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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>
    <atom:link href="http://www.sjweh.fi/list_onlinefirst_rss.php" rel="self" type="application/rss+xml" />
    <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>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=4299</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4299</guid>
      <pubDate>Fri, 17 Apr 2026 16:49:24 +0200</pubDate>
      <category>Review</category>
      <description><![CDATA[Objective   Reviews consistently suggest an association between job strain and ischemic heart disease (IHD), but causality remains uncertain. This study aimed to critically assess causal inference using the most informative epidemiological studies.

Methods   A systematic search in PubMed and Embase up to 15 November 2024 identified observational studies reporting quantitative estimates of associations between job strain (defined by job demands and control) and IHD. Eligible studies were cohort or case–control designs with exposure data obtained independently by medically verified IHD (ICD-8/9: 410–414; ICD-10: I20–I25) and risk estimates adjusted at least for age, sex, and socio-economic status. One estimate per study was included in inverse-variance weighted random-effects meta-analyses. We evaluated main sources of upward and downward bias, potential confounding, and key criteria for causal inference including outcome specificity, exposure–response, and consistency.

Results   This review comprised 25 cohort and 1 case–control study (122 risk estimates). The fully adjusted pooled relative risk estimate (RRE) for job strain and all IHD outcomes combined was 1.14 [95% confidence interval (CI) 1.06–1.23; 21 studies]. For myocardial infarction, the RRE was 1.08 (95% CI 1.00–1.15; 11 studies), and, in studies using job-exposure matrices, it was 1.06 (95% CI 0.99–1.13; 7 studies). Strong heterogeneity, small effect sizes, limited exposure–response evidence, net bias in unpredictable directions, and lack of confirmation of findings in studies using alternatives to self-reported exposure assessment preclude causal inference.

Conclusion   Evidence for a causal relationship between job strain and IHD is limited. At most, any true effect appears to be small.
      <strong>by</strong> <i>Bonde JP, Skaaby S, Flachs EM, Dollard M, Keyes K, Rosengren A, Mehlum IS, Mikkelsen S</i>. doi:10.5271/sjweh.4298]]></description>
         </item>   <item>
      <title>Work-related psychosocial factors and working life expectancy among Finnish public sector employees aged 50 years or older</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4298</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4298</guid>
      <pubDate>Thu, 16 Apr 2026 17:42:01 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   This study aimed to examine the associations between work-related psychosocial factors and working life expectancy (WLE) across occupational groups among Finnish public sector employees aged ≥50 years.

Methods   In this cohort study, 70 662 Finnish public sector employees completed surveys on work-related psychosocial factors in 2000–2002, 2004, 2008, 2011–2012, 2013–2014, and 2015–2016, with each participant responding at least once at age ≥50 years (response rates 66–71%; 80% female). Survey data were linked to pensionable earnings records to verify work participation until 31 December 2018. WLE WLE between  ages 50 and 68 was estimated using a multi-state life tables approach. Analyses were conducted among three occupational groups: managers and specialized professionals, non-manual professionals, and service and manual workers.

Results   The overall WLE at age 50 was 13.1 years [95% confidence interval (CI) 13.1–13.2]. Work-related psychosocial factors were associated with shorter WLE across all occupational groups, with WLE shortening from the highest to the lowest occupational group. High effort–reward imbalance (ERI) was associated with the shortest WLE, approximately five months shorter than among employees with low ERI. Compared with managers and specialized professionals with low psychosocial risks, high ERI, high job strain, high relational or procedural injustice were each associated with an approximately 1-year shorter WLE among service and manual workers. Occupational group showed a stronger association with WLE than the accumulation of psychosocial risk factors. No sex differences in WLE were observed.

Conclusion   These findings suggest that promoting favorable psychosocial working conditions may extend working careers and reduce inequalities in working life participation, particularly among service and manual workers.
      <strong>by</strong> <i>Haukka E, Heikkilä K, Pentti J, Vahtera J, Chungkham HS, Zaninotto P, Kivimäki M, Ervasti J, Stenholm S</i>. doi:10.5271/sjweh.4291]]></description>
         </item>   <item>
      <title>Permanent night work and risk of injuries: A register-based cohort study using payroll data</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4291</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4291</guid>
      <pubDate>Wed, 15 Apr 2026 15:49:12 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   Shift work is associated with a higher injury risk, but the optimal way of organizing night work remains debated. This study examined whether the injury risk among permanent night workers differs from that of employees working other types of work schedules with or without night work.

Methods   This register-based cohort study used payroll data from the Danish Working Hour Database over a 12-year period (2007–2018), with daily information on working hours among all hospital employees in Denmark. Work schedules were categorized according to the proportion of night, evening, and day shifts worked in the preceding 365 days. Hospital-treated injuries were identified using the Danish National Patient Register. Poisson regression with generalized estimating equations was used to estimate incidence rate ratios (IRR) for injuries across work schedules. Main analyses were adjusted for sex, age, and job type.

Results   Among 192 711 employees contributing 298.5 million observation days, we identified 87 185 injuries. Permanent night workers had a lower injury risk compared with all other groups of shift workers and a similar risk as permanent day workers. Relative to permanent night workers, the observed injury risk was higher among evening/night workers [IRR 1.37, 95% confidence interval (CI) 1.23–1.53] and day/evening/night workers (IRR 1.37, 95% CI 1.28–1.47).

Conclusion   Permanent night workers had lower risk of injuries than permanent evening workers and workers in 2- or 3-shift schedules. Differences in tasks, adaptation, and selection may contribute to this pattern. Injury prevention efforts should prioritize workers exposed to night shifts in combination with other shift types.
      <strong>by</strong> <i>Nabe-Nielsen K, Aagaard A, Larsen AD, Nielsen HB, Hansen J, Hansen ÅM, Kolstad HA, Vestergaard JM, Garde AH</i>. doi:10.5271/sjweh.4304]]></description>
         </item>   <item>
      <title>Goodbye work-related musculoskeletal disorders, welcome musculoskeletal health! A call for action</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4304</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4304</guid>
      <pubDate>Mon, 13 Apr 2026 17:35:15 +0200</pubDate>
      <category>Editorial</category>
      <description><![CDATA[Despite decades of global attention, work-related musculoskeletal disorders (MSD) remain a significant challenge, with substantial personal and societal costs (1). The lack of progress in addressing this prevalent problem is not due to a lack of trying. Legislation and campaigns aimed at primary prevention of work-related MSD have been available in numerous countries (1). In an editorial written already about two decades ago, Wells (2) addressed the question "Why have we not solved the (work-related) MSD problem?". Formulated in six questions, Wells established the key factors to assess our ability to prevent work-related MSD: (i) How well do we understand MSD and their burdens?; (ii) How good are our MSD risk factors?; (iii) How effective and informative are current workplace MSD assessment approaches?; (iv) How effective are the recommended interventions in actually reducing MSD in the workplace?; (v) How intensely and widely implemented are workplace interventions to prevent MSD?; and (vi) How well are we improving disability outcomes for MSD?

In our paper on 50 years of research published in the <em>Scandinavian Journal of Work, Environment & Health</em> on MSD, it became clear that the first three questions have been sufficiently addressed to move forward (1). We have strong evidence on mechanisms as to how work-related MSD can develop and how they impact the lives of workers and society. In addition, there is an array of biopsychosocial risk factors for which we have evidence regarding the strength of their association with MSD. And, despite their limitations, we have various interview, questionnaire, observational and device-based approaches to determine exposures when assessing the work-relatedness of MSD.
Yet, there is a scarcity of good and well-implemented interventions to prevent work-related MSD. The CoWork (Copenhagen Work-related) musculoskeletal health model, as presented in this issue of the Journal (3), comes at an opportune time as it addresses the final three questions in Wells’ editorial (2). The authors of the CoWork musculoskeletal health model propose a paradigm shift (3). In short, the CoWork musculoskeletal health model suggests going from work-related biomechanical risk reduction only to adopting a biopsychosocial model for musculoskeletal health promotion at work. Musculoskeletal health is promoted using five integrated elements: (i) a health-oriented approach, (ii) a just-right work-related factor conceptualization, (iii) the Organizational, Management, Group, !ndividual (OMG!) workplace framework, (iv) an intervention guidance, and (v) a health economics perspective. The model provides guidance for all relevant actors – researchers, policymakers, practitioners, employers, and workers – to promote musculoskeletal health at the workplace. We commend the authors for coming up with the model!

What we like most about the CoWork musculoskeletal health model is that it explicitly addresses the positive health benefits of physical activity at work while not neglecting the negative effects by using ‘the just right principle’ (not too much and not too little). Practical examples of this positive benefit and the `just right` principle are based on the authors’ studies on the benefits of micro-exercises (or exercise snacks) (4) and on interventions from the Goldilocks principle (5). In addition, we believe that the focus on supporting the good (musculoskeletal health) instead of preventing the bad (MSD) is probably more motivating for decision- and policy-makers to implement health-enhancing measures. To bring the CoWork musculoskeletal health model forward in science and practice, we make a call for action based on the following three considerations.

<strong>A musculoskeletal health definition and measurement tool for better tailoring and evaluation</strong>
First, although musculoskeletal health is not a completely new concept (1), as far as we are aware, no agreed-upon definition and measurement tool exists. Such a definition and measurement tool are essential to assess the personal features of a worker to tailor a CoWork musculoskeletal health intervention. A good measurement tool is also needed to evaluate the effectiveness of CoWork musculoskeletal health interventions. The CoWork musculoskeletal health authors propose the following definition: "Work-related musculoskeletal health is a state of physical, mental, and social well-being of the locomotor (musculoskeletal) system in relation to work." This definition not just captures the musculoskeletal system but also incorporates important factors like fatigue, fitness, and functioning that play an important role in musculoskeletal health. Yet, reaching an international consensus on the definition of musculoskeletal health is essential – ideally involving all stakeholders – for example through a Delphi study. Next, a measurement tool that captures work-related musculoskeletal health can be developed, preferably based on current instruments to make comparisons with existing findings possible.

<strong>A community of professionals for better intervention implementation</strong>
Second, the CoWork musculoskeletal health model is specifically designed for both research and practice. This brings up the question: ‘What specific competencies are needed for a professional to deliver a CoWork musculoskeletal health intervention?’ As the CoWork musculoskeletal health model is comprehensive and complex, incorporating elements of the full biopsychosocial perspective, effective implementation requires a truly multidisciplinary professional team. Therefore, a training program seems essential to build a community of CoWork musculoskeletal health professionals. A successful blueprint for such a program might be the internationally renowned Work Disability Prevention Canadian Institutes of Health Research Strategic Training Program (6). Key features of this program include participation from around the world, community building through yearly consecutive two-week training sessions, multidisciplinary developers of the training program acting as mentors, recognized guest speakers from around the world, e-courses, and, of course, the active involvement of stakeholders like employers, unions, and workers’ compensation boards. In Europe, perhaps the Marie-Sklodowska Curie actions might provide financial support for such a program, given the proposed excellence in research and innovation for doctoral and postdoctoral training. This would also contribute to community building and establishing a strong research field.

<strong>Making it work: combining health promotion and risk factor prevention for blue-collar workers</strong> 
Finally, promoting work-related musculoskeletal health by stimulating health-enhancing factors such as physical activity can be effective, but this is easier said than done (7,8). We know from the literature that the effectiveness of workplace health promotion is moderate at best (9). The ‘just-right’ work, as advocated in the CoWork paper, is mostly supported by the implementation of exercise snacks (4), while there is limited evidence on the effectiveness of the Goldilocks principle yet (5). Also, interventions on reducing physical workload have shown limited effectiveness (10). Although these interventions show slender effectiveness as standalone measures to either promote health or reduce workload, combining effective elements from these two groups of interventions could be the way forward. This is also theoretically plausible as work, health, and lifestyle are strongly intertwined. As an example, we may not be able to improve health-enhancing physical activity after work without actually doing something about work, since it is known that physical work demands prevent workers from being active during their leisure time (11). The latter is particularly important for workers who should theoretically have the most potential to benefit from the CoWork musculoskeletal health model, namely blue-collar workers in physically demanding jobs. Yet, worksite health promotion and improvement programs among blue-collar workers do not often live up to their potential  (9,12). This is despite the fact that work itself accounts for a large part of the musculoskeletal health of blue-collar workers in physically demanding jobs. For example, the population attributable fraction (PAF) of physical work demands show that they account for 7–10% of low-back pain and 15–25% of lateral epicondylitis among the Dutch workforce (13). Among Dutch blue-collar floor layers, the PAF ranges from 35% for knee osteoarthritis to 55% for lumbosacral radicular syndrome (14). Therefore, we ask CoWorkers to ensure that blue-collar workers are well served in CoWork musculoskeletal health interventions, since there is a large potential for such interventions to reduce health inequalities. 

In addition, research on health promotion – though not always focused on the workplace – shows that interventions are most effective when they move beyond individual-level programs to address the system drivers of unhealthy behaviors (15–17). This literature demonstrates that a systems approach helps explain why unhealthy patterns persist by highlighting issues such as coordination, learning processes, and structural barriers that interventions must address to achieve meaningful impact. Evidence shows that multilevel strategies that reshape organizational culture and job design – and do so with environmental support – could produce more durable lifestyle improvements (15–17). As such, a multifaceted approach that simultaneously stimulates the good (health enhancing work factors) and prevents the bad (strenuous physical work demands) is likely to be most effective. Sundstrup and colleagues (18) presented inspiring examples regarding combining ergonomics, physical exercise programs, and multifaceted strategies at the workplace.

In summary, the CoWork musculoskeletal health model has the potential to facilitate research and practice across disciplines and make a difference for workers’ musculoskeletal health. To do so, a clear definition of musculoskeletal health – along with reliable and validated measurement instruments and an engaged community of professionals – is essential for the successful implementation, testing, and advancement of the model. Thereby, the model might contribute to a better understanding of how to effectively promote, initiate, develop, implement, and evaluate interventions to enhance musculoskeletal health, including, of course, prevention of MSD. By doing so, we are confident that the final three questions of Wells’s editorial will be sufficiently addressed in forthcoming decades. 

<strong>References
</strong>1. 	Kuijer PPFM, van der Wilk S, Evanoff B, Viikari-Juntura E, Coenen P. What have we learned about risk assessment and interventions to prevent work-related musculoskeletal disorders and support work participation? Scand J Work Environ Health. 2024 Jul 1;50(5):317-328. https://doi.org/10.5271/sjweh.4172
2. 	Wells R. Why have we not solved the MSD problem? Work. 2009;34(1):117-21. https://doi.org/10.3233/WOR-2009-0937
3. 	Holtermann A, Sørensen OH, Jacobsen SS, Lindberg L, Andersen LL. Beyond risk reduction of work-related musculoskeletal disorders: The CoWork musculoskeletal health model. Scand J Work Environ Health. 2025 Dec 2:4262. https://doi.org/10.5271/sjweh.4262
4. 	Andersen LL, Sørensen OH, Calatayud J, López-Bueno R. Societal impact of micro-exercise for work-related musculoskeletal disorders: The case of Denmark. Societal Impacts. 2025;5:100102. https://doi.org/10.1016/j.socimp.2025.100102
5. 	Schmidt KG, Lerche AF, Christensen MR, Rasmussen CL, Straker L, Mathiassen SE et al. Effectiveness of a Goldilocks Work intervention in childcare workers - A cluster-randomized controlled trial. Scand J Work Environ Health 2024 Apr;50(3):197-207. https://doi.org/10.5271/sjweh.4145
6. 	Loisel P, Hong QN, Imbeau D, Lippel K, Guzman J, Maceachen E, Corbière M, Santos BR, Anema JR. The Work Disability Prevention CIHR Strategic Training Program: program performance after 5 years of implementation. J Occup Rehabil. 2009 Mar;19(1):1-7. https://doi.org/10.1007/s10926-008-9160-1
7. 	Proper KI, van Oostrom SH. The effectiveness of workplace health promotion interventions on physical and mental health outcomes - a systematic review of reviews. Scand J Work Environ Health. 2019 Nov 1;45(6):546-559. https://doi.org/10.5271/sjweh.3833
8. 	Javanmardi S, Rappelt L, Zangenberg S, Heinke L, Baumgart C, Niederer D, Freiwald J. Effectiveness of workplace health promotion programs for industrial workers: a systematic review. BMC Public Health. 2025 Jan 15;25(1):168. https://doi.org/10.1186/s12889-025-21365-8
9. 	Robroek SJ, Coenen P, Oude Hengel KM. Decades of workplace health promotion research: marginal gains or a bright future ahead. Scand J Work Environ Health. 2021 Nov 1;47(8):561-564. https://doi.org/10.5271/sjweh.3995
10. 	Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018 Jun 9;391(10137):2368-2383. https://doi.org/10.1016/S0140-6736(18)30489-6
11. 	Beenackers MA, Kamphuis CB, Giskes K, Brug J, Kunst AE, Burdorf A, van Lenthe FJ. Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act. 2012 Sep 19;9:116. https://doi.org/10.1186/1479-5868-9-116
12. 	van der Put AC, Mandemakers JJ, de Wit JBF, van der Lippe T. Worksite health promotion and social inequalities in health. SSM Popul Health. 2020 Jan 17;10:100543. https://doi.org/10.1016/j.ssmph.2020.100543
13. 	van der Molen HF, Hulshof CT, Kuijer PPF. How to improve the assessment of the impact of occupational diseases at a national level? The Netherlands as an example. Occup Environ Med. 2019 Jan;76(1):30-32. https://doi.org/10.1136/oemed-2018-105387
14. 	Kuijer PPFM, van der Molen HF, Visser S. A health-impact assessment of an ergonomic measure to reduce the risk of work-related lower back pain, lumbosacral radicular syndrome and knee osteoarthritis among floor layers in The Netherlands. Int J Environ Res Public Health. 2023 Mar 6;20(5):4672. https://doi.org/10.3390/ijerph20054672
15. 	Crielaard L, Nicolaou M, Brown AD, Dijkstra SC, Ter Ellen F, Elsenburg LK, Luna Pinzon A, Waterlander WE, Stronks K. Systems approaches in public health: beyond mapping the causes. Int J Behav Nutr Phys Act. 2025 Jun 12;22(1):74. https://doi.org/10.1186/s12966-025-01766-z
16. 	Ali N, Ellis B, Woolf A, Hamilton S, Fenton KA. Developing partnerships and a whole-system approach for the prevention of musculoskeletal conditions in England. Public Health Panorama 2018;4:407-414. https://iris.who.int/handle/10665/324935
17. 	Hagenaars LL, Schmidt LA, Groeniger JO, Bekker MPM, Ter Ellen F, de Leeuw E, van Lenthe FJ, Oude Hengel KM, Stronks K. Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences. Obes Rev. 2024 May;25(5):e13705. https://doi.org/10.1111/obr.13705
18. 	Sundstrup E, Workplace-based prevention of musculoskeletal disorders: effective interventions and future potentials. PREMUS 2025: 12th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders, PREMUS 2025: 12th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders | Publisso.
      <strong>by</strong> <i>Kuijer PPFM, Coenen P</i>. doi:10.5271/sjweh.4295]]></description>
         </item>   <item>
      <title>Adaptation across consecutive night shifts at 71°N under Arctic summer daylight and winter darkness: Effects on alertness, sleepiness, and fatigue</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4295</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4295</guid>
      <pubDate>Fri, 10 Apr 2026 00:23:00 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   This study aimed to investigate how alertness, sleepiness, and fatigue change across consecutive night compared to morning shifts among Arctic shift workers and whether these effects differ between seasons of midnight sun and polar night.

Methods   We conducted an observational crossover study of 118 shift workers from an industrial plant at a high latitude (71°N) in northern Norway. Eighty-one individuals participated in both the light (near 24-hour daylight) and dark (minimal natural light) seasons. Work schedules included blocks of seven consecutive morning shifts and seven consecutive night shifts, separated by four rest days. Alertness (psychomotor vigilance test), subjective sleepiness (Karolinska Sleepiness Scale), and subjective fatigue were measured at the end of shifts on days 1, 3, and 6 of each shift block. We analyzed data using multilevel mixed-effects regression models with season, shift type (morning/night), and consecutive workday number as fixed effects.

Results   Night shifts were linked to lower alertness and higher sleepiness and fatigue in both seasons, with the largest impairments on the first night. Across six consecutive night shifts, alertness improved and sleepiness and fatigue decreased, with similar trajectories in both seasons. There was no evidence that season significantly affected alertness, sleepiness, or fatigue.

Conclusions   Night shifts generally impair alertness and increase sleepiness and fatigue, yet outcomes improved across consecutive nights. Despite the well-established effects of natural light on circadian rhythms, the seasonal photoperiod altered neither the shift-related impairments in alertness, sleepiness or fatigue nor the subsequent improvements across consecutive nights; workers showed similar adaptation in both seasons.
      <strong>by</strong> <i>Holme AN, Moen LV, Sallinen M, Nilsen KB, Boccara CN, Phillips AJK, Haugen F, Matre D</i>. doi:10.5271/sjweh.4290]]></description>
         </item>   <item>
      <title>Night shift work and risk of total and site-specific cancer: results from a prospective cohort study among Chinese men</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4290</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4290</guid>
      <pubDate>Thu, 09 Apr 2026 23:35:32 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   Epidemiological evidence on the association between night shift work and cancer risk remains limited and inconsistent. This study aimed to systematically investigate this association among Chinese men.

Methods   This population-based prospective cohort study included 61 078 men from the Shanghai Men’s Health Study. Detailed information on night shift work was collected at baseline using a structured questionnaire. Cox regression model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for total cancer and ten major site-specific cancers. Restricted cubic spline functions were used to characterize the dose–response associations for key metrics. Further analysis was conducted with lag periods of 5, 10, 15 and 20 years, and potential effect modification by lifestyle factors was tested.

Results   During a median follow-up period of 16.1 years, 8202 incident cancer cases were identified. Participants with 11–20 years of cumulative night shift work had a higher risk of pancreatic cancer compared with never-shift workers (HR 1.59, 95% CI 1.09–2.31). This association persisted across all lag periods tested, peaking at a 15-year lag (HR 1.82, 95% CI 1.25–2.64). No significant associations were found between night shift work metrics, including night shift work experience, starting age, cumulative duration, and frequency, and the risk of total and other major site-specific cancers. No evidence of effect modification by lifestyle factors was observed.

Conclusions   Night shift work was not associated with the risk of overall or some common cancers among Chinese men. However, an increased risk of pancreatic cancer was associated with intermediate-to-long-term night shift work.
      <strong>by</strong> <i>Shen Q-M, Li Z-Y, Tan Y-T, Gao L-F, Liu D-K, Li H-L, Yang W-S, Xiang Y-B</i>. doi:10.5271/sjweh.4300]]></description>
         </item>   <item>
      <title>Health and working careers of informal carers – what we know and do not yet (but should) know</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4300</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4300</guid>
      <pubDate>Wed, 08 Apr 2026 11:52:17 +0200</pubDate>
      <category>Editorial</category>
      <description><![CDATA[According to OECD estimates, 13% of adults over 50 years provide – usually unpaid – help with personal care to people with functional limitations, that is, informal care. Of these informal carers, 61% are women caring for a family member (1). As the number of older adults needing care in the EU is projected to rise to 27 million by 2050, the need for informal carers is likely to increase substantially (2). In contrast, the pool of potential caregivers is shrinking due to a smaller number of younger adults, thereby increasing the care burden per working-age person.

Ideally, caring for loved ones is a “win-win-win situation”, where caring brings meaning to the life of the carer, is beneficial for the care recipient, and is highly cost-beneficial to society as it includes far less public spending than formally provided, professional care. However, in many cases, caregiving can be burdensome and lead to long-term stress and health problems. Previous research has linked informal caregiving particularly to mental health risks and work disability due to mental disorders (3–7). Evidence on physical health risks is less clear, with studies indicating higher risks (8, 9), lower risks (10, 11), and no association (7, 12, 13). However, these studies have often been cross-sectional or based only on register data. Therefore, we need stronger evidence with longitudinal designs and more varied outcomes. Moreover, combining the roles of employee and informal carer may lead to additional stress through an imbalance of work and private life, but very little empirical evidence exists thus far. Informal care may also affect work participation, work careers, income, and promotion probabilities, particularly among women (14, 15). More research on informal care, health, and working careers is crucial due to the growing demand for both informal and formal long-term care resulting from population aging. 

In addition to more evidence on the health effects of informal care, a major gap in research evidence relates to the role of working conditions in mediating or moderating the association between combining work with informal care and health. There is some evidence that workplace psychosocial factors, such as high worktime control, having a high level of flexibility, good work–private life balance, and social support, may facilitate informal carers’ health and well-being (13, 16–18), whereas job strain in connection with the informal carer role may increase sickness absence (19). To increase knowledge about modifiable factors that have a potential role in shaping the associations between informal caregiving and health, we need more studies on the role of work characteristics, including leadership and other modifiable practices at workplaces, which have thus far received very little attention in longitudinal studies.

A particular risk group with very limited research is individuals with multiple care responsibilities, also known as the `sandwich generation` carers, who simultaneously provide care for both their aging parents (or in-laws) and their own children. There are also indications that combining highly straining work and informal caregiving is associated with poorer health, particularly among women (19). The reason may be that women more often than men perform high-intensity caregiving, but previous studies have seldom considered caregiving intensity. Aging carers also need more attention as they are the largest age group providing informal care. Thus the role of work characteristics and the health effects of post-retirement informal caregiving need more investigation. Additionally, there is little research on carers who provide both formal care, ie, as healthcare professionals, and informal care. Therefore, more comprehensive studies are needed to understand the long-term health and work disability impacts of caregiving across different population groups, life stages, and work environments.

Yet another research gap lies in the lack of international comparisons. Countries differ based on how care is organized; who is supposed to provide informal care; who is supposed to work; and until what age people (men and women) are supposed to work. The structural frameworks defining how care is provided, organized, and divided between the state, market, and family within a country are called care regimes (20). It may be that the health and subsequent work disability effects of informal care differ between different care regimes. In the European Nordic countries, the care regime has traditionally been characterized by a high level of state intervention, public spending, and reliance on professional care. In Central Europe, care is traditionally provided by a mix of public and private providers, voluntary or religious non-profit organizations, and moderate levels of family responsibility. In the Mediterranean/Southern Europe and in the majority of Eastern Europe, traditional care regimes rely heavily on families, particularly women, who are expected to provide informal care (20). The labor markets are organized according to these traditional care regimes as the regime is reflected, for example, in gender- or non-neutral retirement age and expectations of both sexes to equally or unequally participate in the labor market. However, due to political changes, economic downturns, and cuts to public spending, there is increasing pressure for informal care even in countries where the traditional care regime has emphasized high reliance on professional care and all people of working age are expected to participate in the labor force (21, 22). This may create a double or triple burden of caring for one’s own family, disabled or aging relatives, and simultaneously holding full-time paid employment.

We need more research to inform policymakers across Europe as increasing informal care may conflict with the goal of prolonged working lives and healthy aging through a higher age of old age pension. If informal carers are burdened to the extent that they themselves need formal healthcare, the goal of decreasing the costs of formal care cannot be met. Flexibility in terms of worktime control has been linked, in addition to the health of informal caregivers, also to extending work careers beyond retirement age (23). Governments, decision-makers, workplaces, and occupational health care need information on these modifiable factors to develop policies to support sustainable working lives for people with different care responsibilities in private life.

<strong>References</strong>
1. 	Health at a Glance 2025: OECD Indicators. Paris: OECD; 2025.
2. 	Cattaneo A, Vitali A, Regazzoni D, Rizzi C. The burden of informal family caregiving in Europe, 2000-2050: a microsimulation modelling study. Lancet Reg Health - Eur. 2025;53:101295. https://doi.org/10.1016/j.lanepe.2025.101295
3. 	Mikkola TM, Kautiainen H, Mänty M, von Bonsdorff MB, Koponen H, Kröger T, Eriksson JG. Use of antidepressants among Finnish family caregivers: a nationwide register-based study. Soc Psychiatry Psychiatr Epidemiol. 2021;56(12):2209-16. https://doi.org/10.1007/s00127-021-02049-1
4. 	Koyanagi A, DeVylder JE, Stubbs B, Carvalho AF, Veronese N, Haro JM, Santini ZI. Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys. J Psych Res. 2018;96:115-23. https://doi.org/10.1016/j.jpsychires.2017.10.001
5. 	Kaschowitz J, Brandt M. Health effects of informal caregiving across Europe: A longitudinal approach. Soc Sci Med. 2017;173:72-80. https://doi.org/10.1016/j.socscimed.2016.11.036
6. 	Mikkola TM, Mänty M, Kautiainen H, von Bonsdorff MB, Haanpää M, Koponen H, et al. Work incapacity among family caregivers: a record linkage study. J Epidemiol Community Health. 2022;76(6):580-5. https://doi.org/10.1136/jech-2021-217901
7. 	Lacey RE, Xue B, Di Gessa G, Lu W, McMunn A. Mental and physical health changes around transitions into unpaid caregiving in the UK: a longitudinal, propensity score analysis. Lancet Pub Health. 2024;9(1):e16-e25. https://doi.org/10.1016/S2468-2667(23)00206-2
8. 	Lee S, Colditz GA, Berkman LF, Kawachi I. Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med. 2003;24(2):113-9. https://doi.org/10.1016/S0749-3797(02)00582-2
9. 	Park SS. Caregivers’ Mental Health and Somatic Symptoms During COVID-19. J Gerontol B Psychol Sci Soc Sci. 2021;76(4):e235-e40. https://doi.org/10.1093/geronb/gbaa121
10.	Tseliou F, Rosato M, Maguire A, Wright D, O’Reilly D. Variation of Caregiver Health and Mortality Risks by Age: A Census-Based Record Linkage Study. Am J Epidemiol. 2018;187(7):1401-10. https://doi.org/10.1093/aje/kwx384
11. 	Mikkola TM, Kautiainen H, Mänty M, von Bonsdorff MB, Kröger T, Eriksson JG. Age-dependency in mortality of family caregivers: a nationwide register-based study. Aging Clin Exp Res. 2021;33(7):1971-80. https://doi.org/10.1007/s40520-020-01728-4
12. 	Buyck JF, Ankri J, Dugravot A, Bonnaud S, Nabi H, Kivimäki M, Singh-Manoux A. Informal caregiving and the risk for coronary heart disease: the Whitehall II study. J Gerontol A Biol Sci Med Sci. 2013;68(10):1316-23. https://doi.org/10.1093/gerona/glt025
13. 	Mortensen J, Clark AJ, Lange T, Andersen GS, Goldberg M, Ramlau-Hansen CH, et al. Informal caregiving as a risk factor for type 2 diabetes in individuals with favourable and unfavourable psychosocial work environments: A longitudinal multi-cohort study. Diabetes Metab. 2018;44(1):38-44. https://doi.org/10.1016/j.diabet.2017.04.001
14. 	Josten EJC, Verbakel E, De Boer AH. A longitudinal study on the consequences of the take-up of informal care on work hours, labour market exit and workplace absenteeism due to illness. Ageing Soc. 2024;44(3):495-518. https://doi.org/10.1017/S0144686X22000204
15. 	Ciccarelli N, Van Soest A. Informal Caregiving, Employment Status and Work Hours of the 50+ Population in Europe. Economist (Leiden). 2018;166(3):363-96. https://doi.org/10.1007/s10645-018-9323-1
16. 	Vos EE, van der Beek AJ, de Bruin SR, Proper KI. Effects of a workplace participatory approach to support working caregivers in balancing work, private life and informal care: a randomized controlled trial. Scand J Work Environ Health. 2025(3):181-90. https://doi.org/10.5271/sjweh.4208
17. 	Virtanen M, Myllyntausta S, Ervasti J, Oksanen T, Salo P, Pentti J, et al. Shift work, work time control, and informal caregiving as risk factors for sleep disturbances in an ageing municipal workforce. Scand J Work Environ Health. 2021(3):181-90. https://doi.org/10.5271/sjweh.3937
18. 	Bijnsdorp FM, van der Beek AJ, Broese van Groenou MI, Proper KI, van den Heuvel SG, Boot CR. Associations of combining paid work and family care with gender-specific differences in depressive symptoms among older workers and the role of work characteristics. Scand J Work Environ Health. 2022;48(3):190-9. https://doi.org/10.5271/sjweh.4014
19. 	Mortensen J, Dich N, Lange T, Alexanderson K, Goldberg M, Head J, et al. Job strain and informal caregiving as predictors of long-term sickness absence: A longitudinal multi-cohort study. Scand J Work Environ Health. 2017;43(1):5-14. https://doi.org/10.5271/sjweh.3587
20. 	European Commission: Directorate-General for Employment, Social Affairs and Inclusion and London School of Economics and Political Science (LSE), Informal care in Europe – Exploring formalisation, availability and quality, Publications Office, 2018. https://data.europa.eu/doi/10.2767/78836
21. 	Is the Last Mile the Longest? Economic Gains from Gender Equality in Nordic Countries, Gender Equality at Work. Paris: OECD; 2018.
22. 	Rostgaard T, Jacobsen F, Kröger T, Peterson E. Revisiting the Nordic long-term care model for older people-still equal? Eur J Ageing. 2022;19(2):201-10. https://doi.org/10.1007/s10433-022-00703-4
23. 	Virtanen M, Oksanen T, Pentti J, Ervasti J, Head J, Stenholm S, et al. Occupational class and working beyond the retirement age: a cohort study. Scand J Work Environ Health. 2017;43(5):426-35. https://doi.org/10.5271/sjweh.3645
      <strong>by</strong> <i>Ervasti J, Mikkola TM</i>. doi:10.5271/sjweh.4288]]></description>
         </item>   <item>
      <title>Standardizing upper arm movement definitions across observational and sensor-based methods: A Delphi consensus study among European ergonomics experts</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4288</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4288</guid>
      <pubDate>Mon, 06 Apr 2026 17:58:13 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Musculoskeletal disorders from repetitive upper arm movements contribute substantially to sickness absence and productivity loss. Despite widespread use of observational and sensor-based assessments, inconsistent definitions hinder comparison across studies and translation to practice. This study explored threshold criteria for defining upper arm movements and static postures across observational and sensor-based approaches and examined conceptual differences between practical observability and biomechanical measurability.

Methods   We conducted a two-round Delphi study following the ACCORD guidelines. We invited 35 European experts to rate agreement on proposed definitions. A consensus criterion was set to ≥75% agreement. A thematic analysis of free-text responses guided definition revisions between rounds.

Results   Fifteen (43%) and fourteen (93% retention) completed rounds 1 and 2, respectively. Consensus defined a fast-paced movement as ≤1 second (80% agreement) and static posture as ≥4 seconds with ±5° movements (87% agreement). No agreement emerged regarding the minimum amplitude threshold for defining an arm movement (eg, 10° versus 20°; 53% agreement). Experts’ comments reflected a tension between observability, favoring higher amplitude thresholds, and biomechanical relevance, favoring lower thresholds, while highlighting velocity’s importance.

Conclusions   Expert consensus on time-based thresholds for fast-paced movements and static postures provides a starting point for standardized ergonomic assessment. The absence of consensus on amplitude thresholds highlights the need for field validation studies examining which thresholds capture measurement reliability and prediction of musculoskeletal health outcomes. These findings support efforts toward transparency and alignment in upper arm exposure definitions across research and practice, while acknowledging remaining conceptual and methodological challenges.
      <strong>by</strong> <i>Frost AD, Forsman M, Brusaca LA, Holtermann A, Andersen LL, Søgaard K, Gupta N</i>. doi:10.5271/sjweh.4292]]></description>
         </item>   <item>
      <title>From secondary special needs education to the labor market: latent trajectories and inequalities in employment participation</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4292</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4292</guid>
      <pubDate>Mon, 06 Apr 2026 16:25:03 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Individuals with disabilities continue to face barriers to labor market inclusion. The transition from secondary special needs education plays a critical role in shaping long-term employment outcomes. Early labor market disparities are particularly concerning given their lasting impact on health and well-being. This study aims to: (i) assess employment participation after leaving special needs education, (ii) identify distinct employment trajectories, and (iii) examine how gender and migration background are associated with these trajectories.

Methods   This longitudinal study used national registry data from Statistics Netherlands to examine employment outcomes among individuals transitioning from secondary education between 2016 and 2023, with focus on those in special needs education. Employment status was available monthly for up to seven years post-transition. Group-based trajectory modeling was applied separately for each educational track within secondary special needs education to identify patterns of labor market participation over time. Gender and migration background were subsequently examined as predictors of trajectory group membership using multinomial logistic regression models.

Results   Employment participation after seven years was substantially lower among former special needs education students (10–53% across tracks) than among those from regular ‘practice-based’ education (70%). After special needs education, employment participation was initially highest among individuals transitioning from the ‘labor market integration’ track, but plateaued around 45%. In contrast, graduates from the ‘post-secondary education’ track, primarily aimed at continued studies, showed steady improvement, leading to better long-term employment outcomes (53%). Within each educational track, 3–5 distinct latent employment trajectories were identified. Post-hoc analyses indicated that women and individuals with a migration background were consistently more likely to follow less favorable patterns.

Conclusion   Educational pathways alone do fully not account for labor market disparities. Outcomes are shaped by the intersection of education and identity characteristics. These findings highlight the need for individualized vocational support and deliberate, equity-focused guidance during educational transitions.
      <strong>by</strong> <i>Ciliacus R, Porru F, Burdorf A, Schuring M</i>. doi:10.5271/sjweh.4285]]></description>
         </item>   <item>
      <title>Evaluating a new voluntary occupational health and safety management system program in the context of a pandemic</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4285</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4285</guid>
      <pubDate>Thu, 02 Apr 2026 15:22:20 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Shortly before the COVID-19 pandemic, the Workplace Safety and Insurance Board of Ontario, Canada, launched the Health and Safety Excellence program (HSEp), a new voluntary occupational health and safety management system (OHSMS) program. This study conducted a prospective evaluation for the impact of HSEp participation on injury rate reduction during an ongoing pandemic.

Methods   A difference-in-differences study design with a hybrid matching approach was used to evaluate HSEp’s effectiveness in reducing lost-time injury rates with and without COVID-19 claims among participating firms compared with similar non-participating firms. The analysis was stratified by enrollment cohort, industry, firm size, and prior OHSMS experience.

Results   A total of 1680 matched HSEp firms were followed for 48 months. Some evidence of an effect on lost-time injury rates was observed, particularly after excluding COVID-19 claims. Non-COVID-19 lost-time rate reductions were pronounced among firms that enrolled later [incidence rate ratio (IRR) 0.89, 95% confidence interval (CI) 0.82–0.98], manufacturing firms (IRR 0.81, CI 0.68–0.96), larger firms (IRR 0.92, CI 0.85–0.99), and firms that had progressed through the program (IRR 0.91, CI 0.83–0.98). However, the reductions were not apparent among healthcare and construction companies or smaller firms.

Conclusions   Although the evidence of overall injury rate reductions is limited, emerging evidence suggests that participating in HSEp is associated with reductions in non-COVID-19 injuries in certain contexts. These findings suggest that the OHSMS program performance was affected by the pandemic, and accounting for this was crucial in assessing an intervention effect.
      <strong>by</strong> <i>Sivaraj LB, Macpherson RA, McLeod CB</i>. doi:10.5271/sjweh.4293]]></description>
         </item>   <item>
      <title>Re: Park et al. “Association between job insecurity and cardiovascular disease among workers with type 2 diabetes mellitus”</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4293</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4293</guid>
      <pubDate>Thu, 02 Apr 2026 13:09:35 +0200</pubDate>
      <category>Letter to the Editor</category>
      <description><![CDATA[We read with great interest the recent article by Park H et al (1), entitled “Association between job insecurity and cardiovascular disease among workers with type 2 diabetes mellitus”. The study provides important evidence on the impact of labor-related social determinants on cardiovascular health in a particularly vulnerable population: workers living with type 2 diabetes mellitus.

Previous research has consistently shown that psychosocial work-related factors, including job strain and employment insecurity, are associated with an increased risk of cardiovascular disease (2, 3). In this context, the study by Park and colleagues represents a valuable contribution to the field of occupational epidemiology. The use of a large national cohort derived from the Korean National Health Insurance Service, including more than 120 000 participants and a long follow-up period, strengthens the validity of the findings. Furthermore, the possibility of exploring differences according to sex and socioeconomic status aligns with the broader framework of social determinants of health (4).

Nevertheless, several aspects merit further consideration and could contribute to a more nuanced interpretation of the results.
First, the operational definition of job insecurity based on cumulative unemployment duration provides an objective and measurable indicator. However, this approach may not fully capture the broader spectrum of contemporary labor precariousness. Modern labor markets increasingly involve temporary contracts, underemployment, informal employment arrangements, and unstable contractual conditions. These forms of precarious employment may exert substantial effects on workers’ health but may not be adequately reflected by unemployment duration alone. Therefore, future studies may benefit from incorporating multidimensional measures of employment quality and labor instability.

Second, although the authors appropriately acknowledged the possibility of residual confounding in their discussion—particularly regarding unmeasured factors such as dietary habits, genetic predisposition, and limitations in capturing smoking behavior—additional sources of residual confounding may still be relevant. Factors such as depression, access to healthcare services, adherence to antidiabetic treatment, and dietary quality could simultaneously influence both employment stability and cardiovascular outcomes. This issue is especially important among individuals with diabetes mellitus, given their increased cardiometabolic vulnerability (5).

Third, the authors also recognized that the generalizability of their findings may be limited due to differences in occupational and cultural contexts across countries. In this regard, it is important to highlight that South Korea has a nearly universal health insurance system and a specific labor market structure. Consequently, extrapolating these findings to middle-income countries or settings characterized by high levels of labor informality should be done with caution. In such contexts, employment insecurity may manifest in more complex and heterogeneous ways that are not fully captured by administrative data (6).

Despite these considerations, the study has important implications for occupational health policies and clinical practice. The findings highlight the need for multidisciplinary strategies integrating labor policies, workplace health promotion, and interventions aimed at improving metabolic control among workers with chronic diseases. Addressing the interaction between adverse working conditions and noncommunicable diseases represents an emerging challenge for health systems and social protection policies worldwide (7).
Overall, this study significantly contributes to the growing body of literature examining the intersection between employment conditions and chronic disease outcomes. Future research conducted in more heterogeneous labor markets, particularly in settings with higher levels of informal employment, may help expand and strengthen the available evidence on the relationship between job insecurity and cardiovascular health.
We thank the authors for their valuable contribution and hope that these comments may stimulate further research in this important area of occupational and social epidemiology.

Conflict of interest statement<strong>
</strong>The author declares no conflicts of interest.

<strong>References</strong>
1.	Park H, Lee J, Park Y, Sim J, Yoon JH, Yun B. Association between job insecurity and cardiovascular diseases in workers with type 2 diabetes mellitus. Scand J Work Environ Health 2026 Feb. https://doi.org/10.5271/sjweh.4272. [Epub ahead of print].
2.	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.
3.	Virtanen M, Nyberg ST, Batty GD, Jokela M, Heikkilä K, Fransson EI et al.; IPD-Work Consortium. Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis. BMJ 2013 Aug;347:f4746. https://doi.org/10.1136/bmj.f4746.
4.	Marmot M, Friel S, Bell R, Houweling TA, Taylor S; Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008 Nov;372(9650):1661–9. https://doi.org/10.1016/S0140-6736(08)61690-6.
5.	Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N et al.; Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011 Mar;364(9):829–41. https://doi.org/10.1056/NEJMoa1008862.
6.	Benach J, Vives A, Amable M, Vanroelen C, Tarafa G, Muntaner C. Precarious employment: understanding an emerging social determinant of health. Annu Rev Public Health 2014;35:229–53. https://doi.org/10.1146/annurev-publhealth-032013-182500.
7.	Quinlan M, Mayhew C, Bohle P. The global expansion of precarious employment, work disorganization, and consequences for occupational health: a review of recent research. Int J Health Serv 2001;31(2):335–414. https://doi.org/10.2190/607H-TTV0-QCN6-YLT4.
      <strong>by</strong> <i>Suarez JSP</i>. doi:10.5271/sjweh.4282]]></description>
         </item>   <item>
      <title>Adverse occupational outcome among workers with occupational asthma: A systematic review and meta-analysis of influencing factors</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4282</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4282</guid>
      <pubDate>Thu, 02 Apr 2026 12:27:16 +0200</pubDate>
      <category>Review</category>
      <description><![CDATA[Objectives   Occupational asthma (OA) often interferes with workers’ ability to maintain employment. We synthesized the prevalence of adverse occupational outcome (AOO)—unemployment, chronic sick leave, disability, and early retirement—caused by OA.

Methods   Following PRISMA methodological recommendations and PROSPERO registration (CRD42024528750), we searched PubMed, Scopus, and Web of Science for studies published between January 1980 and September 2024 that reported quantitative employment outcomes in adults with OA. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. Pooled prevalences were calculated using random-effects generalized linear mixed models on the logit scale with Hartung–Knapp 95% confidence and prediction intervals (CI and PI).

Results   A total of 25 studies comprising 3393 participants were included. The pooled prevalence of AOO was 35.9% (95% CI 28.6–43.9; I<sup>2</sup>=86.0%; 95% PI 10.2–73.4). Prevalence of AOO varied by: (i) data sources (registry/compensation: 50.1% versus clinic: 32.0%; P=0.015); (ii) study size (>80 participants: 43.4% versus ≤80: 27.9%; P=0.033); (iii) baseline forced expiratory volume in 1 second (FEV<sub>1</sub>) (≤85% predicted: 38.2% versus >85% predicted: 13.8%; P=0.008); and (iv) exposure duration before symptom onset (>7.1 years: 35.7% versus ≤7.1 years: 15.7%; P=0.015). Heterogeneity across studies was substantial and several subgroups included fewer than five studies.

Conclusions   More than one-third of workers with OA experience an AOO. The findings highlight the need for harmonized outcome definitions and for interventions integrating early referral, exposure control, and structured return-to-work programs to avoid AOO.
      <strong>by</strong> <i>Damerau LS, Helm MW, Pieter J, Velasco Garrido M, Harth V, Hoven H, Preisser AM</i>. doi:10.5271/sjweh.4287]]></description>
         </item>   <item>
      <title>The mediating effect of immune-inflammatory indices in shift work and hypertension: a cohort study in China</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4287</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4287</guid>
      <pubDate>Tue, 31 Mar 2026 13:44:50 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Global hypertension prevalence is increasing. Studies of the association of shift work with hypertension have produced inconsistent results, and the role of immune-inflammatory indices in this link remains unclear. This study aimed to clarify the association of shift work with hypertension and to identify the mediating effects of immune-inflammatory indices on hypertension.

Method   This cohort study assessed 1322 oil workers, with baseline data collected from 2013−2015 and final follow-up in 2023. The definition of shift work was in accordance with the International Labor Organization’s Convention on Night Work (No. 171). Hypertension was diagnosed according to the Chinese Hypertension Prevention and Treatment Guidelines (2018 revised edition). Smooth curve fitting, piecewise regression modeling, and the Karlson-Holm-Breen method were used to analyze the associations among immune-inflammatory indices and hypertension.

Results   Shift work was associated with hypertension [two-shift: risk ratio (RR) 1.75, 95% confidence interval (CI) 1.27–2.05; three-shift: RR 1.75, 95% CI 1.10–2.34; four-shift: RR 1.57, 95% CI 1.10–2.14] and elevated immune-inflammatory index [logarithmic (ln) Systemic Immune-Inflammation Index (SII) 0.18, 95% CI 0.10–0.26, Pan Immune-Inflammation Value (PIV) 0.15, 95% CI 0.06–0.23, neutrophil-lymphocyte ratio (NLR) 0.17, 95% CI 0.10–0.24, Systemic Inflammation-Response Index (SIRI) 0.14, 95% CI 0.06–0.22, and platelet-lymphocyte ratio (PLR) 0.05, 95% CI 0.01–0.09]. Cumulative night shifts were associated with hypertension (1–220 nights: RR 2.57, 95% CI 1.26–5.26; 220–660 nights: RR 1.78, 95% CI 1.08–2.95; ≥660 nights: RR 2.02, 95% CI 1.22–2.13). Cumulative night shift exposure levels exerted varying effects impacted immune-inflammatory indices. The SII, PIV, NLR, SIRI, and monocyte-lymphocyte ratio (MLR) were independently associated with hypertension risk (RR 1.82, 95% CI 1.47–2.22; RR 1.85, 95% CI 1.53–2.19; RR 2.04, 95% CI 1.60–2.54; RR 2.03, 95% CI 1.64–2.48; RR 1.85, 95% CI 1.27–2.59). The mediating effects of ln(SII), ln(PIV), ln(NLR), ln(SIRI), and composite inflammatory index were 17.52%, 17.51%, 17.78%, 18.64%, and 21.94%, respectively.

Conclusion   Shift work and elevated immune-inflammatory indices were associated with hypertension. Immune-inflammatory indices mediate the association between shift work and hypertension. Therefore, hypertension monitoring should be strengthened among shift workers and immune-inflammatory markers should be considered for early hypertension detection. Future targeted intervention trials are warranted.
      <strong>by</strong> <i>Lu H, Jin Y, Huang C, Lin L, Zhang X, Wang W, Lian Y</i>. doi:10.5271/sjweh.4284]]></description>
         </item>   <item>
      <title>Farming exposures and Alzheimer's disease: cross-sectional analysis within the French AGRICAN cohort</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4284</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4284</guid>
      <pubDate>Tue, 17 Mar 2026 20:21:39 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   There is epidemiological evidence of an association between occupational pesticide exposure and cognitive impairment, but studies on the link with Alzheimer`s disease are scarce. We explored the association between agricultural exposures and Alzheimer`s disease in the AGRICAN cohort.

Methods   We analyzed the relationship between doctor-diagnosed Alzheimer`s disease and life-long exposures separately among men and women with the following exposures: work on a farm, pesticide use in any job, growing specific crops (N=13) or rearing animals (N=5), pesticide use on these crops/livestock, with adjustment for age, education, smoking, alcohol consumption and body mass index.

Results   Among 109 287 participants in the analysis, 818 (267 men, 551 women) were classified as Alzheimer`s disease cases. Increased risks were seen for work on a farm [men: odds ratio (OR) 1.81, 95% confidence interval (CI) 0.92–3.57; women: OR 1.58, 95% CI 0.94–2.86] or pesticide use in any job (men: OR 1.14, 95% CI 0.85–1.53; women: OR 1.42, 95% CI 1.10–1.85). Risks for crops and livestock were close to unity when compared with non–farmers, except for pigs (OR 1.38, 95% CI 1.01–1.89) and rapeseed among men (OR 1.45, 95% CI 1.00–2.11) and sunflower among women (OR 1.55, 95% CI 0.90–2.66). Using pesticides increased the risk among men especially for sheep/goats (OR 1.98, 95% CI 1.18–3.34), pigs (OR 1.80, 95% CI 1.19–2.74), potatoes (OR 1.47, 95% CI 1.03–2.10) and meadows (OR 1.54, 95% CI 1.14–2.08). Among women, risks associated with pesticide use on crops were generally elevated, reaching a two–fold increase for corn, rapeseed, sunflower, field peas and fruit growing.

Conclusion   Our results suggest that agricultural exposures may play a role in Alzheimer’s disease among both men and women, with the highest risks associated with pesticide use in certain livestock and crop activities.
      <strong>by</strong> <i>Madeline V, Galvin A, De Graaf L, Engelhardt J, Lebailly P, Baldi I</i>. doi:10.5271/sjweh.4286]]></description>
         </item>   <item>
      <title>Clinical and screening utility of the Burnout Assessment Tool: A comparative evaluation of BAT23, BAT12 and BAT4 in Sweden</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4286</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4286</guid>
      <pubDate>Mon, 16 Mar 2026 23:38:45 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Clinical burnout may have serious personal and societal impacts, such as reduced productivity, prolonged sick leave and long rehabilitation. Regular screening using clinically relevant cut-offs to identify individuals at risk is essential for effective prevention. This study aimed to: (i) establish Swedish clinical cut-off scores for the Burnout Assessment Tool (BAT) versions (ie., BAT23, BAT12, BAT4); (ii) assess the BAT4’s ability to classify burnout severity; and (iii) calculate burnout complaints in the Swedish workforce.

Methods   A national representative sample of the Swedish working population (N=1603) and a burned-out group (N=159) diagnosed with exhaustion disorder (ED) were surveyed using BAT23, BAT12, and BAT4. Receiver operating characteristic (ROC) analyses determined diagnostic accuracy and cut-offs for mild (orange) and severe (red) burnout complaints. A sensitivity analysis using clinician-confirmed ED patients (N=25) validated findings.

Results   BAT23 showed the highest accuracy in differentiating between mild and severe complaints. Among the subscales, exhaustion performed best. BAT12 showed good accuracy at the orange and slightly reduced sensitivity at the red cut-off. BAT4, while showing excellent sensitivity (0.93) at the orange cut-off, had poor sensitivity (0.47) at the red cut-off, limiting its clinical utility. Prevalence estimates using Swedish cut-offs showed approximately 13% of the workforce had severe burnout complaints (BAT23 and BAT12).

Conclusions   BAT23 is recommended for comprehensive assessments; BAT12 is useful for workplace screening where a shorter questionnaire is required and BAT4 for broad organizational screening using only the orange cut-off. Findings support the structured application of BAT across varying settings and a deeper understanding of the BAT4.
      <strong>by</strong> <i>Hadžibajramović E, Dahlqvist I, Jonsdottir IH, De Witte H</i>. doi:10.5271/sjweh.4279]]></description>
         </item>   <item>
      <title>Development of a European job exposure matrix (EuroJEM) for psychosocial exposures and their association with diagnosed depression in register-based cohorts</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4279</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4279</guid>
      <pubDate>Sun, 08 Mar 2026 18:30:26 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   This study developed a European job exposure matrix (EuroJEM) for psychosocial work factors in order to examine their prospective associations with diagnosed depression in three register-based Nordic cohorts.

Methods   National, gender-specific psychosocial JEM from Finland, Norway, and Sweden were evaluated for similarities in exposures, exposure definitions, and occupational coding. The EuroJEM harmonized two exposures: quantitative job demands and decision authority. Disagreements on exposure categories across the national JEM were addressed among experts. Associations between exposures and diagnosed depression were examined across three register-based cohorts.

Results   The EuroJEM provides gender-specific exposure categories, based on the proportion of workers exposed, for 371 ISCO-88 (COM – European version of the International Standard Classification of Occupations) occupational codes. All associations were similar across the three cohorts, except for medium-high / high likelihood of exposure to high job demands among women. The pooled hazard ratios (pHR) for depression among workers with a medium-high / high likelihood of exposure to low decision authority had pHR of 1.50 [95% confidence interval (CI) 1.33–1.68] among men and 1.28 (95% CI 1.22–1.35) among women. High strain jobs had pHR of 1.19 (95% CI 1.15–1.24) and 1.07 (95% CI 1.01–1.14) and active jobs 0.79 (95% CI 0.72–0.87) and 0.86 (95% CI 0.79–0.94) among men and women, respectively. The associations between job demands and depression were less clear, especially among women.

Conclusion   We found consistent associations between diagnosed depression and EuroJEM-based psychosocial exposures. Especially decision authority and job strain indicate a good performance of this JEM. The performance for job demands may be suboptimal.
      <strong>by</strong> <i>Salonen L, Falkstedt D, Pan K-Y, Albin M, Mehlum IS, Undem K, Leinonen T, Solovieva S</i>. doi:10.5271/sjweh.4280]]></description>
         </item>   <item>
      <title>Occupational exposure limits for psychosocial hazards: A promising concept or a premature leap?</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4280</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4280</guid>
      <pubDate>Mon, 02 Mar 2026 13:24:50 +0200</pubDate>
      <category>Commentary</category>
      <description><![CDATA[Objectives  We critically examined the proposal to establish occupational exposure limits (OEL) for psychosocial hazards, evaluating its scientific feasibility, methodological challenges, and implications for occupational health practice.

Methods   We reviewed the conceptual framework and recommendations by Pauli et al and compared them with established approaches for chemical and physical hazards. Key obstacles were analyzed, including the reliance on latent constructs, terminological ambiguity, and the absence of objective exposure metrics, while considering the advent of the exposome in epidemiology, emerging technologies and political economy factors.

Results   Our analysis shows that analogies with physical and chemical OEL offer useful insights but cannot be directly applied to psychosocial hazards. Unlike traditional hazards, psychosocial hazards are context-dependent, socially constructed, and often measured through self-reported surveys, limiting the derivation of adverse effect levels. Current psychosocial models of occupational stress aggregate diverse stressors under broad constructs, impeding actionable risk assessment. While organizational hazards such as shift work and long working hours can be objectively quantified using human resource data and sensors, social and moral dimensions remain elusive. Individual biomarkers might not offer adequate diagnostic value, while using multiple biomarkers in combination introduces challenges related to cost and feasibility. Furthermore, regulatory decisions are shaped by economic interests and stakeholder conflicts, complicating consensus and OEL adoption.

Conclusions   A paradigm shift is required: moving from generic theoretical models to specific, measurable indicators, integrating multi-source data, and harmonizing methodologies. Without this transformation, OEL risk over-simplifying complex psychosocial phenomena and failing to achieve meaningful preventive outcomes. For occupational safety and health practice, work organizations should prioritize the more specific identification and measurement of psychosocial hazards, using context-specific data and harmonized methods, to enable more effective risk management and prevention, pending the establishment of formal occupational exposure limits for psychosocial hazards.
      <strong>by</strong> <i>Guseva Canu I, van der Molen HF</i>. doi:10.5271/sjweh.4281]]></description>
         </item>   <item>
      <title>Trends in healthy working life expectancy and its difference by workload group among aged over 50 years: a longitudinal perspective</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4281</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4281</guid>
      <pubDate>Thu, 26 Feb 2026 23:09:55 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   While extending working life is a key policy objective, its impact on population health is not fully understood. This study investigated the long-term effects of physical and psychological workloads as well as initial health-work status on healthy working life expectancy (HWLE), working life expectancy (WLE), and total life expectancy (TLE) at age 50.

Methods   Data were drawn from the Health and Retirement Study covering 1992–2022. The study population consisted of US adults aged ≥50 years. We implemented a multi-state life table approach based on continuous-time Markov models. Transition intensities between health and employment states were modeled to derive HWLE. Analyses were stratified by physical and psychological workload levels across three temporal cohorts.

Results   Over the study period, WLE increased significantly for both sexes, while TLE slightly declined. Conversely, HWLE decreased substantially across all groups and health states. Individuals in high physical workload groups experienced shorter WLE and HWLE compared to low workload groups. High psychological load was associated with a lower proportion of healthy working years, particularly among those with initial health limitations.

Conclusions   The extension of working lives is occurring at the cost of healthy years. Physical and psychological workloads exert distinct but equally detrimental effects on the sustainability of a healthy working life. These findings underscore the urgent need for targeted workplace interventions to protect worker health, particularly for vulnerable groups in high-stress or physically demanding jobs.
      <strong>by</strong> <i>Ma J, Pingcuo Y, Jin X, Wang J, Wang H, Lan Y</i>. doi:10.5271/sjweh.4278]]></description>
         </item>   <item>
      <title>Precarious employment and its relation to mental well-being in the gig economy: comparing main and supplementary workers</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4278</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4278</guid>
      <pubDate>Mon, 23 Feb 2026 17:50:51 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   This study investigates the association between precarious employment (PE) and mental well-being and examines the mediating role of five intrinsic quality of work (IQW) dimensions: autonomy, physical demands, work intensity, skill discretion, and social support. We distinguish between main (>24 hours/week) and supplementary (≤24 hours/week) gig workers.

Methods   Survey data from 397 Belgian gig workers were used to construct a multidimensional, gig-specific measure of PE (the Employment Precariousness Scale for gig work: ‘EPRES-gw’). Structural equation modeling was applied to test mediation by IQW dimensions and examine differences between main and supplementary gig workers.

Results   PE was positively associated with poor mental well-being among main but not supplementary workers. Among main gig workers, the relationship was mediated by high work intensity, physical demands, and low social support. For supplementary workers, low autonomy mediated the association.

Conclusion   PE is particularly relevant for the mental well-being of main gig workers. The role of IQW is important, though the key dimensions differ by time spent in in gig work. These findings highlight the need for policy interventions and research addressing both employment rights and IQW-related psychosocial risks, with approaches tailored to the distinct challenges of main versus supplementary gig workers.
      <strong>by</strong> <i>Vandevenne E, Vanroelen C, Stas L, Gevaert J</i>. doi:10.5271/sjweh.4277]]></description>
         </item>   <item>
      <title>What do we know about limiting after-hours availability expectations and work-related connectivity? A systematic review of interventions and policies</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4277</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4277</guid>
      <pubDate>Fri, 06 Feb 2026 13:09:31 +0200</pubDate>
      <category>Review</category>
      <description><![CDATA[Objectives   Concerns about the health and well-being effects of high after-hours availability expectations and work-related connectivity have prompted calls for organizational and national disconnection measures, such as the right-to-disconnect legislation. However, the effectiveness of such measures remains unclear. This is the first systematic review that aims to evaluate interventions and policies designed to limit availability expectations and after-hours work connectivity.

Methods   We searched Embase, Medline, PsycINFO, and Web of Science for studies published (2004-2024) for peer-reviewed empirical studies. Two reviewers independently screened records extracted data and assessed study quality using the Effective Public Health Practice Project tool. The review was registered in PROSPERO (CRD42024599491). Effectiveness was assessed using a structured qualitative approach that accounted for various study design and methodological rigor across intervention types.

Results   Twelve studies (N=2306) were included: one national policy, three organizational disconnection guidelines, one supervisor-targeted program, and seven employee-focused programs. Half of the quantitative studies were randomized controlled trials; overall methodological quality was rated as weak. Most organizational and national-level policies showed limited or no effects, with benefits contingent on the person–environment fit and implementation quality. Supervisor-targeted and multi-component programs, particularly those allowing for flexibility and combining boundary management with other elements, showed significant modest effects on detachment, boundary control, and work–life balance, though effect sizes were generally small.

Conclusions   The evidence base is small, heterogenous, and methodologically limited. Policies alone are unlikely to reduce harmful connectivity without active organizational implementation and cultural change. Developing and testing rigorous, multi-level interventions that address norms and supervisory practices, as well as individual boundary preferences, are urgently needed.
      <strong>by</strong> <i>Nilsen W, Nordberg T, Lescoeur K, Ingelsrud MH, Egeland C</i>. doi:10.5271/sjweh.4272]]></description>
         </item>   <item>
      <title>Association between job insecurity and cardiovascular diseases in workers with type 2 diabetes mellitus</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4272</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4272</guid>
      <pubDate>Mon, 02 Feb 2026 15:32:08 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   This study analyzes the association between job insecurity, measured by cumulative unemployment, and the risk of cardiovascular disease (CVD) among middle-aged workers with type 2 diabetes mellitus.

Methods   We utilized data from the National Health Insurance Service of Korea, focusing on patients with type 2 diabetes, aged 40–50 who were continuously employed in 2009–2010. Job insecurity was defined by cumulative unemployment in 2012–2016 and categorized as stable, partially stable, or unstable. Participants were followed until December 2023, with incident CVD as the primary outcome. Cox regression models estimated sex-stratified hazard ratios (HR) with 95% confidence intervals (CI), with additional subgroup and sensitivity analyses.

Results   Among 128 704 participants (107 071 males and 21 633 females; median age 51 years), CVD occurred among 6.1% of males and 3.9% of females. Job insecurity was associated with an increased risk of CVD [males: HR 1.12 (95% CI 1.05–1.19) for partially stable, HR 1.25 (95% CI 1.16–1.34) for unstable; females: HR 1.00 (95% CI 0.85–1.19) for partially stable, HR 1.33 (95% CI 1.13–1.57) for unstable]. Subgroup analyses showed particularly elevated risks among low-income males and high-income females. By age, males aged 40–49 in the partially stable and unstable groups had increased CVD risks, while those aged 50–59 had the highest risk in the unstable group. Among females, significant associations appeared only in the 40–49 age group.

Conclusions   Among middle-aged workers with type 2 diabetes, prolonged job insecurity was significantly associated with an increased risk of CVD.
      <strong>by</strong> <i>Park H, Lee J, Park Y, Sim J, Yoon J-H, Yun B</i>. doi:10.5271/sjweh.4275]]></description>
         </item>   <item>
      <title>Occupational exposures and risk of pulmonary alveolar proteinosis (PAP)</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4275</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4275</guid>
      <pubDate>Mon, 26 Jan 2026 12:38:10 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   Occupational exposures to dust have been associated with pulmonary alveolar proteinosis (PAP) in case series, but population-based epidemiological data are needed.

Methods   We identified 286 cases of PAP from the Swedish National Patient Register and the Cause-of-Death Register between 1991 and 2022. For the present analysis, we included 212 cases aged 20–65 years with available occupational information before the index date or within two years thereafter. Controls matched on age and sex were drawn from the population register and assigned the same index date as their corresponding case; of these, 1438 controls had available occupational information and were included in the analyses. We linked cases and controls to Swedish registries to obtain socioeconomic status and occupational data. We applied an established job-exposure matrix to characterize occupational exposure to inorganic dust, with the subset silica dust, fumes, vapors and gases and organic dust. We used adjusted conditional logistic analyses to estimate the odds ratios (OR) with 95% confidence intervals (CI) for the occupational exposures in the year before index date and PAP.

Results   None of the occupational exposures analyzed showed a statistically significant association to PAP. The OR for inorganic dust was 1.08 (95% CI 0.75–1.55); silica dust alone was 1.55 (95% CI 0.75–3.23) and organic dust was 1.48 (95% CI 0.92–2.38). Among men, however, exposure to organic dust was associated with PAP [OR 1.92 (95% CI 1.18–3.23)]. Among women, the results were inconclusive.

Conclusions   There were no associations between occupational exposure to fumes, vapors and gases and inorganic dust and risk of PAP. Among men, exposure to organic dust was associated with increased risk for PAP. Some occupational inhalants may increase the risk of PAP.
      <strong>by</strong> <i>Torén K, Olin A-C, Åberg M, Cummings KJ, Schiöler L, Blanc PD</i>. doi:10.5271/sjweh.4269]]></description>
         </item>   <item>
      <title>Employers’ utilization of and collaboration with occupational health services in preventive occupational health and safety management</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4269</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4269</guid>
      <pubDate>Sun, 04 Jan 2026 21:55:34 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objectives   Occupational health services (OHS) are an important resource within employers’ preventive occupational health and safety management (OHSM). The aims of this study were to investigate employers’ utilization of OHS in preventive OHSM and identify decisive contextual, structural and/or processual conditions in ensuring successful collaboration with OHS in preventive OHSM.

Methods   A total of 122 organizations within the Swedish welfare sector (education, social services and healthcare), of which 112 had access to OHS, responded to a quantitative survey on the organization and management of their preventive OHSM. Responses were investigated using both conventional descriptive analysis and configurational analysis.

Results   Only a third of the participating organizations utilized OHS to a high or very high degree within their preventive OHSM. Factors for successful collaboration with OHS within preventive OHSM included having a contract that made it possible to use OHS and having established routines for involving OHS in the early phases of preventive measures, especially when managing external demands and complex challenges.

Conclusions   The utilization of OHS within preventive OHSM is limited, and increased utilization may improve the ability of employers to successfully implement OHSM. The successful organization of OHSM practices and the OHS contract were key factors in a successful collaboration with OHS. Working together in preventive OHSM may also strengthen social capital for all stakeholders, which could further enhance collaboration.
      <strong>by</strong> <i>Akerstrom M, Wahlström J, Reineholm C, Jonsdottir IH</i>. doi:10.5271/sjweh.4262]]></description>
         </item>   <item>
      <title>Beyond risk reduction of work-related musculoskeletal disorders: The CoWork musculoskeletal health model</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4262</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4262</guid>
      <pubDate>Tue, 02 Dec 2025 17:49:39 +0200</pubDate>
      <category>Discussion paper</category>
      <description><![CDATA[Objectives   Work-related musculoskeletal disorders (MSD) affect over 1.7 billion people globally with a huge economic burden. Despite decades with legislations, policies and risk-reduction interventions, we see no decreases in MSD prevalence. Current prevention models focus on eliminating workplace hazards, overlooking that physical and psychosocial work factors can also promote musculoskeletal health (MSH). We were commissioned through the Danish Working Environment Agreement to develop new approaches addressing this conceptual gap.

Methods   Through iterative stakeholder dialogue with Danish policymakers, social partners, and workplace practitioners, we developed and visualized the CoWork (Copenhagen work-related) MSH model to shift the focus from preventing MSD through risk reduction toward actively promoting work-related MSH. The model aims to bridge theory with workplace structure and implementation by addressing stakeholder requests for clear terminology, conceptual understanding in a workplace context, and actionable guidance.

Results   The CoWork MSH model provides a new definition of work-related MSH as “a state of physical, mental, and social well-being of the locomotor system in relation to work” as well as five integrated elements; (i) a health-oriented approach, (ii) a just-right work factor conceptualization, (iii) the Organizational, Management, Group, !ndividual (OMG!) workplace framework, (iv) an intervention guidance, and (v) health economics perspective. This approach recognizes that work factors can benefit rather than harm health when properly designed and implemented.

Conclusions   The CoWork MSH model represents a paradigm shift, extending from risk reduction to MSH promotion, providing researchers, policymakers, and practitioners with a framework for understanding, researching, and practice to promote workplace MSH.
      <strong>by</strong> <i>Holtermann A, Sørensen OH, Jacobsen SS, Lindberg L, Andersen LL</i>. doi:10.5271/sjweh.4260]]></description>
         </item>   <item>
      <title>Occupational physical behaviors and knee pain among eldercare workers: A prospective accelerometer study</title>
      <link>http://www.sjweh.fi/show_abstract.php?abstract_id=4260</link>
      <guid>http://www.sjweh.fi/show_abstract.php?abstract_id=4260</guid>
      <pubDate>Sun, 23 Nov 2025 22:12:00 +0200</pubDate>
      <category>Original article</category>
      <description><![CDATA[Objective   The aim of this study was to explore the prospective association between compositions of accelerometry-measured occupational physical behaviors and the risk of knee pain among eldercare workers.

Methods   We performed a prospective study among 377 eldercare workers employed across 20 Danish nursing homes. Occupational physical behaviors were measured using thigh-worn accelerometers over 1–4 working days. Workers reported intensity of and days with knee pain in a questionnaire at baseline and after one year. We explored associations between compositions of occupational physical behaviors [ie, sedentary, standing, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)] and knee pain, adjusting for potential confounders.

Results   No significant associations were found. Trends were found for increased occupational time spent in MVPA and decreased risk of days with knee pain [relative risk (RR) 0.58, 95% confidence interval (CI) 0.32–1.05, P=0.07] in main analyses, and for decreased risk of knee pain intensity among non-knee pain cases (RR 0.36, 95% CI 0.12–1.13, P=0.08) in sensitivity analyses.

Conclusions   No significant associations were found between baseline occupational physical behaviors and knee pain at one-year follow-up. However, a non-significant trend suggested that increasing occupational MVPA might be associated with reduced risk of knee pain at follow-up, though studies with larger samples are needed to confirm this finding.
      <strong>by</strong> <i>Skovlund SV, Wester CT, Kyriakidis S, Brusaca LA, Andersen LL, Sundstrup E, Rasmussen CDN</i>]]></description>
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