer registers. Simultaneously, a detailed understanding of sickness benefits and sick‑pay schemes is needed to elucidate cross‑country differences in sick‑leave rates. The long‑term dynamic trajectory (1970–2020) and regional differentiation effects on absenteeism among countries were considered. Using correlation coefficients and one‑way analysis of variance, a robustness check was performed, and the limitations of the proposed approach to measuring absenteeism were presented. The results evidence that the aforementioned indices present a unique and valid approximation to evaluate and monitor the state of sick absence and inequality in national policies.

Abstract Background Concussion may lead to persisting post-concussive symptoms affecting work ability and employment. This study examined the transitions between labour market states an individual can experience after the acute phase of concussion. The aim was to describe the incidence of favourable and adverse transitions between different labour market states (e.g., employment, sick leave) in relation to socioeconomic and health characteristics in individuals with concussion relative to matched controls. Methods This Danish nationwide register-based cohort study extracted 18–60-year-old individuals between 2003–2007 with concussion from the Danish National Patient Register (ICD-10 S06.0). Controls were matched on age, sex, and municipality. Patients and controls were followed for 5 years starting three months after injury. Exclusion criteria were neurological injuries and unavailability to the labour market in the inclusion period (2003–2007) and 5-years before injury (1998–2002). Labour market states were defined from transfer income data in the Danish Register for Evaluation of Marginalization. Incidence rates of transitions between these labour market states were analysed in multistate models. Transitions were bundled in favourable and adverse transitions between labour market states and the difference in incidence rates between individuals with concussion relative to matched controls were assessed with hazard ratios from Cox regression models. Results Persons with concussion (n = 15.580) had a lower incidence of favourable transitions (HR 0.88, CI 0.86–0.90) and a higher incidence of adverse transitions (HR 1.30, CI 1.27–1.35), relative to matched controls (n = 16.377). The effect of concussion differed depending on health and socioeconomic characteristics. Notably, individuals between 30–39 years (HR 0.83, CI 0.79–0.87), individuals with high-income (200.000–300.000 DKK) (HR 0.83, CI 0.80–0.87), and wage earners with management experience (HR 0.60, CI 0.44–0.81) had a markedly lower incidence of favourable transitions compared to controls. Additionally, individuals with high income also had a higher incidence of adverse transitions (HR 1.46, CI 1.34–1.58) compared to controls. Conclusions Concussion was associated with enhanced risk of adverse transitions between labour market states and lower occurrence of favourable transitions, indicating work disability, potentially due to persistent post-concussive symptoms. Some age groups, individuals with high income, and employees with management experience may be more affected.