Biomedical subjects

J Pentti

Publications and source records attributed to J Pentti.

At least 19 recordsLinked to original sources

PubMed2006

Increased absence due to sickness among employees with fibromyalgia.

BACKGROUND: Little is known about the effect of fibromyalgia on absence due to sickness in working populations. OBJECTIVE: To examine the risk of absence due to sickness among employees with fibromyalgia. METHODS: A prospective cohort study with 1-year follow-up of recorded and certified absence due to sickness after a survey of chronic diseases among 34 100 Finnish public sector employees (27 360 women and 6740 men) aged 17-65 years at baseline in 2000-2. RESULTS: 20 224 days of absence due to sickness for the 644 employees with fibromyalgia and 454 816 days for others were documented. Of those with fibromyalgia, 67% had co-occurring chronic conditions such as osteoarthritis, rheumatoid arthritis, depression or other psychiatric disorders. Compared with employees with none of these chronic conditions, the hazard ratio (HR) adjusted for age, sex and occupational status was 1.85-fold (95% confidence interval (CI) 1.53 to 2.18) for people with fibromyalgia alone and 2.63-fold (95% CI 2.34 to 2.96) for employees with fibromyalgia with coexisting conditions. The excess rate of absence due to sickness was 61 episodes/100 person-years among people with fibromyalgia alone. Among employees with musculoskeletal and psychiatric disorders, secondary fibromyalgia was associated with a 1.4-1.5-fold increase in risk of absence. CONCLUSION: Fibromyalgia is associated with a substantially increased risk of medically certified absence due to sickness that is not accounted for by coexisting osteoarthritis, rheumatoid arthritis or psychiatric disorders.

Age Factors↗

PubMed2006

Long hours in paid and domestic work and subsequent sickness absence: does control over daily working hours matter?

OBJECTIVES: To explore the associations of working hours (paid, domestic, commuting, and total) with sickness absence, and to examine whether these associations vary according to the level of employee control over daily working hours. METHODS: Prospective cohort study among 25 703 full-time public sector employees in 10 towns in Finland. A survey of working hours and control over working hours was carried out in 2000-01. The survey responses were linked with register data on the number of self-certified (< or =3 days) and medically certified (>3 days) sickness absences until the end of 2003. Poisson regression analyses with generalised estimating equations were used to take into account the fact that the employees were nested within work units. Adjustments were made for work and family characteristics and health behaviour. The mean follow-up period was 28.1 (SD 8.1) months. RESULTS: Long domestic and total working hours were associated with higher rates of medically certified sickness absences among both genders. In contrast, long paid working hours were associated with lower rates of subsequent self-certified sickness absences. Long commuting hours were related to increased rates of sickness absence of both types. Low control over daily working hours predicted medically certified sickness absences for both the women and men and self-certified absences for the men. In combinations, high control over working hours reduced the adverse associations of long domestic and total working hours with medically certified absences. CONCLUSIONS: Employee control over daily working hours may protect health and help workers successfully combine a full-time job with the demands of domestic work.

Cohort Studies↗

PubMed2006

Effort/reward imbalance and sedentary lifestyle: an observational study in a large occupational cohort.

OBJECTIVES: To investigate the association between effort/reward imbalance (ERI) at work and sedentary lifestyle. METHODS: Cross sectional data from the ongoing Finnish Public Sector Study related to 30,433 women and 7718 men aged 17-64 were used (n = 35,918 after exclusion of participants with missing values in covariates). From the responses to a questionnaire, an aggregated mean score for ERI in a work unit was assigned to each participant. The outcome was sedentary lifestyle defined as <2.00 metabolic equivalent task (MET) hours/day. Logistic regression with generalised estimating equations was used as an analysis method to include both individual and work unit level predictors in the models. Adjustments were made for age, marital status, occupational status, job contract, smoking, and heavy drinking. RESULTS: Twenty five per cent of women and 27% of men had a sedentary lifestyle. High individual level ERI was associated with a higher likelihood of sedentary lifestyle both among women (odds ratio (OR) = 1.08, 95% CI 1.01 to 1.16) and men (OR = 1.17, 95% CI 1.02 to 1.33). These associations were not explained by relevant confounders and they were also independent of work unit level job strain measured as a ratio of job demands and control. CONCLUSIONS: A mismatch between high occupational effort spent and low reward received in turn seems to be associated with an increased risk of sedentary lifestyle, although this association is relatively weak.

Adolescent↗

PubMed2004

Economy and job contract as contexts of sickness absence practices: revisiting locality and habitus.

This study revisits two Finnish local governments-Raisio and Nokia-that in an earlier study showed different sickness absence rates in the early 1990s. The locality difference was interpreted sociologically, within a framework inspired by Bourdieu's theory of social field, habitus and practice. The same framework is applied in the present study, starting out from the hypothesis that a constant historical and cultural locality context tends to reproduce prevailing sickness absence practices. The hypothesis was tested by extending the context beyond the locality to the macroeconomic fluctuations that occurred during the 1990s and to the type of employment contract. In both localities a 30% rise was observed in levels of sickness absence from 1991-1993 to 1997-2000. At the beginning of the 1990s the absence rate among permanent employees was 1.86 times higher in Nokia than in Raisio; at the end of the decade the corresponding rate ratio was 1.88. The absence rates were significantly lower among fixed-term employees than permanent employees, but the locality difference was seen in their case, too. Both results support the hypothesis. In spite of major changes taking place in the national economy, the differences between the two towns' sickness absence rates persisted, which in this particular case probably reflects the persisting working-class character of Nokia and middle-class character of Raisio. The theory also applies to the difference between permanent and fixed-term employees: the peripheral power position of the latter on work related social fields leads to the observed practices, i.e. to the relatively low absence rate. The results of our revisit give reason to recapitulate and elaborate upon our theoretical interpretation with a view to deepening our understanding of the social origins of sickness absence practices in the post-industrial workplace, which is characterised by increasing atypical employment and growing job insecurity.

Absenteeism↗

PubMed2004

Sickness absence as a predictor of mortality among male and female employees.

OBJECTIVE: To determine the extent to which sickness absence is predictive of mortality. DESIGN: Prospective cohort study. Data on medically certified long term absences (>3 days), self certified short term absences (1-3 days), and sick days were derived from employers' records and data on mortality from the national mortality register. SETTING: 10 towns in Finland. PARTICIPANTS: 12821 male and 28915 female Finnish municipal employees with a job contract of five consecutive years. The mean follow up was 4.5 years. MAIN RESULTS: After adjustment for age, occupational status, and type of employment contract, the overall mortality rate was 4.3 (95% confidence intervals 2.6 to 7.0) and 3.3 (2.1 to 5.3) times greater in men and women with more than one long term absences per year than in those with no absence. The corresponding hazard ratios for more than 15 annual sick days were 4.7 (2.3 to 9.6) and 3.7 (1.5 to 9.1). Both these measures of sickness absence were also predictive of deaths from cardiovascular disease, cancer, alcohol related causes, and suicide. Associations between short term sickness absences and mortality were weaker and changed to non-significant after adjustment for long term sickness absence. CONCLUSIONS: These findings suggest that measures of sickness absence, such as long term absence spells and sick days, are strong predictors of all cause mortality and mortality due to cardiovascular disease, cancer, alcohol related causes, and suicide.

Adolescent↗

PubMed2004

Effect of employee worktime control on health: a prospective cohort study.

AIMS: To investigate the health effects of employee worktime control. METHODS: Prospective cohort study among 4218 permanent full time municipal employees linking questionnaire data from 1997 and 2000 with sickness absence records from 1997 and 2001. Worktime control was considered high for the highest tertile in both 1997 and 2000, low for the lowest tertile for both years, and intermediate for all other combinations. Self rated health status, psychological distress, and medically certified periods of sickness absence were used as the health outcomes. Adjustments were made for age, baseline health status, occupational status, marital status, dependent children, and behavioural health risks. RESULTS: In the follow up, women with a low level of worktime control had a 1.9 times (95% CI 1.4 to 2.5) higher odds ratio for poor self rated health, a 1.4 times (95% CI 1.1 to 1.8) higher odds ratio for psychological distress, and a 1.5 times (95% CI 1.3 to 1.7) higher risk of medically certified sickness absences than women with a high level of worktime control. The health effects of worktime control were particularly evident among women with families. Among men, worktime control was not associated with self rated health or distress, but it predicted sickness absences in two subgroups: those with dependent children and those with manual occupations. CONCLUSIONS: A low level of worktime control increases the risk of future health problems. The risk is highest among women, especially those with families, and among manual workers. The results suggest that worktime control can help workers integrate their work and private lives successfully.

Cohort Studies↗

PubMed2003

Computerized quality assurance of decisions to transfuse blood components to critically ill patients.

BACKGROUND: In critically ill patients optimal transfusion therapy for most clinical settings has not been determined. The objective of this study was to evaluate the impact of a computerized audit on transfusion decisions of red blood cells (RBC), fresh frozen plasma (FFP), and platelets among critically ill patients. METHODS: Two hundred and ninety consecutive patients admitted to nine-bed medical-surgical intensive care unit at a university hospital were included in this prospective study. Prior to the study, the criteria for transfusions of RBCs, FFP and platelets were established. Phase I, the first 3-month period served as a control period. During phase II the fulfilment of these criteria was prospectively monitored by an audit software belonging to the computerized blood request program. If the predefined transfusion criteria were not met the audit software was automatically activated. The last 3-month period, phase III, was to assess if possible effects on transfusion decisions were permanent. RESULTS: The proportion of RBC transfusions administered according to predefined trigger during the study phases I, II, and III were 55.9%, 75.1% and 67.9%, respectively (P < 0.001). The proportion of FFP and platelet transfusions according to a predefined trigger did not differ statistically significantly between the study phases. Logistic multiple regression analysis revealed an independent effect of the audit phase on the decision to transfuse RBCs and FFP. CONCLUSIONS: The data suggests that a computerized prospective transfusion audit has impact on the realisation of predefined transfusion decisions.

Adult↗

PubMed2002

Employee control over working times: associations with subjective health and sickness absences.

STUDY OBJECTIVE: To investigate the impact of employees' worktime control on health, taking into account other aspects of job control. DESIGN: Analysis of questionnaire data in 1997 and register data on sickness absence during 1996-1998. SETTING: Eight towns in Finland. PARTICIPANTS: 6442 municipal employees (1490 men and 4952 women) representing the staff of the towns studied. Follow up was 17 706 person years. MAIN RESULTS: In women, poor health and psychological distress were more prevalent among those in the lowest quartile of worktime control than those in the highest (after adjustment for potential confounders including other aspects of job control, odds ratios and their 95% confidence intervals for poor health and psychological distress were 1.8 (1.5 to 2.3) and 1.6 (1.3 to 2.0), respectively). Correspondingly, the adjusted sickness absence rate was 1.2 (1.1 to 1.2) times higher in women with low worktime control than in women with high worktime control. In men, no significant associations between worktime control and health were found. These results, obtained from the total sample, were replicable within a homogeneous occupational group comprising women and men. CONCLUSIONS: Exploration of specific aspects of job control provides new information about potentially reversible causes of health problems in a working population. Worktime control is an independent predictor of health in women but not in men. Dissimilarities in the distribution of occupations between men and women are not a probable explanation for this difference.

Absenteeism↗

PubMed2002

Employment security and health.

OBJECTIVE: To study the relation of contractual and perceived employment security to employee health. DESIGN: Cross sectional survey. SETTING: Municipal sector employees in eight Finnish towns. PARTICIPANTS: 5981 employees with a permanent contract and 2786 employees with a non-permanent contract (2194 fixed term contract, 682 government subsidised contract). OUTCOME MEASURES: Poor self rated health, chronic disease, and psychological distress. RESULTS: Compared with permanent employees, fixed term men and women had better self rated health (men odds ratio 0.70; 95% confidence intervals 0.50 to 0.98, women 0.70 (0.60 to 0.82) and less chronic disease (men 0.69; 0.52 to 0.91; women 0.89; 0.79 to 1.02), but women had more psychological distress (1.26; 1.09 to 1.45). The only difference between subsidised employees and permanent employees was the high level of psychological distress in women (1.35; 1.09 to 1.68). Low perceived employment security was associated with poor health across all three indicators. The association of low perceived security with psychological distress was significantly stronger in permanent employees than among fixed term and subsidised employees, indicating that perceived security is more important for mental health among employees with a permanent contract. CONCLUSIONS: Contractual security and perceived security of employment are differently associated with health. It is therefore important to distinguish between these aspects of employment security in studies of labour market status and health. Such studies will also need to control for health selection, which is unlikely to operate in the same way among permanent and non-permanent employees.

Chronic Disease↗

PubMed2002

Cancer at sea: a case-control study among male Finnish seafarers.

AIMS: To study the possible work related reasons for the increased incidence of many cancers among seafarers. METHODS: A case-control study, nested in a cohort of all male seafarers (n = 30 940) who, according to the files of the Seamen's Pension Fund, had worked on board Finnish ships for any time during the period 1960-80. Cases of cancer of the lung, nervous system, kidney, and pancreas, leukaemia, lymphoma, and all cases histologically defined as mesotheliomas were identified from the Finnish Cancer Registry in 1967-92. The preceding numbers of years at sea in various occupational categories were collected according to the type of ship (dry cargo ship, tanker, passenger vessel, icebreaker, other vessel). RESULTS: The incidence for lung cancer among engine crew increased with the increase in employment time, the odds ratio (OR) after three years being 1.68 (95% CI 1.17 to 2.41). The OR of lung cancer for deck officers was 0.42 (95% CI 0.29 to 0.61). Deck personnel on icebreakers had a significantly increased risk of lung cancer > or =20 years after first employment (OR 3.41, 95% CI 1.23 to 9.49). The OR for mesothelioma among engine crew with a latency of 20 years was 9.75 (95% CI 1.88 to 50.6). The OR for renal cancer among deck officers after three years employment was 2.15 (95% CI 1.14 to 4.08), but there was no increase by employment time or by latency. A rise of OR for lymphoma was detected among deck personnel on tankers, if the employment had lasted over three years (OR 2.78, 95% CI 0.98 to 7.92). The risk pattern for leukaemia was similar to that of lymphoma, the OR among deck personnel on tankers varying from 2.26 (95% CI 1.01 to 5.06) to 6.86 (95% CI 1.62 to 28.8) depending on the length of employment. CONCLUSIONS: Results indicate that occupational exposures of deck crews on tankers add to their risk of renal cancer, leukaemia, and possibly lymphoma. Engine crews have an asbestos related risk of mesothelioma, and the engine room conditions also seem to increase risk of lung cancer.

Adult↗

PubMed2001

The prevalence of voice disorders among day care center teachers compared with nurses: a questionnaire and clinical study.

The acceptance of voice disorders by day care center teachers as an occupational disease is not an invariably established practice. This is due to the lack of reliable evidence of a higher risk for voice disorders in this profession. To find out the risk of voice disorders, an epidemiological study was conducted among day care center teachers (n = 262), using hospital nurses (n = 108) as a control group. Symptoms were charted by a questionnaire. In a clinical examination made by a laryngologist, the voice quality was assessed and the laryngeal status noted. Teachers at day care centers had significantly more voice disorders than did nurses. Vocal nodules and laryngitis findings appeared significantly more frequently among day care center teachers than among those in the control group. The results prove voice disorders to be more frequent among day care center teachers than among control group subjects, and also that the main cause for this may be a higher vocal loading among day care center teachers than among control group subjects.

Adult↗

PubMed2001

Organisational downsizing and musculoskeletal problems in employees: a prospective study.

OBJECTIVES: To study the association between organisational downsizing and subsequent musculoskeletal problems in employees and to determine the association with changes in psychosocial and behavioural risk factors. METHODS: Participants were 764 municipal employees working in Raisio, Finland before and after an organisational downsizing carried out between 1991 and 1993. The outcome measures were self reports of severity and sites of musculoskeletal pain at the end of 1993 and medically certified musculoskeletal sickness absence for 1993-5. The contribution of changes in psychosocial work characteristics and health related behaviour between the 1990 and 1993 surveys was assessed by adjustment. RESULTS: After adjustment for age, sex, and income, the odds ratio (OR) for severe musculoskeletal pain between major and minor downsizing and the corresponding rate ratios for musculoskeletal sickness absence were 2.59 (95% confidence interval (95% CI) 1.5 to 4.5) and 5.50 (3.6 to 7.6), respectively. Differences between the mean number of sites of pain after major and minor downsizing was 0.99 (0.4 to 1.6). The largest contribution from changes in work characteristics and health related behaviour to the association between downsizing and musculoskeletal problems was from increases in physical demands, particularly in women and low income employees. Additional contributory factors were reduction of skill discretion (relative to musculoskeletal pain) and job insecurity. The results were little different when analyses were confined to initially healthy participants. CONCLUSIONS: Downsizing is a risk factor for musculoskeletal problems among those who remain in employment. Much of this risk is attributable to increased physical demands, but adverse changes in other psychosocial factors may also play a part.

Adult↗

PubMed2001

The role of extended weekends in sickness absenteeism.

OBJECTIVES: Employees are thought to lengthen their weekends by voluntary absenteeism, but the magnitude of such potentially reversible behaviour is not known. METHODS: A follow up study based on employers' registers on the dates of work contracts and absences in 27 541 permanent full time municipal employees in five towns during 1993-7. The absence rate on each weekday separately for all sick leaves and for 1 day sick leaves was determined. RESULTS: 3.4% of the male employees and 5.0% of the female employees were on sick leave daily. The mean rate of sickness absence was lowest on Mondays, after which it increased towards Wednesday, and remained on the same level for the rest of the week. This pattern applied to both sexes, to each year of the follow up, and across towns, age groups, and income groups. For 1 day sick leaves, representing 4.5% of the total sickness absenteeism, the rates of sick leave for Mondays and Fridays were 1.4 and 1.9 times greater than those for other weekdays. However, these excess rates account for less than 1% of all days lost due to sickness absenteeism. Extended weekend absences were more common in men, in young employees, and in those in a low socioeconomic position, and they varied between towns. CONCLUSION: Extended weekends seem to contribute only marginally to the days lost due to sickness absenteeism.

Absenteeism↗

PubMed2001

Health promotion in the Finnish shipping industry.

In autumn 1997 a pilot project was started in Finland to develop methods for promoting the health of sailors. Four Finnish shipping companies, (4 cargo ships and 2 passenger-cruise ferries), with altogether 730 sailors participated in the project. Special attention was paid to individuals with health problems and those who generally did not take care of their own health or fitness. Three-quarters of the respondents saw their health as good and one fifth as fair. Thirty-four persons responded that their working capacity was poor. 154 sailors were selected into further physical fitness evaluations. The main task of the project team was to activate sailors to take care of their own health and well-being. The health-promoting activities were directed especially at those persons who needed it. Information lectures concerning healthier eating habits and meals were given. Anti-smoking and anti-alcohol drinking information was given. On board one cruise ferry a project was started on how to react as early as possible to alcohol abuse among seafarers. Courses on shore for sailors were arranged to improve their physical fitness and to increase their resting benefit between working periods at sea. The intervention time was one year. Information about smoking and alcohol led to reduced alcohol consumption. The sailors had started to exercise more often both on board ship and on shore. Those who had increased their physical exercise during free time more often found their own health and working ability to have improved than those who had not changed their exercise habits. It appeared that health intervention projects are really needed especially by older sailors. The results also showed that positive effects could be achieved in the fitness of sailors. Better fitness was good for their health and also increased the work safety.

Accidents, Occupational↗

PubMed2000

Factors underlying the effect of organisational downsizing on health of employees: longitudinal cohort study.

OBJECTIVE: To explore the underlying mechanisms between organisational downsizing and deterioration of health of employees. DESIGN: Longitudinal cohort study. Data were assembled from before downsizing (time 1); during major downsizing affecting some job categories (time 2); and after downsizing (time 3). Contributions of changes in work, support, and health related behaviours between time 1 and time 2 to the relation between downsizing and sickness absence at time 3 were assessed by multilevel modelling. Mean length of follow up was 4.9 years. SETTING: Raisio, a town in Finland. SUBJECTS: 764 municipal employees who remained in employment after downsizing. MAIN OUTCOME MEASURES: Records of absences from work from all causes with medical certificate. RESULTS: Downsizing was associated with negative changes in work, impaired support from spouse, and increased prevalence of smoking. Sickness absence rate from all causes was 2.17 (95% confidence interval 1.54 to 3.07) times higher after major downsizing than after minor downsizing. Adjustment for changes in work (for instance, physical demands, job control, and job insecurity) diminished the relation between downsizing and sickness absence by 49%. Adjustments for impaired social support or increased smoking did not alter the relation between downsizing and sickness absence. The findings were unaffected by sex and income. CONCLUSIONS: The exploration of potential mediating factors provides new information about the possible causal pathways linking organisational downsizing and health. Downsizing results in changes in work, social relationships, and health related behaviours. The observed increase in certificated sickness absence was partially explained by concomitant increases in physical demands and job insecurity and a reduction in job control. A considerable proportion of the increase, however, remained unexplained by the factors measured.

Adult↗

PubMed2000

Hostility and ill health: role of psychosocial resources in two contexts of working life.

OBJECTIVE: The purpose of this study was to examine the extent to which increased risk to health problems in hostile employees is associated with psychosocial resources and life context. METHODS: Social relationships, job control, and sickness absence were assessed among 757 hostile and nonhostile municipal employees in two life contexts: during a stressful organizational downsizing; and during a period after the downsizing. The follow-up time was 550 person-years for men and 1677 person-years for women during the period of downsizing, and 519 person-years for men and 1568 person-years for women during the period after downsizing. RESULTS: The risk of sick leave was 1.2-1.4-fold higher in the hostile individuals than in the others. Small network size in hostile employees related to a 1.4-2.5-fold higher risk of sick leave compared to large network size. In nonhostile employees, network size did not associate with sick leave. Poor job control effected a 50% higher risk of sick leave in hostile than in nonhostile individuals during downsizing. During the less stressful period, both hostility and poorjob control increased absence rates independently of one another. Strong spouse support protected only nonhostile employees from sickness. No differences between hostile and nonhostile employees were found in the levels of psychosocial resources or changes in them. CONCLUSION: The risk of health problems in hostile persons could be linked with heightened vulnerability in poor psychosocial resource conditions and with the inability to benefit from existing psychosocial resources. Such personal deficits seem to be resource-specific and vary somewhat according to an individual's life context.

Adaptation, Psychological↗

PubMed2000

Locality and habitus: the origins of sickness absence practices.

This article aims to understanding the differences observed in the sickness absence practices of three municipal work organisations. Sickness absence figures were contextualised with a two-level analysis. The working communities were studied with the material collected for the study from documents, interviews, and a postal questionnaire survey on psychosocial working conditions. At the locality level the quality and quantity of economic, social, and cultural capitals were assessed. On the basis of this material, community diagnoses of the three localities are presented. The relationship of the way of life and being ill in the locality to the sickness absences among the employees of the municipality is discussed using the concepts of 'field', 'habitus', 'practice' and 'capital' as presented by Bourdieu. Sickness absence practices seem to be connected to the relative dominance of social classes in the locality. We conclude that the sickness absence practice of the municipal working community is an expression of the sickness absence habitus which is deeply rooted in the social history of the locality and in the health-related behaviour of the residents. In being not too structuralistic and not too relativistic, Bourdieu's theory helps us to understand the reality of the sickness absences; they can only be influenced marginally and temporarily by simple intervention measures in the work-places. More lasting changes in the level of sickness absences would require profound changes in the working community and-ultimately-in the whole locality.

Absenteeism↗

PubMed2000

Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees.

STUDY OBJECTIVE: To investigate the impact of changes in psychosocial work environment on subsequent sickness absence. DESIGN: Analysis of questionnaire and sickness absence data collected in three time periods: 1990-1991, before the recession; 1993, worst slump during the recession; and 1993-1997, a period after changes. SETTING: Raisio, a town in south western Finland, during and after a period of economic decline. PARTICIPANTS: 530 municipal employees (138 men, 392 women) working during 1990-1997 who had no medically certified sick leaves in 1991. Mean length of follow up was 6.7 years. MAIN RESULTS: After adjustment for the pre-recession levels, the changes in the job characteristics of the workers during the recession predicted their subsequent sick leaves. Lowered job control caused a 1.30 (95% CI = 1.19, 1.41) times higher risk of sick leave than an increase in job control. The corresponding figures in relation to decreased social support and increased job demands were 1.30 (95% CI = 1.20, 1.41) and 1.10 (95% CI = 1.03, 1.17), respectively. In some cases there was an interaction with socioeconomic status, changes in the job characteristics being stronger predictors of sick leaves for employees with a high income than for the others. The highest risks of sick leave (ranging from 1.40 to 1.90) were associated with combined effects related to poor levels of and negative changes in job control, job demands and social support. CONCLUSION: Negative changes in psychosocial work environment have adverse effects on the health of employees. Those working in an unfavourable psychosocial environment before changes are at greatest risk.

Adolescent↗