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    <title>SJWEH - Online-first articles</title>
    <description>List of Online-first articles on the SJWEH website</description>
    <link>http://www.sjweh.fi/list_onlinefirst_rss.php</link>
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    <language>en-US</language>

    <copyright>SJWEH</copyright>
    <ttl>1</ttl>
    <managingEditor>lodo@ttl.fi (Lisa O\'Donoghue-Lindy)</managingEditor>
    <webMaster>risto@toivonen.biz (Risto Toivonen)</webMaster>

   <item>
      <title>Mental health problems and suicidal behaviors in person-related work: a Swedish register-based cohort study</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4316</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4316</guid>
      <pubDate>Thu, 25 Jun 2026 15:38:30 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Person-related work requires workers to interact with individuals who are not employed at the workplace, eg, clients or patients. Besides (i) the general demands of interpersonal contact, this can entail (ii) emotional demands and (iii) conflicts/quarrels. These three potential stressors may negatively affect workers’ mental health. We examined the associations of these three dimensions of person-related work with the risk of mental health problems, including diagnoses of depressive, anxiety/stress-related and alcohol-/drug-use disorders, pharmacotherapy for such disorders, and suicidal behaviors, including deaths and suicide attempts.

Methods   Around 3.6 million workers aged 20–60 years in Sweden in 2006 were included in the study. Dimensions of person-related work were assessed respectively using a job exposure matrix. Mental health and suicide outcomes in 2007–2020 were determined based on patient, drug, and death registers. Multi-variable Cox regression models were used.

Results   Of the study participants, 1 481 900 individuals experienced at least one of the studied outcomes. Among women, high exposure to each dimension of person-related work was respectively associated with increased risks of the outcomes [hazard ratios (HR) of 1.04–1.27 for general contact with people, 1.16–1.41 for emotional demands, and 1.11–1.19 for conflicts/quarrels], after adjusting for potential confounders. Among men, a high exposure to each dimension was respectively associated with increased risks (HR of 1.11–1.16 for general contact with people, 1.10–1.23 for emotional demands, and 1.08–1.16 for conflicts/quarrels) of mental health diagnoses and pharmacotherapy. The associations with suicide deaths and attempts were not observed after adjusting for income and previous mental health problems and suicide attempts.

Conclusions   Person-related work is associated with a slightly increased risk of mental health problems and suicidal behaviors among women and with mental health problems among men. Estimates seem to be strongest for emotional demands.
      <strong>by</strong> <i>Pan K-Y, Nevriana A, Blindow K, Almroth M, Kjellberg K, Falkstedt D</i>. doi:10.5271/sjweh.4310]]></description>
         </item>   <item>
      <title>Relative risk and excess fraction of preterm birth across maternal occupation and industry: a Danish nationwide register-based cohort study of employed pregnant women</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4310</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4310</guid>
      <pubDate>Wed, 24 Jun 2026 14:57:40 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Occupational exposures can increase the risk of preterm birth (PTB). We hypothesized that the risk varies significantly according to maternal work tasks and aimed to quantify relative risks and excess fractions of PTB related to occupation and industry during pregnancy.

Methods   This nationwide study of 644 349 singleton pregnancies (2004–2018), classified maternal employment the year of conception into 38 occupational and 39 industrial groups. To approximate the lowest risk and excess fraction of PTB, ie, live birth before 37 completed gestational weeks, we constructed simulation-based reference groups that accounted for within-group random variation. Adjusted risk ratios (RR) and 99% confidence intervals (CI) of PTB were estimated relative to the simulation-based lowest risk reference and the population average.

Results   Increased risks of PTB were observed for 22 occupational and 10 industrial groups, compared with the simulation-based lowest risks. The highest RR were found for assembly workers (1.42, 99% CI 1.12–1.79) and home care workers (1.35, 99% CI 1.24–1.47). For industries, the highest RR were found for agriculture, forestry and fishing (1.29, 99% CI 1.06–1.57) and manufacture of metals and machinery (1.22, 99% CI 1.07–1.40). Compared to the population average, risks were significantly higher for home care workers, nursing home workers, clerks (not elsewhere classified), shop assistants, and jobs with unstated job codes, and for the industrial groups of manufacture of metals and machinery and residential centers and home help.

Conclusion   Several maternal occupational and industrial groups in Denmark had elevated risks of PTB. The findings are exploratory and further research is needed to identify the potential for prevention in the occupational setting.
      <strong>by</strong> <i>Andersen AJ, Pedersen M, Hannerz H, Tøttenborg SS, Flachs EM, Bonde JPE, Selander J, Begtrup LM, Sejbaek CS, Hougaard KS</i>. doi:10.5271/sjweh.4315]]></description>
         </item>   <item>
      <title>Job strain and ischemic heart disease: the balance of methodological bias and implications for prevention. Response to: Bonde JP et al. The demands–control–support work stress model and risk of ischemic heart disease: causal inference based on observational epidemiology</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4315</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4315</guid>
      <pubDate>Thu, 18 Jun 2026 12:58:59 +0200</pubDate>
      <category>Letter to the Editor</category>
      <description><![CDATA[We read with interest Bonde et al’s (1) recent review. We agree with their premise: strengthening causal inference is an important objective for occupational epidemiology. However, we believe the conclusion that “at most, any true effect [of job strain on ischemic heart disease (IHD)] appears to be small” is not supported by a valid appraisal of the available evidence. The pooled relative risk estimate (RRE) of 1.14 is most likely underestimated, as common limitations in the available literature tend to bias results toward the null.

The authors acknowledge underestimation sources: nondifferential exposure misclassification, overadjustment for cardiometabolic risk factors, and healthy-worker survivor selection (1). Additional sources of underestimation are not discussed. Dichotomizing exposure by combining active and passive exposures into a single “non–high-strain” category may attenuate risk estimates by increasing heterogeneity in the reference group. Indeed, workers with passive exposure may also be at increased IHD risk (2). The pooled RRE may further be attenuated by sex: women develop IHD at older ages partly due to pre-menopausal estrogen cardioprotection, thus working-age follow-up captures fewer events, reducing pooled estimates and precision (3).

Sources of overestimation raised also warrant closer scrutiny. For instance, lower estimates in job-exposure matrix (JEM) studies are interpreted as evidence of upward bias in self-reported studies. However, even when exposure values are imputed within subgroups defined by sex and age, JEM do not fully capture individual-level variability in exposure within occupational categories (4). The resulting non-differential misclassification likely attenuates estimates, a limitation the authors acknowledge but do not take into account in their conclusion. The supporting reference for overestimation relies on a 4-item measure of perceived stress (5), limiting its relevance to job strain. An additional source of overestimation is negative affectivity, in which adverse health perceptions inflate individual-level exposure reports. However, this mechanism is not supported in prospective studies with control for anger, hostility, and cynicism (6, 7). Finally, the authors raise concerns about a health-reporting bias: workers with prodromal IHD symptoms may over-report perceived job strain, inflating observed associations. In prospective studies excluding early incident IHD events, associations were not attenuated and, if anything, marginally strengthened (6, 8), providing no support for reverse causation as a source of overestimation. More broadly, methodological characteristics are presented as isolated binary indicators rather than as interdependent dimensions. This hinders the overall appraisal of study quality.

These methodological considerations have implications for burden estimation. There has been considerable debate about whether the population attributable fraction (PAF) of 3.4% that the IPD-Work Consortium reported for job strain and IHD (8) was an underestimate when accounting for exposure misclassification, alternative referent group definitions, and other sources of attenuation identified in the literature (9, 10). A subsequent prospective cohort study designed to address several of the sources of underestimation discussed here estimated that 18.2% of incident IHD were attributable to job strain exposure (11).
In sum, while we share Bonde et al’s emphasis on causal inference, the balance of methodological bias in this literature is more plausibly downward than unpredictable. Given the substantial burden of IHD, debates about the precise magnitude should not delay the development and evaluation of workplace interventions to reduce job strain and improve cardiovascular health.

<strong>References</strong>
1.	Bonde JP, Skaaby S, Flachs EM, Dollard M, Keyes K, Rosengren A et al. The demands-control-support work stress model and risk of ischemic heart disease: causal inference based on observational epidemiology. Scand J Work Environ Health 2026 Apr. [Epub ahead of print].  https://doi.org/10.5271/sjweh.4299.
2.	Xu S, Huang Y, Xiao J, Zhu W, Wang L, Tang H et al. The association between job strain and coronary heart disease: a meta-analysis of prospective cohort studies. Ann Med 2015;47(6):512–8. https://doi.org/10.3109/07853890.2015.1075658.
3.	Zahiriharsini A, Gilbert-Ouimet M, Hervieux V, Trudel X, Matteau L, Jalbert L et al. Incorporating sex and gender considerations in research on psychosocial work exposures and cardiovascular diseases: A systematic review of 55 prospective studies. Neurosci Biobehav Rev 2024 Dec;167:105916. https://doi.org/10.1016/j.neubiorev.2024.105916.
4.	Schwartz JE, Pieper CF, Karasek RA. A procedure for linking psychosocial job characteristics data to health surveys. Am J Public Health 1988 Aug;78(8):904–9. https://doi.org/10.2105/AJPH.78.8.904.
5.	Metcalfe C, Davey Smith G, Macleod J, Heslop P, Hart C. Self-reported stress and subsequent hospital admissions as a result of hypertension, varicose veins and haemorrhoids. J Public Health Med 2003 Mar;25(1):62–8. https://doi.org/10.1093/pubmed/fdg013.
6.	Lavigne-Robichaud M, Trudel X, Talbot D, Milot A, Gilbert-Ouimet M, Vézina M et al. Psychosocial stressors at work and coronary heart disease risk in men and women: 18-year prospective cohort study of combined exposures. Circ Cardiovasc Qual Outcomes 2023 Oct;16(10):e009700. https://doi.org/10.1161/CIRCOUTCOMES.122.009700.
7.	Tiwa Diffo E, Lavigne-Robichaud M, Milot A, Brisson C, Gilbert-Ouimet M, Vézina M et al. Psychosocial stressors at work and atrial fibrillation incidence: An 18-year prospective study. J Am Heart Assoc 2024 Aug;13(16):e032414. https://doi.org/10.1161/JAHA.123.032414.
8.	Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L et al.; IPD-Work Consortium. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet 2012 Oct;380(9852):1491–7. https://doi.org/10.1016/S0140-6736(12)60994-5.
9.	Choi BK, Schnall P, Landsbergis P, Dobson M, Ko S, Gómez-Ortiz V et al. Recommendations for individual participant data meta-analyses on work stressors and health outcomes: comments on IPD-Work Consortium papers. Scand J Work Environ Health 2015 May;41(3):299–311. https://doi.org/10.5271/sjweh.3484.
10.	Kivimäki M, Singh-Manoux A, Virtanen M, Ferrie JE, Batty GD, Rugulies R; IPD-Work consortium. IPD-Work consortium: pre-defined meta-analyses of individual-participant data strengthen evidence base for a link between psychosocial factors and health. Scand J Work Environ Health 2015 May;41(3):312–21. https://doi.org/10.5271/sjweh.3485.
11.	Lavigne-Robichaud M, Trudel X, Talbot D, Milot A, Pena-Gralle AP, Mésidor M et al. Coronary heart disease attributable to psychosocial stressors at work. JACC Adv 2025 Oct;4(10 Pt 2):102160. https://doi.org/10.1016/j.jacadv.2025.102160.
      <strong>by</strong> <i>Lavigne-Robichaud M, Landsbergis P, Brisson C, Sembajwe G, Gilbert-Ouimet M, Li J, Milot A, Trudel X</i>. doi:10.5271/sjweh.4308]]></description>
         </item>   <item>
      <title>Employment and working conditions and risk of suicidal behaviors: a systematic review and meta-analysis of longitudinal studies</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4308</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4308</guid>
      <pubDate>Thu, 11 Jun 2026 17:20:00 +0200</pubDate>
      <category>Review</category>
      <description><![CDATA[Objectives   Systematic research on employment/working conditions as risk or protective factors for suicidal behaviors is limited. In this study, we systematically reviewed the literature on a range of employment or working conditions and the risk of suicidal behaviors (suicide and suicide attempt), focusing on longitudinal studies.

Methods   We searched Web of Science, Scopus, PsycInfo, and Embase during 1995–2024 for cohort and case-control studies and performed meta-analysis to pool data if there were ≥2 studies on the same type of conditions and outcome.

Results   A total of 27 studies met the eligibility criteria, of which 14 studies were used in meta-analyses. Meta-analyses showed statistically significant associations between part-time work [relative risk (RR) 1.21, 95% confidence interval (CI) 1.12–1.30], job loss (RR 2.27, 95% CI 1.12–4.61), job insecurity (RR 1.64, 95% CI 1.36–1.96), high job demands (RR 1.14, 95% CI 1.08–1.20), low job control (RR 1.11, 95% CI 1.05–1.17), job strain (RR 1.32, 95% CI 1.29–1.36), workplace bullying (RR 1.78, 95% CI 1.16–2.73), and suicide. In terms of the evidence, we found moderate and low certainty for job loss and job insecurity, respectively. For other working conditions, certainty of evidence was considered very low or could not be assessed because of too few studies. Studies investigating suicide attempts were limited, and we only found very low evidence for workplace bullying and suicide attempt (RR 1.33, 95% CI 1.09–1.62, in a previously published meta-analysis). For all other conditions, we could not assess certainty of evidence of associations with suicide attempt.

Conclusions   Although some working conditions may be risk factors for suicide, the number of studies is still too limited to allow for certainty of evidence on associations between specific working conditions and suicide.
      <strong>by</strong> <i>Magnusson Hanson LL, Madsen IEH, Blomqvist S, Holmgren R, Sørensen K, Rugulies R</i>. doi:10.5271/sjweh.4311]]></description>
         </item>   <item>
      <title>Association between pesticide use and liver injury: A field study in Taiwan</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4311</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4311</guid>
      <pubDate>Thu, 11 Jun 2026 00:06:17 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Pesticides are crucial for agricultural development but can be harmful to humans. We conducted a study to investigate the association between pesticide use and liver injury.

Methods   We recruited participants ≥40 years from a district with two agricultural regions where water caltrops and mangoes are cultivated. A random sample of 200 residents from each region was selected, and prevalence ratios (PR) for abnormal liver tests were compared.
Results   A total of 331 individuals participated (participation rate: 82.8%), with 151 from the water caltrop region and 180 from the mango region. Most participants were ≥60 years and predominantly females. Pesticide users had a higher risk of abnormal liver tests [PR 1.74, 95% confidence interval (CI) 1.15–2.62]. Stratified analyses showed higher risks among those with a positive HBsAg test (PR 2.50, 95% CI 1.34–4.64) or a positive anti-HCV Ab test (PR 10.61, 95% CI 6.00–18.77). Multivariable analysis identified a positive HBsAg test [adjusted PR (PR<sub>adj</sub>) 3.21, 95% CI 1.38–7.48], a positive anti-HCV Ab test (PR<sub>adj</sub> 23.52, 95% CI 11.30–48.96), and upward pesticide spraying (PR<sub>adj</sub> 3.39, 95% CI 1.52–7.54) as independent risk factors for abnormal liver tests.

Conclusions   Pesticide use was associated with a higher risk of liver injury, particularly among upward sprayers and those with hepatitis B or C infection. The abnormal liver test cases attributable to upward pesticide spraying in this population might be as large as hepatitis B, supporting the importance of pesticide exposure.
      <strong>by</strong> <i>Liu Y-C, Kuo T-C, Guo H-R</i>. doi:10.5271/sjweh.4312]]></description>
         </item>   <item>
      <title>Large language model exposure and precarious occupations: Unpacking relationships in the Canadian labor force</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4312</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4312</guid>
      <pubDate>Wed, 03 Jun 2026 20:23:36 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   The adoption of digital technologies has historically impacted the most precarious occupations and contributed to widening labor market inequities. Large language models (LLM) may reshape this relationship. This study examines the association between occupational exposure to LLM and occupational precarity.

Methods   Using Canada’s Labour Force Survey, occupational exposure to LLM and four dimensions of precarity (contractual instability, earnings inadequacy, schedule unpredictability, working-time mismatch) were examined. A multidimensional index was developed to summarize an occupation’s overall exposure to precarity. Four multivariate linear regression models with cluster-robust standard errors estimated the associations between LLM exposure and each dimension of precarity. A fifth multivariate model examined the relationship between LLM exposure and the multidimensional precarity index. Utilizing model coefficients, mean estimates of occupational LLM exposure were produced.

Results   Using the multidimensional precarity index, our analysis showed that occupations characterized by low exposure to precarity had a significantly higher mean LLM exposure [mean 0.386, 95% confidence interval (CI) 0.356–0.417] compared to occupations with medium (mean 0.258, 95% CI 0.221–0.295), high (mean 0.260, 95% CI 0.194–0.328) or very high precarity (mean 0.205, 95% CI 0.136–0.275). Apart from earning adequacy, LLM exposure was also lower among occupations using each separate dimension of precarity.

Conclusion   Occupations most likely to be exposed to LLM are those where precariousness is lowest. These occupations have previously been sheltered from technological change. There is a need of examine the impacts of LLM on workers in job where the technology is prominent.
      <strong>by</strong> <i>Jetha A, Liao Q, Smith P, Vu V, Biswas A, Smith B, Vahid Shahidi F</i>. doi:10.5271/sjweh.4289]]></description>
         </item>   <item>
      <title>Multiple maternal occupational exposures during pregnancy and newborn size at birth: analysis of the ELFE cohort, a French longitudinal study of children</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4289</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4289</guid>
      <pubDate>Thu, 14 May 2026 21:36:58 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   We aimed to study multiple occupational exposures selected using an priori hypothesis as well as small-for-gestational age (SGA), birthweight (BW), and head circumference (HC).

Methods   We analyzed data from the Étude Longitudinale Française depuis l`Enfance (ELFE) cohort (N=12 851 mother-child pairs with a gestational age >33 weeks). The outcomes of interest were SGA, BW, and HC. Of 47 factors (17 chemical, 8 physical, 4 biological, 12 biomechanical, 3 organizational and 3 psychosocial) to which mothers were exposed in their occupation assessed by job-exposure matrices in this cohort, we included those for which the epidemiological or experimental literature suggests an association with fetal growth. Logistic and linear regression models that included all preselected exposure variables were performed and adjusted for potential confounders. We conducted additional analysis stratified by trimester of pregnancy.

Results   The logistic model, which included all preselected variables, reported that – for all women – exposure to ultrafine particles (UFP) increased SGA risk [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.12–1.90] while standing decreased it (OR 0.82, 95% CI 0.67–1.00). Among mothers who stopped working during the first/second trimester of pregnancy, we found the same SGA risk for UFP; exposure to high strain also increased the risk (OR 1.81, 95% CI 1.18–2.83). Among those who stopped working during the third trimester, exposure to oxygenated solvents increased SGA risk (OR 2.24, 95% CI 1.08–4.41). In the linear model, for all women, there was a decrease in BW (β -34 grams, 95% CI -66– -1.1) among those exposed to UFP. For mothers who stopped working during the first/second trimester, exposure to vibration increased BW, while among those who stopped working during the third trimester, exposure to night work increased BW. Exposure to oxygenated solvents decreased HC (β -0.22 cm, 95% CI -0.44–0.00) among all women.

Conclusion   These findings suggest the possible influence of chemical and strenuous factors at work on fetal growth, particularly depending on the trimester in which pregnant mothers stopped working. While the combined assessment of multiple exposures did not reveal clear associations, further studies are needed to explore potential interactions and underlying biological mechanisms.
      <strong>by</strong> <i>Tartaglia M, Jaunas K, Audignon-Durand S, Houot M-T, Turuban M, Roeleveld N, Siemiatycki J, Dufourg MN, Carles C, Pilorget C, Uuksulainen S, Turner MC, Descatha A, Garlantézec R, Delva F</i>. doi:10.5271/sjweh.4305]]></description>
         </item>   <item>
      <title>Labor market participation among patients referred to occupational medicine with low-back pain: a Danish nationwide register-based cohort study</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4305</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4305</guid>
      <pubDate>Tue, 05 May 2026 12:36:26 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   This study aimed to characterize long-term labor market participation from five years before to five years after assessment at departments of occupational medicine among patients referred with low-back pain (LBP) and to compare these patterns with those in a matched general working population. Secondary objectives were to assess subgroup differences and time to return to work.

Methods   In this nationwide register-based cohort study, we included Danish residents aged 18–60 years referred for assessment (N=8256) and matched comparators (1:5 on sex, age, and calendar year; N=41 280). Using weekly register data, we calculated the prevalence of different labor market states before and after assessment as well as propensity score-weighted prevalence differences and ratios, and we performed stratified analyses. We estimated the five-year cumulative incidence of return to work among individuals on temporary public benefits using the Aalen–Johansen estimator.

Results   At assessment, 37% of patients were working versus 83% of comparators. Five years post-assessment, 40% of patients were working and 32% received permanent health-related public benefits. We observed substantial heterogeneity, with larger deficits in work participation in several subgroups. Among patients on temporary public benefits at assessment, the five-year cumulative incidence of return to work was 42%, with no increase in overall work prevalence.

Conclusions   LBP patients had persistently poorer labor market participation than matched comparators, with declines already evident one year before assessment. Prognosis was particularly poor among older patients, those with weaker labor market participation at assessment, and those with comorbidities. These findings highlight the need for early identification and timely intervention and referral.
      <strong>by</strong> <i>Rønnow MM, Vestergaard JM, Rytter D, Fenger-Grøn M, Willert MV, Andersen JH, Kyndi M</i>. doi:10.5271/sjweh.4294]]></description>
         </item>   <item>
      <title>Occupational heat stress and the role of wearable cooling interventions: A systematic review and meta-analysis of physiological and perceptual outcomes</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4294</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4294</guid>
      <pubDate>Thu, 30 Apr 2026 01:52:12 +0200</pubDate>
      <category>Review</category>
      <description><![CDATA[Objective   Occupational heat stress, driven by high ambient temperatures, humidity, and radiant heat impairs health, safety, and productivity. Among the interventions for mitigating heat strain, wearable cooling technologies [eg, water/ice, phase-change materials (PCM), ventilated/evaporative garments] is increasingly used, but their comparative effectiveness remains unclear. This systematic review aimed to evaluate the effectiveness of wearable cooling intervention on physiological and perceptual outcomes during heat exposure.

Methods   Adhering to PRISMA guidelines (PROSPERO: CRD42025631559), we searched PubMed, Embase, and Scopus (February 2026) for randomized or non-randomized intervention trials among workers or acclimatized adults. Data were extracted as mean/standard deviation (or transformed equivalents) and pooled using random-effects meta-analysis. Heterogeneity (I2), small-study effects (Egger’s test) and sensitivity/subgroup analyses of cooling modalities were performed. Risk of bias (RoB 2, ROBINS-I) and certainty (GRADE) were assessed.

Results   Sixty-nine studies were included in our review. Post-exposure, wearable cooling significantly reduced rectal temperature [mean difference (MD) -0.24°C; 95% confidence interval (CI) -0.37– -0.1; I<sup>2</sup>=43.91%], gastrointestinal temperature (MD -0.26°C; -0.52– -0.001; I<sup>2</sup>=98.13%), skin temperature (MD -1.14°C; -1.85– -0.42; I<sup>2</sup>=96.56%), and heart rate (MD -7.69 bpm; -11.22– -4.15; I<sup>2</sup>=73.19%). Egger’s tests suggested possible small-study effects for skin temperature and heart rate but not for core temperatures. Subgroup analyses indicated more consistent benefits with water/ice and PCM garments. Overall certainty ranged from low to very low due to risk of bias, inconsistency, and imprecision.

Conclusions   Wearable cooling attenuates physiological heat strain and improves thermal comfort, particularly via water/ice and PCM systems. Given high heterogeneity and low certainty, adequately powered, standardized, head-to-head trials are needed.
      <strong>by</strong> <i>Sheth A, Viramgami A, Thakor M, Modi B, Bagepally B, Kar A, Ram E, Dave A, Balachandar R</i>. doi:10.5271/sjweh.4302]]></description>
         </item>   <item>
      <title>Onset of workplace bullying and violence and changes in health-related behaviors: a multi-cohort study</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4302</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4302</guid>
      <pubDate>Thu, 30 Apr 2026 01:22:23 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   The aim of the study was to examine whether exposure to workplace bullying and violence is associated with changes in health-related behaviors over time.

Methods   This multi-cohort study included four cohorts from Sweden, Denmark, Finland, and Norway, comprising 78 624 participants aged 18–65 years at baseline between 2004 and 2016. The data were analyzed using an emulated trial design. The main analysis ascertained both onset of workplace bullying and violence (exposures) and changes in health-related behaviors (outcome) using data from time T<sub>X</sub> and T<sub>X+1</sub> (concurrent analysis). To clarify temporality, changes in health-related behaviors were further calculated at time T<sub>X+1</sub> to T<sub>X+2</sub> (longitudinal analysis). We applied logistic regression with generalized estimating equations. Subgroup differences by sex were examined.

Results   Among 125 854 participant-observations across 2–3 study phases of the 78 624 participants, 6–8% experienced onset of workplace bullying and 9–14% reported onset of workplace violence over 1–2 years. The strongest association was observed between onset of violence and becoming obese, with an odds ratio (OR) of 1.13 [95% confidence interval (CI) 1.00–1.27] in the concurrent and 1.31 (95% CI 1.05–1.64) in the longitudinal analysis. In addition, onset of bullying (OR 1.23, 95% CI 1.06–1.44) and violence (OR 1.11, 95% CI 0.99–1.24) were concurrently associated with initiation of excessive alcohol use, with weaker associations in the longitudinal analysis. Exposure–response relationships were observed for all aforementioned associations and findings were consistent across cohorts. Men were more likely to initiate excessive alcohol use than women after experiencing violence (P=0.008).

Conclusion   Exposure to workplace bullying and violence was associated with adverse changes in health-related behaviors.
      <strong>by</strong> <i>Xu T, Nielsen MB, Clark AJ, Rugulies R, Pentti J, Sørensen JK, Nordentoft M, Westerlund H, Stenholm S, Vahtera J, Madsen IEH, Hansen ÅM, Virtanen M, Knardahl S, Oksanen T, Kivimäki M, Magnusson Hanson LL, Rod NH</i>. doi:10.5271/sjweh.4303]]></description>
         </item>   <item>
      <title>The consequences of changes in exercise habits on work engagement and presenteeism: Evidence from an event-study analysis using Japanese longitudinal data</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4303</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4303</guid>
      <pubDate>Thu, 30 Apr 2026 00:07:54 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   This study aimed to estimate the consequences of changes in employee exercise habits (starting and quitting) on work engagement and presenteeism.

Methods   Since January 2023, the Japan Institute for Labour Policy and Training has conducted the semi-annual JILLS-i longitudinal, web-based survey to represent Japan’s middle-aged population structure (512 strata defined by gender, age, employment status, region, education). Of the 11 148 regular employees in the first wave, we analyzed the four-wave data of 6576 individuals (N=26 304 person-waves). We utilized work engagement and productivity (presenteeism) as our analytical outcomes. Binary indicators for relative time from changes in exercise habits were included as explanatory variables to estimate temporal associations with job-related outcomes using an event-study analysis, a quasi-experimental approach.

Results   Both starting and quitting exercise habits showed no significant association with presenteeism. However, starting exercise was positively associated with work engagement, whereas quitting was negatively associated with it. Starting exercise showed a significant association over longer follow-up waves than quitting exercise. Gender differences were observed in the association of quitting exercise with work engagement.

Conclusions   The acquisition of exercise habits may lead to a sustained improvement in work engagement, a crucial psychological resource for employees. Our results potentially suggest a divergence in the dynamics of effect between organizational support for starting versus preventing quitting exercise. Although exercise promotion may not lead to substantial improvements in productivity as measured by presenteeism, it may still yield meaningful psychological benefits.
      <strong>by</strong> <i>Kashima R, Takada T, Matsuo T, So R</i>. doi:10.5271/sjweh.4297]]></description>
         </item>   <item>
      <title>Workplace mistreatment and problem drinking among physicians in Sweden: a longitudinal study</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4297</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4297</guid>
      <pubDate>Mon, 20 Apr 2026 17:46:58 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Recent studies report high levels of workplace mistreatment among Swedish physicians. Various types of mistreatments have been correlated with adverse alcohol use. This study investigated the impact of workplace mistreatment (ie, threats and violence, harassment and incivility) on subsequent problem drinking among physicians in Sweden.

Methods   Data from the Longitudinal Occupational Health survey in Healthcare Sweden (LOHHCS) were used, including 1618 clinically active physicians aged <67 years. Baseline data were collected between March and June 2022, and follow-up data between October and December 2023. Associations between three different types of workplace mistreatment and problem drinking were analyzed using logistic regressions adjusted for relevant confounders.

Results   Exposure to threats and violence [odds ratio (OR) 2.78, 95% confidence interval (CI) 1.48–5.20] and workplace incivility (OR 3.25, 95% CI 1.24–8.54), respectively, significantly predicted problem drinking at follow-up. No significant association was found between harassment and problem drinking. When adjusting for co-occurring forms of mistreatment, only threats and violence remained a significant predictor.

Conclusion   This study reveals a significant association between exposure to threats and violence at work and workplace incivility, respectively, and subsequent problem drinking among physicians. The findings underscore the need for interventions to prevent mistreatment within the healthcare system, as well as treatment and support for individuals who have been exposed.
      <strong>by</strong> <i>Peláez Zuberbuhler J, Strömberg A, Thern E, Landstad BJ, Sjöström M, Brulin E</i>]]></description>
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