Work-related psychosocial risk factors and risk of disability pension among employees in health and personal care: A prospective cohort study

Contribution of age, gender and occupational group to the higher risk of disability retirement among Finnish public sector employees

BACKGROUND

The aim of this study was to examine the differences in disability retirement between public and private sector employees and to examine the contribution of age, gender and occupational group to the differences between the sectors.

METHODS

Our Finnish register data consisted of about two million non-retired men and women aged 30-62 years. Cox proportional hazard models were used to calculate hazard ratios for any, full and partial disability retirement in the public sector compared with the private sector.

RESULTS

The risk of any disability retirement was higher in the public sector than in the private sector in all occupational groups. The unadjusted hazard ratio ranged from 1.29 (95% CI 1.16-1.44) among teaching professionals to 2.25 (95% CI 1.95-2.58) among skilled agricultural, forestry and fishery workers. Adjustment for age and gender attenuated the differences between the sectors. After adjusting for age, gender and occupational group, the hazard ratio was 1.29 (95% CI 1.27-1.32) for any disability retirement and 2.02 (95% CI 1.96-2.08) for partial disability retirement, but there was no difference between the public sector and private sector employees for full disability retirement.

CONCLUSIONS

Adjustment of age and gender attenuated the higher risk of disability retirement in the public sector, while adjustment for occupational group widened the sector differences in any and full disability retirement. The risk of partial disability retirement was higher in all occupational groups in the public sector than in the private sector. For full disability retirement, the differences between the sectors were small or non-existent.

Job demands and job control and their associations with disability pension-a register-based cohort study of middle-aged and older Swedish workers

OBJECTIVES

Job demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose-response shape of the associations, and potential confounding effects of physical workload.

METHODS

Approximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models.

RESULTS

In models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose-response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis.

CONCLUSION

The results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.

Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden

OBJECTIVE

To investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP.

METHODS

This study uses a sample of 1,804,242 Swedish workers aged 44-63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects.

RESULTS

Heavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18-1.55, women: SI 1.19 95%CI 1.05-1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08-1.69, women: 1.13 95%CI 0.85-1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant.

CONCLUSION

Heavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.

Prolonging working life among blue-collar workers: The buffering effect of psychosocial job resources on the association between physically demanding and hazardous work and retirement timing

The need to delay retirement timing has been acknowledged in Western countries due to demographic ageing. The aim of the present study was to examine the buffering effects of job resources (decision authority, social support, work-time control, and rewards) on the association of exposures to physically demanding work tasks and physically hazardous work environment with non-disability retirement timing. Results from discrete-time event history analyses, in a sample of blue-collar workers (n = 1741; 2792 observations) from the nationwide longitudinal Swedish Longitudinal Occupational Survey of Health (SLOSH), supported that decision authority and social support may buffer the negative impact of heavy physical demands on working longer (continuing working vs retiring). Stratified analyses by gender showed that the buffering effect of decision authority remained statistically significant for men, while that of social support remained statistically significant for women. Moreover, an age effect was displayed, such that a buffering effect of social support on the association of heavy physical demands and high physical hazards with working longer were found among older men (≥64 years), but not younger (59-63 years). The findings suggest that heavy physical demands should be reduced, however, when not feasible physical demands should be accompanied by social support at work for delaying retirement.

[The Employment Perspective in the Health Care Sector - Until What Age do Older Employees Want to, Can and Plan to Work?]

OBJECTIVE

The aim of the study was to compare the employment perspective of older employees in different occupations in the health care sector. A distinction is made between three aspects of the employment perspective: until what age older employees want to, can and plan to work.

METHODS

The data are based on the second (2014) and third (2018) wave of the representative lidA study, which surveyed employees born in 1959 and 1965, at intervals of 3 to 4 years since 2011. In descriptive cross-sectional and longitudinal analyses, five occupational groups of the health care sector were compared to further selected occupational groups (NSample=2.580).

RESULTS

The occupational groups examined differed significantly in terms of their employment perspective. Employees in care professions stood out as, on average, they wanted to leave working life early, but most importantly, they could not work for as long as they had planned to. Longitudinal analyses indicated that the employment perspective shifted to higher age as the individuals approached the legal retirement age.

CONCLUSIONS

Care professions are risk groups with regard to employment at higher working age and require special attention in health care organisations. The results also document substantial variability of employment perspective in individual employees over time. This finding has implications regarding opportunities for human resource management.

Adverse social behaviour at work and health-related employment exit: a prospective population-based four-wave survey

BACKGROUND

The level of evidence for various aspects of adverse social behaviour (ASB) at work as risk factors for exit from employment due to health problems or diseases is inconclusive.

METHODS

We obtained data from four consecutive surveys (2006/09/13/16) of the general population of Norway. Respondents who were interviewed in two consecutive surveys and employed at the first survey time point constituted the sample (n = 17 110 observations). We investigated associations of self-reported exposure to ASB (i.e. experiencing sexual harassment, bullying or violence/threats in the first survey) and health-related employment exit (i.e. individuals reporting exit from employment due to health problems or disease between two consecutive surveys) by means of mixed-effect logistic regression.

RESULTS

The prevalence of ASB and health-related employment exit was 10.8% (n = 1853) and 2.6% (n = 440), respectively. Adjusted for age, sex, level of education, occupation and weekly work hours, sexual harassment, bullying and violence/threats were associated with an increased risk of exit from employment. The odds ratios (ORs) for the association between exposure to any of the three aspects of ASB and employment exit was 1.78 [95% confidence interval (CI) 1.33-2.38]; the estimated corresponding population attributable risk was PAR% = 7.32 [95% CI 2.67-12.27]. Further adjustment of mental distress attenuated the observed association between exposure to any ASB and exit from employment (OR = 1.45 [95% CI 1.07-1.95], i.e. a reduction of 42% in the OR).

CONCLUSIONS

ASB at work increases the risk of health-related exit from employment in the Norwegian workforce.

Can workplace intervention prolong work life of older workers? A quasi-experimental study

BACKGROUND

We aimed to evaluate the impact of a workplace senior program intervention on early exit from labor market and on the disability retirement among older employees and work-related physical factors associated with it.

METHODS

A total of 259 individuals aged 55 + years participated in the study (107 in intervention and 152 were controls). A questionnaire survey was conducted among Finnish food industry employees between 2003 and 2009 and the intervention "senior program" was provided between 2004 and 2009. The type of pension for the respondents who had retired by 2019 was obtained and dichotomized as statutory vs. early labor market exit. Disability pension was investigated as a separate outcome. Information on work-related factors was obtained from the survey. Cox regression analysis was used to estimate hazard ratios (HR) with their 95% confidence intervals.

RESULTS

Fifty-one employees had early labor market exit. Of them, 70% (n = 36) were control participants. Employees in the senior program worked for longer years (mean years 7.4, 95% CI 6.4-8.1) compared to the control (6.6, 95% CI 6.3-7.5). Sixty percent lower risk of early labor market exit (HR 0.40, 95% CI 0.19-0.84) and disability pension was found among employees in the senior program compared to the control group. Good work ability had a 94% lower risk (0.06, 95% CI 0.01-0.29) of early labor market exit and 85% lower risk (0.15, 95% CI 0.03-0.73) of disability pension compared to poor work ability. Employees with musculoskeletal pain had 4 times higher risk of disability pension compared to those without musculoskeletal pain.

CONCLUSIONS

A workplace senior program intervention prolonged work life and had positive effect on reducing disability pension among older industrial workers.

Psychosocial risk factors identification in Mexican workers and RGIII validation

BACKGROUND

Since 2018, NOM-035-STPS-2018 has been applied in Mexico, focused on measuring psychosocial risk factors (PRFs) in workers and the Reference Guide III (RGIII) has been presented, however, research focused on its validation has been scarce, in very specific sectors and with small samples.

OBJECTIVE

Determine the levels of PRFs of five work centers and reliability and validity aspects of RGIII.

METHOD

The RGIII was applied to 1458 workers (806 women and 652 men) from five workplace in the industrial sector of Ensenada (Mexico), and the level of risk of the PRFs was analyzed, as well as their reliability and validity through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

RESULTS

The PRFs with medium, high and very high-risk levels are Workload, Lack of control over work and Workday. The RGIII presents adequate reliability with Cronbach's α, Alpha ordinal RHO and Omega of 0.93, 0.95 and 0.95, respectively. The EFA shows all five subscales maintain factor loadings greater than 0.43, although Leadership and relationships at work has better saturation values, and Work environment ended with only three items. The CFA indicates Leadership and work relationships with a Root Mean Square Error of Approximation (RMSEA) goodness of fit index of 0.072.

CONCLUSION

The RGIII allows the identification and evaluation of the level of risk of PRFs. It complies with sufficient internal consistency. It does not have a clear factorial structure, because it does not meet the minimum values of goodness-of-fit indexes that would allow confirming the structure proposed in RGIII.

Exposure to work-related violence and/or threats of violence as a predictor of certified sickness absence due to mental disorders: a prospective cohort study of 16,339 Swedish men and women in paid work

OBJECTIVES

The aim of this prospective cohort study was to investigate if exposure to work-related violence and/or threats of violence predict certified sickness absence due to mental disorders.

METHODS

Information on work-related exposure to violence and/or threats of violence were derived from the biannual Swedish Longitudinal Occupational Survey of Health (SLOSH) study 2012-2016, including individuals in paid work across Sweden and from different occupations/sectors (n = 16,339). Certified sickness absence due to mental disorders were ascertained from register data from the Swedish Social Insurance Agency. Odds ratios of certified sickness absence due to mental disorders according to exposure to work-related violence were estimated using multiple logistic regression. Several potential confounding variables, such as demographic and socio-economic factors, age, sex, cohabitation, children living at home, socio-economic status, educational level, as well as other types of psychosocial work environmental factors, were adjusted for in the analyses.

RESULTS

In the total study sample, 9% reported exposure to violence and/or threats of violence and the prevalence of sickness absence due to mental disorders was 5%. Exposure to work-related violence and/or threats of violence was associated prospectively with certified sickness absence due to mental disorders (odds ratio 1.46, 95% confidence interval 1.17-1.82, p < 0.01). Analysis of possible interaction showed no difference in association when comparing women to men and different age groups.

CONCLUSIONS

Exposure to work-related violence and/or threats of violence appear to increase the odds of certified sickness absence due to mental disorders. Preventive measures aiming to lower the risk of exposure is thus of great importance.

Individual and organisational factors in the psychosocial work environment are associated with home care staffs' job strain: a Swedish cross-sectional study

BACKGROUND

Home care staff (HCS) provide essential service to enable older adults to age in place. However, unreasonable demands in the work environment to deliver a safe, effective service with high quality has a negative impact on the individual employee's well-being and the care provided to the older adults. The psychosocial work environment is associated with employees´ well-being, although, knowledge regarding which individual and organisational factors that contribute to job strain for HCS is limited. These factors need to be identified to develop targeted interventions and create sustainable work situations for HCS. This study aimed to explore how HCS´s perceived job strain is associated with, and to what extent can be explained by, individual and organisational factors of the psychosocial work environment and psychosomatic health.

METHOD

An explorative cross-sectional questionnaire survey design was used in a large Swedish county. Five home care agencies with a total of 481 HCS were asked to respond to a questionnaire regarding their perceived level of job strain (Strain in Dementia Care Scale), psychosocial work environment (QPS_Nordic³⁴⁺), and psychosomatic health (Satisfaction with Work Questionnaire). Multiple linear regression (MLR) analyses were conducted to explore the association between job strain and individual and organisational factors.

RESULTS

In total, 226 (46%) HCS responded to the questionnaire. Both individual and organisational factors were significant predictors of job strain and explained a variance ranging between 39 to 51% (p = 0.001). The organisational factor job demand and the individual factor feeling worried and restless was most frequently represented in these MRL models. A higher job strain was also associated with adverse outcomes regarding leadership, organisational culture and climate, and control at work.

CONCLUSION

This study indicates that there is an intertwined complexity of individual and organisational factors that are associated with the HCS´s perception of job strain. Implementation of new multidimensional work strategies, such as a reablement approach, could support the development of efficient strategies for HCS and reduce the level of job strain. Policy changes for the provision of home care are also needed to support the development of a sustainable and healthy psychosocial work environment.

Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study

Background

Pregnancy and childbirth entail increased risks of sickness absence (SA). Many women work in education and care, two branches characterised by high SA levels; it is not known if the link between childbirth and SA in these branches differs between private and public sectors. We examined SA and disability pension (DP) in relation to childbirth among women working in the education and care branches, and if these patterns differed between public and private sectors.

Methods

We performed a Swedish register-based cohort study. Study participants were nulliparous women living in Sweden in December 2004 and employed in education or care (n = 120,013). We compared SA/DP in the three years before and after 2005 among women who had no childbirth during follow-up (B0), had one childbirth in 2005 and no more (B1), and had one childbirth in 2005 and at least one more during follow-up (B1+). Analyses were performed for all and by public or private sector.

Results

Of all studied women, 70% worked in the public sector. Women in B1 and B1+ had, except for the year before childbirth, comparable or lower mean combined SA/DP days than women in the B0 group; women in the B1+ group had, except for the year before childbirth, the lowest mean level of SA/DP. We observed no substantial differences in these patterns between public and private sectors.

Conclusions

Patterns of SA/DP among nulliparous women who did or did not give birth did not differ substantially between public and private sectors among women in the educational and care branches.

Can a Healthy Lifestyle Prevent Disability Pension among Female Healthcare Workers with Good and Poor Self-Rated Health? Prospective Cohort Study with 11-Year Register Follow-Up

BACKGROUND

Our purpose was to investigate whether healthy lifestyle habits prevent disability pension among female healthcare workers.

METHODS

We conducted a prospective cohort study with an 11-year register follow-up in which 8159 female healthcare workers from Denmark completed a questionnaire concerning self-rated health, work environment, leisure-time physical activity (LTPA), smoking, and body mass index (BMI). Data on disability benefit payments were obtained from the Danish Register for Evaluation of Marginalization during an 11-year follow-up. Potential confounders included age, occupational education, psychosocial work factors, and physical exertion during work.

RESULTS

Among workers in good health at baseline, smoking, obesity, and low levels of LTPA were risk factors for disability pension during 11-year follow-up. Among workers with poor health, only low levels of physical activity were a risk factor for disability pension.

CONCLUSIONS

This underscores the importance of a healthy lifestyle, specially being physically active, for preventing premature exit from the labor market in female healthcare workers.

Prevalence Of Neck and Back Pain Among Gynecologists and Obstetrics in Tertiary Care Hospital of Lahore

Neck pain is identified as the ache, irritation and discomfort in the area below your head up to third Thoracic vertebrae. It can radiate to shoulders, arms and fingers also. The presenting complaints of cervical patients include headache, stiff neck, stress, muscle pain, fever, and tenderness, radiating pain, weakness in the arm and difficulty in lifting or gripping activities. Patients may also present with numbness, tingling and weakness of the arm. Objective: To determine the prevalence of neck and back pain among gynecologists and obstetrics in different tertiary care hospitals of Lahore. Methods: The cross-sectional study included 310 gynecologist and obstetrics that were recruited using non-probability convenience sampling. The cases of the neck pain were recruited from the obstetrics and gynecology department of different hospitals including: Fatima Memorial Hospital, Shalimar Hospital, Services Hospital, Mayo Hospital and Sir Ganga Ram Hospital, Lahore. Research was completed within six months from 23 October 2021 to 30th April 2022. Results: Among 310 participants, 196 (63.2%) reported neck pain among which; 153 (44.4%) gynecologists reported pain two times per week. Out of total, 306 (98.7%) reported fatigue especially on long days. Results regarding pain area showed that 196 (63.2%) had neck pain, 64 (24.6%) had back pain and 50 (16.1%) had shoulder pain. Results regarding frequency of pain showed that out of 310 (100%), 153 (49.4%) had pain 2 times per week and 105 (33.9%) had pain 0-2 times per month. Conclusions: Prevalence of low back pain was 20.65% whereas prevalence of neck pain in gynecologists was 63.23%. The study suggests that neck pain and fatigue were common in gynecologists and obstetrics. They lack of postural awareness and don’t follow ergonomics principles during surgical procedures. 

The impact of national legislation on psychosocial risks on organisational action plans, psychosocial working conditions, and employee work-related stress in Europe

Work-related psychosocial hazards are recognised as a key priority in the future of work. Even though European Union (EU) legislation requires employers to assess and manage all types of risks to workers' health and safety associated with all types of hazards in the work environment, it does not include clear reference to psychosocial risks and work-related stress. In several EU member states, there is now more specific legislation on psychosocial risks that clarifies employer responsibilities. The aim of this study is to explore whether the introduction of specific legislation on psychosocial risks and/or work-related stress is related to organisations implementing action plans to prevent work-related stress, and in turn, better psychosocial working conditions (job demands and resources), and less reported work-related stress in the workforce. It does so by comparing EU member states and candidate countries that have introduced more specific legislation to those that have not, conducting multilevel modelling analysis by linking two representative European-level datasets, the 2014 employer European Survey of Enterprises on New & Emerging Risks and the 2015 employee European Working Conditions Survey. Findings indicate that the presence of specific national stress legislation is associated with more enterprises having a work-related stress action plan. The existence of action plans was found to be associated with increased job resources but not decreased job demands. Furthermore, only in those countries with specific national legislation on stress, job resources were found to be associated with less reported stress through the existence of organisational action plans. Findings lend support to the argument for more specific legislation on psychosocial risks/work-related stress in the EU. However, they also raise questions on whether current interventions implemented at organisational level to deal with work-related stress may be geared more towards the development of individual resources and less towards better work organisation and job design.

Depression and Psychological Stress Among Health Workers in Remote Areas in Indonesia

Background

The Indonesian government launched the Nusantara Sehat program in 2015, under which teams of health workers were assigned to community health care centers in remote, border, and island areas for 2 years. The deployment to remote areas is likely to affect their psychological condition if they are not equipped with facilities and strong motivation. This study aimed to describe the psychological condition of health workers in remote areas in Indonesia, focusing on the proportion of the prevalence of depression and psychological stress.

Materials and Methods

This cross-sectional study was conducted between April and December of 2018. Participants were 140 health workers placed in 26 community healthcare centers in 13 provinces. Interviews were conducted by enumerators using a questionnaire that included questions from the Mini International Neuropsychiatric Interview (MINI) and Self-Reporting Questionnaire-20 (SRQ-20).

Results

Of the participants, 7.1% experienced depression and 10.0% experienced psychological stress. Motivation was related to psychological stress in participants with an odds ratio of 0,218 (95% confidence interval = 0.065–0.729, p = 0.013). Health workers with high motivation tend not to experience psychological stress compared to individuals with lower motivation.

Conclusion

Health workers with high motivation experience relatively low levels of psychological stress. To overcome stress, high motivation is needed to control psychological risk factors before and during placement.

Estilos de gestão no trabalho de enfermagem ambulatorial: impactos na saúde do trabalhador

RESUMO Objetivo: Analisar os estilos de gestão em ambulatórios de hospitais universitários e seus impactos na saúde dos trabalhadores de enfermagem. Método: Estudo quantitativo, transversal, participaram 388 profissionais de enfermagem atuantes em 11 ambulatórios vinculados a universidades públicas no Rio de Janeiro. Utilizamos a Escala de Estilos de Gestão, a Escala de Sofrimento Patogênico no Trabalho e a Escala de Danos Físicos e Psicossociais relacionados ao Trabalho. Resultados: Os estilos de gestão gerencialista e coletivo apresentaram presença moderada para a equipe de enfermagem dos ambulatórios. As características do estilo de gestão predominantemente gerencialista, evidenciadas pela falta de participação na tomada de decisão, o trabalho fortemente hierarquizado, focado nas normas e controle, atuaram como preditores das vivências de sofrimento e dos danos físicos, psíquicos e sociais apresentados pelos profissionais atuantes nesse contexto. Conclusão A análise dos estilos de gestão permitiu elucidar características que têm potencial para impactar negativamente a saúde dos trabalhadores destacando-se a necessidade de rever os modelos de gestão atualmente adotados para a equipe de enfermagem ambulatorial.

PSYCHOSOCIAL RISKS RELATED TO THE ORGANIZATION OF OUTPATIENT NURSING WORK

ABSTRACT Objective: to analyze the psychosocial risks related to the organization of nursing work in outpatient clinics of university hospitals. Method: cross-sectional epidemiological study developed in 11 outpatient units linked to the three public universities of the city of Rio de Janeiro, Brazil. Participants were 388 nursing professionals who worked in patient care at the time of the research. Data were collected from July to December 2018, using a self-applicable instrument. A questionnaire was used for sociodemographic, occupational and health characterization, and the Work Organization Scale. The bivariate analyses were performed using the odds ratio (OR), with a confidence interval of 95%, significance level of 5%. Results: the organization of nursing work received an assessment of medium psychosocial risk by the professionals participating in the research, demanding interventions in the short and medium term. There was no association between sociodemographic, occupational and health characteristics and the organization of outpatient work. Conclusion: interventional measures should be performed in the psychosocial risk factors presented in this research, with a view to improving the work environment, so that the importance of maintaining satisfactory material conditions is considered, as well as the adequate quantity of human resources. In addition, it aims to expand the spaces of nursing participation in decision-making, strengthening its autonomy as a profession.

Management styles in outpatient nursing work: impacts on the worker’s health

ABSTRACT Objective: To analyze management styles in outpatient clinics of university hospitals and their impacts on the nursing workers’ health. Method: Quantitative, cross-sectional study with 388 nursing professionals working in 11 outpatient clinics linked to public universities in Rio de Janeiro. The Management Styles Scale, the Pathogenic Suffering at Work Scale, and the Work-Related Physical and Psychosocial Harms Scale were used. Results: The managerial and collective management styles showed a moderate presence for the outpatient clinics nursing staff. The characteristics of the predominantly managerial management style, evidenced by the lack of participation in decision-making, the strongly hierarchical work, focused on norms and control, acted as predictors of the experiences of suffering and of the physical, psychological, and social damages presented by the professionals working in this context. Conclusion: The analysis of management styles allowed elucidating characteristics that have the potential to negatively impact the workers’ health, highlighting the need to review the management models currently adopted for the outpatient nursing team.

Self-reported sickness absence and presenteeism as predictors of future disability pension: Cohort study with 11-year register follow-up

Many healthcare workers in eldercare are pushed out of the labor market before the official retirement age due to poor health. Identification of early warnings signs is important to avoid complete loss of work ability. The aim of this study was to investigate to what degree sickness absence and presenteeism increase future risk for disability pension among eldercare workers. A total of 8952 Danish female eldercare workers responded to a survey about work environment and health. They were followed for 11 years in the Danish Register for Evaluation of Marginalization, with time-to-event analyses estimating the hazard ratios (HRs) for disability pension from sickness absence and presenteeism at baseline. Analyses were adjusted for age, education, body mass index, leisure-time physical activity, smoking, physical exertion at work, and psychosocial factors related to the work environment. During the 11-year follow-up, 11.9% participants received disability pension. For the whole cohort, the highest risk for disability pension was observed for the category of >30 days of combined sickness absence and presenteeism at baseline in the fully adjusted model (HR = 7.93 [95%CI 5.20-12.09]). Eldercare workers aged >45 years were at a higher risk for disability pension in all included categories. Sickness absence and presenteeism increased the risk of disability pension among female eldercare workers. These results suggest that organizations would benefit from identifying early warning signs among workers in the prevention of involuntary early retirement.

Determinants of transition from partial to full disability pension: A register study from Finland

Aims: This study explored the rate of transition from partial to full disability pension (DP) and aimed to determine whether age, sex, education, employment status, employment sector, pension type and medical cause of disability were associated with transition to full DP during a four-year follow-up. Methods: We used register data, including a 70% random sample of partial disability pensioners aged 20-58 at the time that their partial DP started in 2010 or 2011 (N=5277). Competing risk analysis was used to estimate sub-hazard ratios (SHR) and their 95% confidence intervals (CI) for full DP. Results: One third of partial disability pensioners transitioned to full DP during the four-year follow-up. More than half (52%) continued on partial DP, and 15% were in some other state. Men, older people, those with low education levels, those whose pension was granted until further notice and those whose pension was due to mental disorders (MD) proceeded to full DP more often than others. The SHR for full DP was 1.62 (95% CI 1.43-1.83) among partial disability pensioners with MD and 1.15 (95% CI 1.02-1.28) among partial disability pensioners with other diseases compared to those whose pension was granted due to musculoskeletal diseases. Conclusions: Partial DP is a relatively stable state, and moving to full DP is relatively rare. However, male sex, older age, low education level, a pension granted until further notice and partial DP due to MD are important risk factors for full DP. The risk factors for ending up on full DP varies by diagnosis and pension type.

Interaction Effects of Physical and Psychosocial Working Conditions on Risk for Sickness Absence: A Prospective Study of Nurses and Care Assistants in Sweden

Employees in health and social care are often simultaneously exposed to both physical and psychosocial challenges that may increase their risk for sickness absence. The study examines interaction effects of physical and psychosocial work conditions on the future risk for sickness absence among nurses and care assistants in Sweden. The study was based on 14,372 participants in any of the Swedish Work Environment Surveys conducted during the years 1993-2013 with linked register information on background factors and compensated sickness absence. Adjusted hazard ratio (HR), stratified by occupation, and measures of additive interaction effects were estimated. The combinations of high psychosocial job demands and heavy physical work and strenuous postures, respectively, significantly increased the risks for sickness absence among nurses (HR 1.43; CI 1.09-1.88 and HR 1.42; CI 1.16-1.74, respectively), as well as among care assistants (HR 1.51; CI 1.36-1.67 and HR 1.49; CI 1.36-1.63, respectively). The combinations of low job control and both heavy physical work (HR 1.44; CI 1.30-1.60) and strenuous postures (HR 1.42; CI 1.30-1.56) were also associated with excess risk for sickness absence among care assistants. We also found interaction effects among care assistants but not among nurses. The results indicate that the high sickness absence rate among care workers in Sweden can be reduced if the simultaneous exposures of high psychosocial and high physical challenges are avoided. Management policies for reduced time pressure, improved lifting aids, and measures to avoid awkward work postures are recommended. For care assistants, increased influence over work arrangements is likely to lower their sickness absence risk.

Health behaviours and psychosocial working conditions as predictors of disability pension due to different diagnoses: a population-based study

BACKGROUND

To investigate whether the clustering of different health behaviours (i.e. physical activity, tobacco use and alcohol consumption) influences the associations between psychosocial working conditions and disability pension due to different diagnoses.

METHODS

A population-based sample of 24,987 Swedish twins born before 1958 were followed from national registers for disability pension until 2013. Baseline survey data in 1998-2003 were used to assess health behaviours and psychosocial Job Exposure Matrix for job control, job demands and social support. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

During follow-up, 1252 disability pensions due to musculoskeletal disorders (5%), 601 due to mental diagnoses (2%) and 1162 due to other diagnoses (5%) occurred. In the models controlling for covariates, each one-unit increase in job demands was associated with higher (HR 1.16, 95%CI 1.01-1.33) and in job control with lower (HR 0.87, 95%CI 0.80-0.94) risk of disability pension due to musculoskeletal disorders among those with unhealthy behaviours. Among those with healthy behaviours, one-unit increase of social support was associated with a higher risk of disability pension due to mental and due to other diagnoses (HRs 1.29-1.30, 95%CI 1.04-1.63).

CONCLUSIONS

Job control and job demands were associated with the risk of disability pension due to musculoskeletal disorders only among those with unhealthy behaviours. Social support was a risk factor for disability pension due to mental or other diagnoses among those with healthy behaviours. Workplaces and occupational health care should acknowledge these simultaneous circumstances in order to prevent disability pension.

Work environment risk factors for the duration of all cause and diagnose-specific sickness absence among healthcare workers in Sweden: a prospective study

OBJECTIVES

Increasing sickness absence (SA) has been reported among healthcare workers in Sweden. Our aim was to analyse the impact of work environment factors on short-term and long-term SA based on musculoskeletal and psychiatric diagnoses among healthcare workers.

METHODS

The study sample consisted of healthcare workers (n=12 452) drawn from representative samples of workers aged 16 to 64, who participated in the Swedish Work Environment Surveys (SWES) between 1993 and 2013. The outcomes were either short-term (≤28 days) or long-term (>104 days) SA between 1994 and 2016. HRs and 95% CIs were calculated for the impact of physical and psychosocial working conditions on risk of subsequent short-term or long-term SA for 3 years after participation in SWES.

RESULTS

Heavy physical work and strenuous work postures showed elevated HRs for short-term and long-term SA compared with those without these work exposures. Similarly, high job demands and low job control each increased the risk for both short-term and long-term SA compared with employees with low job demands and high job control. Low job support increased the risk for short-term SA compared with those with high job support. Working conditions were strongly related to short-term SA due to musculoskeletal diagnoses but not to short-term SA due to psychiatric diagnoses. None of the work characteristics, except strenuous postures, elevated the risk for long-term SA due to psychiatric diagnosis compared with employees without these characteristics.

CONCLUSIONS

Ergonomic improvements and stress reduction among healthcare workers are likely to reduce the prevalence of SA foremost due to musculoskeletal diagnoses.

Physical effort of middle-aged women in a university hospital - Field tests in comparison to standardized cardiopulmonary exercise testing (CPET)

Physical effort of workload of female employees in the healthcare system is perceived to rise. Research focused mainly on physical activity levels of registered nurses (RN). Therefore, we investigated physical strain during daily routine of other hospital workers next to RN. O₂uptake, heart rate, breathing frequency and ventilation were measured in 33 female medical (associate) professionals (MAP) and Cleaners&Helpers (Cl&H) using Oxycon Mobile. Physical work load was compared to standardized CPET. Wilcoxon-test and ANOVA were calculated using SPSS 20.0. Cl&H performed heavy-lifting and had the lowest power during CPET. The O₂-uptake for heavy-lifting as strong effort, differed significantly from office work (p < 0.001) and bedside-patient-care (p = 0.001). Compared with metabolic equivalent (MET) cleaning, heavy-lifting, and office work are underestimated. Bedside-patient-care, walking, pushing performed by MAP are overestimated. While Cl&H had the lowest maximal power in CPET, their work required the highest O₂-uptake. The tasks are underestimated in the MET-tables.

Presenteeism, Psychosocial Working Conditions and Work Ability among Care Workers-A Cross-Sectional Swedish Population-Based Study

Presenteeism, attending work while ill, has been examined in different contexts in the last few decades. The aim was to examine whether poor psychosocial working conditions and perceived work ability are associated with increased odds ratios for presenteeism, focusing on nursing professionals and care assistants. A cross-sectional population-based study was conducted. The selected individuals were extracted from representative samples of employees, aged 16–64, who participated in the Swedish Work Environment Surveys between 2001 and 2013 (n = 45,098). Three dimensions of psychosocial working conditions were measured: job demands, job control, and job support. Presenteeism and perceived work ability was measured. Using multiple logistic regression analyses, odds ratios for presenteeism with 95% confidence intervals (CI) were estimated. While nurses (n = 1716) showed the same presenteeism level as all the other occupation groups (n = 37,125), it was more common among care assistants (n = 6257). The odds ratio for presenteeism among those with high job demands (OR = 2.37, 95% CI 2.21–2.53), were higher among women than among men. For nursing professionals and care assistants, the odds ratios for presenteeism were highest among those with the lowest work ability level. The problems of presenteeism and low work ability among many health and care workers may be lessened by a reduction in psychosocial demands.

Working conditions and compensated sickness absence among nurses and care assistants in Sweden during two decades: a cross-sectional biennial survey study

OBJECTIVES

The aims of the study were to trace the patterns of work environment factors and compensated sickness absence (SA) among nurses and care assistants compared with other occupations and to compare SA among exposed and non-exposed nurses and care assistants.

DESIGN

A cross-sectional survey on work environment factors based on the biennial Swedish Work Environment Surveys 1991-2013, linked to longitudinal register data on SA 1993-2014.

PARTICIPANTS

The study included 98 249 individuals, stratified into nurses and care assistants (n=16 179) and a reference population including all other occupations (n=82 070).

OUTCOME MEASURE

Annual days of compensated SA (>14 days) 3 years after exposure years.

RESULTS

Nurses and care assistants had higher SA in 1993-2014 compared with all other occupations, and differences in background factors only partly explained this relationship. For both groups, exposure to physical work factors remained steady, but the number of exposed were 10%-30% higher among nurses and care assistants. Those exposed to heavy physical work and strenuous working postures had in most years significantly higher SA when compared with non-exposed (rate ratio range: 1.4-1.9). Exposure to high job demands increased 10%-25% in 1991-1999 among nurses and care assistants but became more stable in 2001-2013 and high proportions of high job demands coincided with the increase in SA in 1995-1999. Nurses and care assistants exposed to high job demands had for most years significantly higher SA than non-exposed (rate ratio range: 1.5-2.1). Low job control and low support from supervisors elevated SA significantly only for a few years.

CONCLUSIONS

Exposure to negative work factors among nurses and care assistants was weakly associated with variations in SA, but may be related to their higher level of SA when compared with other occupations. Improved physical and psychosocial working conditions may reduce the elevated SA level in these occupations.

Evaluating the use of Clavien-Dindo classification and Picker Patient Experience Questionnaire as quality indicators in gynecologic endoscopy

PURPOSE

Over the last few decades, laparoscopy has become a standard procedure within gynecological surgery. Validated quality indicators for the determination of the objective (perioperative complications) and subjective (patient satisfaction) quality of treatment as a surrogate parameter for the success of the treatment have so far found no regular application in the clinical routine. The purpose of this study was to evaluate the use of the Clavien-Dindo (CD) classification for postoperative complications and the Picker Patient Experience Questionnaire (PPE-15) as tools in the evaluation of endoscopic therapies in clinical routine.

METHODS

Retrospectively, perioperative complications using the CD classification and patient satisfaction utilizing the PPE-15 were reviewed for a total of 212 consecutive patients at a gynecologic endoscopic referral center (Agaplesion Diakonie Kliniken, Kassel, Germany) in September 2018.

RESULTS

An overall complication rate of 13.21% (28 out of 138 patients) was observed. Five patients (2.36%) had complications grade III and above according to the CD classification system. 138 patients out of 212 chose to answer the PPE-15 (return rate 65.01%). 112 patients (81.16%) reported about problems during their treatment in our hospital in their PPE-15. "Purpose of medicines not explained" was the most mentioned item (28.99%) by patients during their hospital stay.

CONCLUSION

CD classification and PPE-15 may be helpful instruments to evaluate the quality of care in gynecology. The application of both instruments for the assessment of treatment quality in clinical routine should be further investigated in prospective studies.

Statistical significance testing and p-values: Defending the indefensible? A discussion paper and position statement

Much statistical teaching and many research reports focus on the 'null hypothesis significance test'. Yet the correct meaning and interpretation of statistical significance tests is elusive. Misinterpretations are both common and persistent, leading many to question whether significance tests should be used at all. While most take aim at the arbitrary declaration of p < 0.05 as a threshold for determining 'significance', others extend the critique to suggest the 'p-value' should be dispensed with entirely. P-values and significance tests are still widely used as if they give a measure of the size and importance of relationships, even though this misunderstanding has been observed and discussed for many years. We argue that p-values and significance tests are intrinsically misleading. Point estimates of relationships and confidence intervals give direct information about the effect and the uncertainty of the estimate without recourse to interpreting how a particular p-value might have arisen or indeed referring to them at all. In this paper we briefly outline some of the problems with significance testing, offer a number of examples selected from a recent issue of the International Journal of Nursing Studies and discuss some proposed responses to these problems. We conclude by offering some guidance to authors reporting statistical tests in journals and present a position statement that has been adopted by the International Journal of Nursing Studies to guide its' authors in reporting the results of statistical analyses. While stopping short of calling for an outright ban on reporting p-values and significance tests we urge authors (and journals) to place more emphasis on measures of effect and estimates of precision/uncertainty and, following the position of the American Statistical Association, emphasise that authors (and readers) should avoid using 0.05 or any other cut off for a p-value as the basis for a decision about the meaningfulness/importance of an effect. If point estimates and confidence intervals are used, then the p-value may be redundant and can be omitted from reports. When authors talk about 'significance' they need to be explicit when referring to statistical significance and we recommend authors adopt the language of 'importance' when talking about effect sizes to avoid any confusion.