Finnish Institute of Occupational Health

Adult obesity has been linked to specific infections, but evidence across the full spectrum of infectious diseases remains scarce. In this multicohort study with impact modelling, we examined the association between this preventable risk factor and the incidence, hospitalisations, and mortality of 925 bacterial, viral, parasitic, and fungal infectious diseases, and estimated their global and regional attributable impact. We used pooled data from two Finnish cohort studies and repeated analyses in an independent population from the UK Biobank. BMI was assessed at baseline (1998-2002 in the Finnish studies; 2006-10 in UK Biobank), and participants were categorised as having healthy weight (18·5-24·9 kg/m2), overweight (25·0-29·9 kg/m2) or obesity, classified as class I (30·0-34·9 kg/m2), class II (35·0-39·9 kg/m2), or class III (≥40·0 kg/m2). Participants were followed up through national hospitalisation and mortality registries for hospital admissions and deaths due to infectious diseases. Using hazard ratios derived from the Finnish cohorts and UK Biobank, along with obesity prevalence estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study database, we estimated the proportion of fatal infections attributable to obesity globally, regionally, and by country for the years 2018 (before), 2021 (during), and 2023 (after the COVID-19 pandemic). The analysis included 67 766 adults (mean age 42·1 [SD 10·8] years; 49 516 [73·1%] females, 18 250 [26·9%] males) from the Finnish cohorts and 479 498 adults (mean age 57·0 [SD 8·1] years; 261 084 [54·4%] females, 218 414 [45·6%] males) from UK Biobank. Participants had no recent history of infection-related hospitalisations at baseline. During follow-up, there were 8230 incident infection cases in the Finnish cohorts and 81 945 in UK Biobank. Compared with individuals of healthy weight, those with class III obesity had a three-times higher risk of infection-related hospital admissions (Finnish cohorts 2·75 [95% CI 2·24-3·37], UK Biobank 3·07 [2·95-3·19]), death (Finnish cohorts 3·06 [1·25-7·49], UK Biobank 3·54 [3·15-3·98]), or either outcome (Finnish cohorts 2·69 [2·19-3·30], UK Biobank 3·07 [2·95-3·19]). The corresponding pooled hazard ratio for either fatal or non-fatal severe infection among individuals with any obesity (classes I-III) was 1·7 (1·7-1·8). This association was consistent across different indicators of obesity (BMI, waist circumference, and waist-to-height ratio), demographic and clinical subgroups, and a wide range of infections (non-fatal and fatal, acute and chronic, bacterial and viral [including subtypes], and parasitic and fungal). Applying these risk estimates to global burden of disease data, the population attributable fractions of infection-related deaths due to obesity were estimated at 8·6% (6·6-11·1) in 2018, 15·0% (12·8-17·4) in 2021, and 10·8% (8·6-13·6) in 2023. Adult obesity is a risk factor for infection-related hospitalisations and mortality across diverse pathogen types, populations, and baseline clinical profiles, with evidence suggesting that approximately one in ten infection-related deaths worldwide might be attributable to obesity. Wellcome Trust, Medical Research Council, and Research Council of Finland.

As an important driver of inequality in the labor market, it is crucial to develop measures to assess precarious employment. Most previous measures have been survey-based. We used register data on wage-earners aged 20–64 residing in Finland in 2013 (N = 1 873 210) to develop a novel measure of precarious employment, including items on job discontinuity, multijob holding, agency employment, underemployment, and employment income. We assessed the performance of the measure by examining the distribution of precarious employment by sociodemographic factors and occupation as well as exploring its associations with subjective (job insecurity with survey information from the same year 2013 linked to the register data at an occupational-group-level) and objective (unemployment over a 5-year follow-up) employment outcomes using linear regression. In the total study population, approximately 5% had precarious employment. It was more prevalent among women, younger age groups, individuals with a foreign background, those with lower education, manual workers, and private sector employees. Large-size occupations with more than 10% of precariously employed individuals included teachers’ aides, waiters, food service counter attendants, car, taxi and van drivers, security guards, kitchen helpers, and cooks. Precarious employment was not consistently associated with subjective job insecurity. It was nevertheless associated with objective occurrence and duration of unemployment. Precarious employment, as captured by the novel Finnish register-based measure, has similar background factors as recognized in previous literature and identifies occupations expected to be characterized by precarious employment. Those classified as precariously employed based on objective characteristics of their employment relationships do not necessarily perceive their job as insecure, although they have a clearly increased risk of subsequent unemployment. The measure can be considered to perform well for use in further studies applying Finnish register data.

BackgroundMultifactorial health complaints associated with indoor work environments can impact on employees' work ability and arouse controversies in the workplace. Traditionally, solutions have centered on building-related factors, however supporting work ability requires a multi-perspective approach.ObjectiveThis study explored relevant perspectives for implementing a multi-perspective work ability support model. This model represents a complex intervention within the intricate context of indoor environment-related health complaints in the workplace.MethodsWe used recordings and notes from the workshops of a project aiming to implement the work ability support model in three organizations and used reflexive thematic analysis. We developed overarching themes from the data, using the Consolidated Framework for Implementation Research (CFIR) as an interpretative lens to structure the findings into implementation perspectives.ResultsWe developed four overarching themes encompassing all CFIR domains and most constructs: (1) the acknowledgment and validation of employees' emotions and experiences as a solution, (2) reliable information and detailed facts as the key to managing work ability support, (3) existing tools as a means to normalization and collaboration, and (4) supervisors as central actors in a challenging task.ConclusionsImplementing a work ability support model regarding complex phenomena affecting work ability, such as indoor environment-related health complaints, requires identifying and addressing the potential tensions and controversies underlying the model and requires consideration of the context. Viewing communication as a process of developing shared understanding and co-constructing knowledge throughout the implementation process and all its dimensions can be beneficial for the implementation.

We investigated the effects of a shift schedule evaluation tool with ergonomics recommendations on employee wellbeing. The study sample was from the Finnish Public Sector study (n=7002 employees). The shift planners' use of the shift schedule evaluation tool was linked to employees' self-reported wellbeing outcomes. Inverse probability weights, reflecting the likelihood of the evaluation tool's use by the shift planner, were calculated using multilevel mixed-effects logistic regression for each participant and logistic regression for each ward. Wards using the tool (intervention group) were compared to those not using it (control group) with a generalized linear model. No association was found between the tool's use and wellbeing at the ward level. In the individual level, lower psychological distress was found in the intervention group (Risk ratio 0.92, 95% Confidence interval 0.85-0.99). More rigorous use of the tool may be necessary to achieve significant benefits for wellbeing.

This quasi-experimental study aimed to examine whether favorable changes in health- and work-related factors improve work ability of midlife and older workers. The study included 2,312 Finnish social and health care employees (89.4% women, mean age 51.5 ± 5.8 years) who participated in repeated surveys between 2017 and 2022. Propensity score weighting and generalized linear models were applied to estimate the associations of a one standard deviation favorable change in health and lifestyle factors, psychosocial work environment and working hour characteristics with perceived work ability. Favorable changes in health-related factors including improvement in sleep quality (RR 2.03, 95% CI 1.47–2.82), reduction in psychological distress (RR 1.68, 95% CI 1.24–2.30), increase in leisure-time physical activity (1.53, 95% CI 1.13–2.08), quitting smoking (RR 1.58, 95% CI 1.01–2.48), decrease in alcohol intake (RR 2.21, 95% CI 1.54–3.17) were associated with improved work ability. Of work-related factors, reduction in job demands (RR 1.51, 95% CI 1.12–2.03) and job demand-control ratio (RR 1.55, 95% CI 1.11–2.16), and increase in job control (RR 1.49, 95% CI 1.05–2.13) and job rewards (RR 1.60, 95% CI 1.20–2.13) were associated with improved work ability. Positive changes in modifiable health- and work-related risk factors can improve work ability of midlife and older social and health care employees. These identified risk factors are essential in design and implementation of multidimensional interventions aimed at supporting extended workforce participation among older workers.

There is limited research on how family-related events are associated with sustainable working life, which is defined as the absence of long-term periods of unemployment, sickness absence, or disability pension. We aimed to investigate whether family-related events, such as living with children, marriage, or divorce, are associated with sustainable working life. We also examined whether these associations could be explained by health behaviours including physical activity, smoking, and alcohol consumption, as well as by genetic factors and early life environment. Registry data and surveys on family-related events, sustainable working life, and health behaviours of 49,611 Swedish twins in 1993-2016 were used. Cox proportional hazards regressions were applied to estimate the associations between family-related events and sustainable working life, while conditional Cox models for twin pairs accounted for confounding genetic factors and early life environment. Further, the analyses were stratified by health behaviours. The results showed that a change from being single living without children to being married and living with children was associated with a sustainable working life. Moreover, individuals who experienced divorce and single individuals who changed their status of living with children were less likely to experience a sustainable working life. Genetic factors and early life environment played a role in some associations. Those with healthy behaviours were more likely to have sustainable working lives despite changes in family life, compared with those with unhealthy behaviours. Family formation (i.e. change from being single to getting married and having children) is associated with sustainable working life, whereas divorce seems to decrease the possibility of sustainable working life. Health behaviours, as well as genetic factors and early life environment, also need to be considered with changes in family life to support sustainable working life.

Suomalaisessa asiantuntija- ja hallintotyössä on meneillään koronapandemian jälkeinen murros kohti etätyön ja lähityön yhdistelmää, hybridityötä. Julkisen sektorin etätyötä koskevassa tutkimuskirjallisuudessa on vasta niukasti tietoa siitä, miten pysyväluontoinen hybridityö vaikuttaa yhteisöllisyyteen ja yhdessä tapahtuvaan oppimiseen. Tarkastelemme käytäntöteoreettisen lähestymistavan avulla, millaisia huolenaiheita sekä uusia käytäntöjä hybridityöhön liittyy. Tutkimusaineisto koostuu 35 teemahaastattelusta, joihin osallistui johtajia, esihenkilöitä ja työntekijöitä kahdesta kaupunkihallinnosta. Analyysissä piirtyy esiin huoli yhteisöllisyyden katoamisesta ja työn yksilöllisten arvojen, kuten autonomian, korostumisesta. Työn merkityksellisyyden kokeminen ja yhteisen ymmärryksen muodostuminen työyhteisössä on hybridityön vuoksi vaakalaudalla. Kehitys kuvastaa digitalisoitumisen myötä tapahtuvaa yksilöllistymistä ja yhteisöllisyyden muotojen muutosta länsimaisissa yhteiskunnissa. Yhteinen kehittäminen edellyttää satunnaisten kohtaamisten sijaan suunnitelmallisia ja organisoituja käytäntöjä kukoistaakseen hybridimäisesti työskentelevissä organisaatioissa. Aihe vaatisi tulevaisuudessa enemmän pitkittäistutkimusta.

Abstract MET-FINGER is the first randomized controlled trial combining healthy lifestyle changes with a putative disease-modifying drug (metformin) for the prevention of cognitive impairment, in an APOEε4-enriched at-risk population of older adults. The potential benefits of metformin repurposing are based on the link between Type-II Diabetes (T2D) and Alzheimer’s Disease (AD), and emerging evidence of independent neuro-protective effects. Findings will provide crucial information for innovative precision-prevention strategies aimed at cognitive impairment and dementia risk-reduction. 600 participants are randomly allocated to the FINGER 2.0 intervention (lifestyle for all + metformin, where appropriate; active arm), or regular health advice (control arm). Participants in the FINGER 2.0 group and at increased risk of T2D, are further randomised to 2000mg/day metformin, 1000mg/day metformin, or placebo (double-blind). The multimodal lifestyle intervention is an optimised version of the FINGER model. Metformin is administered as Glucophage®XR/SR 500, (Merck Healthcare KGaA, Darmstadt, Germany; 500mg oral tablets). Primary outcome is change in global cognition (combined z-score of a neuropsychological test battery). Secondary outcomes are changes in individual cognitive domains; functional ability; and risk factors for AD/dementia. The feasibility, potential lifestyle-metformin interaction, and disease-modifying effects of the lifestyle-metformin combination are exploratory outcomes. 489 eligible participants have been identified; 365 have been randomised. The main challenges experienced are linked to balancing APOEε4-carriers enrichment and the eligibility rate for metformin treatment (e.g., APOEε4-carriers were less likely to fulfil some eligibility criteria for metformin). Lessons learned, pertaining to trial design, set-up, recruitment, and delivery, for future combination-therapy studies, will be presented.

Behaviour-related health risk factors are associated with an increased risk of early exit from the working life, but their contribution to working life expectancy (WLE) remains unclear. We investigated the associations of obesity, alcohol intake, smoking and low levels of physical activity with WLE among adults aged 50years and older. Individuals working at study baseline with 18years of follow-up data from the English Longitudinal Study of Ageing (ELSA) (n = 3233) and the Finnish Public Sector study (FPS) were included (n = 65,255). Obesity, alcohol consumption, smoking and low physical activity were self-reported at study baseline. WLE from age 50 to 70years was estimated using a multi-state modelling, separately for men and women across occupational position categories (low, intermediate and high), with adjustment for age. Our findings suggest that individuals who were obese, smoked, had low physical activity levels and reported heavy alcohol use (only in FPS) could expect to work fewer years than those who did not have these behaviour-related health risk factors. A higher number of risk factors was associated with shorter WLE across sex and occupational position categories in both studies. The difference in WLEs between those with no behaviour-related health risk factors and those with ≥ 2 risk factors was up to 1.5years in ELSA and less than 1year in FPS. Having multiple behaviour-related health risk factors is linked to shorter WLE after age of 50years, a difference that may have important economic implications in societies with ageing populations.

Persulfate salts in hair bleaches are a well-documented cause of occupational asthma (OA) among hairdressers, but little information is available on OA caused by hair products containing other low-molecular-weight chemicals. The aim of this study was to investigate the prevalence and clinical characteristics of OA caused by oxidative hair dyes containing para-amino compounds (PACs). This retrospective multicenter study was conducted among 98 hairdressers with OA ascertained by a positive specific inhalation challenge (SIC) with hair products completed between 2006 and 2018 in 14 European tertiary centers. Nine hairdressers (9%) with a positive SIC response to hair dyes containing PACs were identified and reviewed. Eight hairdressers developed a bronchial response during "work-simulation" SICs with hair dyes used at work, whereas one subject was challenged with pure para-phenylene diamine. The pattern of bronchial reactions was isolated late, dual, and isolated early in four, three, and two subjects, respectively. A significant post-challenge increase in nonspecific airway hyperresponsiveness was detected in three of the seven (43%) subjects with both pre- and post-SIC measurements available. Among subjects with fractional exhaled nitric oxide measurements (n = 3) or sputum eosinophil counts (n = 4) available both before and after the SIC, none showed a significant increase in these airway inflammatory markers. Hair dyes containing PACs may contribute substantially to OA among hairdressers. This possibility should be considered carefully when evaluating hairdressers with work-related asthma symptoms. However, there is a need for further investigation of the underlying inflammatory and immunological mechanisms.