Scandinavian journal of work, environment & health最新文献

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.

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.

Objectives: The aim of this review was to map the characteristics and the effects of interventions that reduce working hours with full pay maintained on workers' health, well-being and work-life balance and to assess whether a gender perspective was incorporated.

Methods: A scoping review was conducted following PRISMA-ScR and JBI guidelines. Scientific databases (PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cochrane, ProQuest, Epistemonikos) and grey literature sources (international, European and national labor and occupational health agencies) were systematically searched for studies published between April 2014 and May 2025 in English or Spanish. Eligible studies comprised employed adults in Scandinavian and Western European countries, the United States, Canada, Australia and New Zealand exposed to interventions reducing working hours with full pay maintained. Screening, data extraction, and quality appraisal were conducted independently. An evidence map was developed to synthesize the findings.

Results: Ten scientific articles and five grey literature reports were included, seven from Scandinavian, seven from Western European countries, and one that included both regions. Working time reductions ranged from 10-25%. Most studies reported positive effects on work-life balance (100%), mental health (81.8%), and general health and well-being (58.3%). Qualitative data confirmed improvements in recovery, fatigue, and family time. Eleven studies included a gender perspective, with eight providing stratified analyses. Several studies indicated that women increased the time dedicated to caregiving and household, reinforcing traditional roles, while men's involvement rose slightly without shifting responsibility equity.

Conclusions: Despite heterogeneity of interventions and limited implementation contexts, it seems that reducing working hours to around 30-35 per week without pay loss may improve work-life balance, health, and well-being. Gender differences emerged, with women often facing increased unpaid work. As the evidence is still scarce particularly regarding long-term effects, sector-specific interventions, and gendered effects, further research is needed to inform and evaluate policies that promote equitable and sustainable work-time arrangements.

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.

Objectives: Sleepiness is a specific aspect of fatigue and considered a key factor linking working time to health and safety outcomes, such as occupational injuries. Therefore, this meta-analysis synthesizes evidence on how specific work schedule characteristics relate to sleepiness. Specifically, we examine how sleepiness varies with: (a) shift type (eg, day versus night), (b) shift length, and (c) the number of consecutive shifts.

Methods: We conducted a systematic literature search across multiple platforms and databases. Only studies that measured sleepiness using the Karolinska Sleepiness Scale were included. Mean effect sizes (Hedges` g) were calculated using random-effects models.

Results: The analysis included 48 studies (28 on shift type, 30 on shift length, and 13 on shift number). Compared to day shifts, sleepiness was significantly higher during night shifts and lower during afternoon shifts. Sleepiness increased with shift length during night shifts but showed no consistent pattern during day shifts. Furthermore, sleepiness was highest on the first night shift and decreased over subsequent nights, whereas it remained relatively stable across consecutive day shifts. Due to the low number of studies, results on shift length and shift number were limited or unavailable for afternoon shifts.

Conclusions: Overall, this meta-analysis shows that sleepiness is most pronounced during night shifts, particularly the first in a block. These findings emphasize the importance of circadian and homeostatic factors in shift work. Therefore, shift schedules should be designed to mitigate these heightened risks, for example by allowing sufficient recovery time before and during the first night shift.

Objectives: This study investigated the associations between shift work characteristics and self-reported work-related accidents as well as incidents of dozing off at work and during the work commute.

Methods: Data from a Norwegian hospital's working-time register encompassed information on quick returns (<11 hours between shifts), day-, evening-, night-, and long (≥12 hours) shifts worked during 2020, and were linked to questionnaire data from 1195 healthcare workers collected in January 2021. The questionnaire assessed work-related accidents causing harm to oneself, patients/others, and/or equipment the last year, as well as dozing off at work the last month and/or during commute the last year. Data were analyzed using negative binomial regressions, adjusting for age, sex, children, marital status, shift work experience, monthly working hours, circadian type, and night shifts.

Results: Number of quick returns the last year was positively associated with causing harm to oneself [incidence rate ratio (IRR) 1.021, 95% confidence interval (CI) 1.009-1.034]. Number of day shifts and evening shifts were negatively associated with causing harm to patients/others (IRR 0.987, 95% CI 0.981-0.992; IRR 0.989, 95% CI 0.982-0.996, respectively). Number of night shifts was positively associated with dozing off at work (IRR 1.005, 95% CI 1.002-1.008) and during commute (IRR 1.007, 95% CI 1.003-1.010), but was not associated with work-related accidents. Number of long shifts was positively associated with healthcare workers causing harm to oneself (IRR 1.198, 95% CI 1.111-1.291), patients/others (IRR 1.209, 95% CI 1.122-1.304), and equipment (IRR 1.174, 95% CI 1.080-1.275).

Conclusion: Limiting quick returns and long shifts may be relevant considerations for improving employee and patient safety.

Objective: Shift work is associated with various leading causes of premature death, which has been linked with individuals with specific chronotypes. This study synthesized evidence on chronotype's role in associations between ever shift work and health outcomes.

Methods: Six databases were searched (inception-September 2025) for cohort/case-control studies assessing chronotype-specific shift work impacts on breast/prostate cancer, diabetes mellitus, and mental health. PRISMA guidelines were used for reporting.

Results: Fourteen studies were included in the review, comprising 2247 breast cancer cases, 3045 prostate cancer cases, 336 218 participants in diabetes studies, and 2128 poor mental health cases. Compared to daytime workers, both night shift workers with morning or evening chronotypes were more susceptible to breast cancer [morning type: pooled odds ratio (OR) 1.54, 95% confidence interval (CI) 1.01-2.37; evening type: pooled OR 1.41, 95% CI 1.04-1.90) and poor mental health (morning type: pooled OR 1.19, 95% CI 1.12-1.27; evening type: pooled OR 1.11, 95% CI 1.05-1.17]. Notably, night shift workers with evening chronotype were 84% more likely to develop prostate cancer than daytime workers. A positive dose-response relationship was identified between cumulative years of night shifts and prostate cancer among night shift workers with evening chronotype, indicating a 2.1% increase in risk for each additional year (P=0.012).

Conclusions: Chronotype-matched scheduling does not effectively mitigate night shift risks. Nevertheless, evening chronotype night shift workers are particularly susceptible to various chronic non-communicable diseases, with a notable positive dose-response relationship observed between prostate cancer and evening chronotype night shift workers.

Objective: This paper discusses the contribution of a widely used theoretical model of the psychosocial work environment, effort-reward imbalance (ERI), to occupational health research. It highlights the development of this approach, its measurement, and its main findings over the past three decades, focusing on epidemiological investigations. Furthermore, several limitations and challenges in view of far-reaching changes of modern work are discussed.

Methods: Based on systematic reviews, meta-analyses, and an extended search for key publications, this discussion paper sets out the main evidence of associations of the model`s measures with health risks, prioritizing prospective investigations. Complementing results addressing psychobiological markers as potential pathways underlying these associations, as well as findings on the model`s expansion beyond paid work, are briefly summarized.

Results: Currently available findings document consistent, moderately elevated related risks of ischemic heart disease (IHD) and depression following exposure to ERI. Quasi-experimental findings on physiological parameters as potential mediators of the link with IHD support this evidence. Results on a range of other disorders, in particular metabolic diseases, drug-related disorders, and indicators of reduced health functioning, while supportive, are less robust.

Conclusions: This paper synthesizes three decades of international research on ERI as a parsimonious model of adverse psychosocial working conditions. At the same time, conceptual and methodological limitations-particularly in light of rapid changes in modern work and employment-point to priorities for future refinement and application of the model.

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.