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    <title>SJWEH - Online-first articles</title>
    <description>List of Online-first articles on the SJWEH website</description>
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    <copyright>SJWEH</copyright>
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    <managingEditor>lodo@ttl.fi (Lisa O\'Donoghue-Lindy)</managingEditor>
    <webMaster>risto@toivonen.biz (Risto Toivonen)</webMaster>

   <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>. doi:10.5271/sjweh.4299]]></description>
         </item>   <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.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.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.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.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.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>]]></description>
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