Psychotherapy duration and work disability: A prospective Finnish register study

INTRODUCTION

The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD-related work disability and the change in psychotropic drug purchases is scarce.

METHODS

We used a register-based cohort representing 33% of the Finnish population. The participants included working-age individuals (N = 12,047, 76% women, mean age = 36) who initiated long-term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration-dependent changes in CMD-related work disability (primary outcome, operationalized as depression or anxiety-related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes).

RESULTS

There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the <1-year duration group (88% decline for SA and 43%-44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases).

CONCLUSION

Work disability outcomes and duration varied among individuals, even with similar initial mental health-related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements.

The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study

PURPOSE

This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups.

METHODS

Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18-55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence.

RESULTS

Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group.

CONCLUSIONS

Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

Influence of water color and catchment lake cover on stream macroinvertebrate communities: Ecological insights into browning effects

Browning of streams due to increased export of dissolved organic carbon (DOC) and iron has been observed in vast areas of the northern hemisphere with likely adverse ecological effects. Lake basins in stream catchments can moderate DOC export and influence stream communities, which complicates understanding of the effects of DOC. In this study, we explored the independent and interactive effects of water color (proxy for DOC and iron) and catchment lake cover on benthic macroinvertebrate communities in 94 medium-sized boreal forest streams. We first investigated the role of lake basins and other catchment characteristics in controlling water color. We then studied the effects of water color and catchment lake cover on macroinvertebrate community composition, biodiversity, and functional feeding traits. Water color correlated negatively with catchment lake cover, whereas the correlation with peatland cover and drainage intensity was positive. PERMANOVA and GLS analyses indicated that both color and catchment lake cover had a distinct independent effect on invertebrate community composition and community attributes, without significant interactions. Color had an independent negative effect on EPT (Ephemeroptera, Plecoptera, Trichoptera) taxa richness irrespective of lake cover. Increasing water color had negative effect on relative abundance of grazer, but no significant effect on shredder trait, while lake cover had a negative effect on both of the traits. Lake cover exhibited a negative influence on collector-gatherers, and a positive effect on filter feeders, while the predators were positively affected by both factors. The results highlight that water color influences the community structure of boreal stream ecosystems, and the effects are similar regardless of catchment lake cover. Mitigation measures should be emphasized, aimed at reducing DOC and iron runoff, in land use planning and river basin management.

Sociodemographic Factors as Predictors of the Duration of Long-term Psychotherapy: Evidence from a Finnish Nationwide Register Study

OBJECTIVE

The role of sociodemographic factors in determining psychotherapy duration has been largely unexplored despite their known association with treatment use. We examined the association between sociodemographic factors and rehabilitative psychotherapy treatment duration, as well as any changes in duration over time.

METHOD

We used three register-based nationally representative cohorts. Participants included employed Finnish individuals (n = 5572, 77% women, mean age = 37) who started psychotherapy treatment in 2011, 2013 or 2016 and were followed until 2019. We used negative binomial regression to examine the association between sociodemographic factors (age, gender, education, occupational status, income, geographical area of residence, and onset year of treatment) with treatment duration.

RESULTS

The mean treatment duration was 27 months (with a standard deviation of 12 months). Several sociodemographic factors were associated with treatment duration. Gender and education were found to have the largest impact on treatment duration, with females having a longer duration (IRR 1.08, 95% CI 1.04-1.11) and those with low education having a shorter duration (IRR 0.91, 95% CI 0.85-0.97), resulting in a difference of 2-3 months. Treatment duration also increased in later years, which suggests potentially increasing differences in treatment implementation. At largest, the combined effect of all factors corresponded to a 10-month difference in treatment duration.

CONCLUSIONS

The duration of long-term psychotherapy varied across the sociodemographic groups and increased in all studied groups in the 2010s.

Income gradient in psychotherapy use and psychotropic drug purchases: A longitudinal register study in Finnish employed population

OBJECTIVE

We examined the income gradient changes in the use of long-term rehabilitative psychotherapy and psychotropic drug purchases in men and women during a 9-year follow-up.

METHODS

We used register data from a random sample of the working-age population (18-64 years) with information on annual income, psychotherapy use and psychotropic drug purchases from 2011 to 2019 (N = 736 613, 49.7% women). Sex-stratified generalized estimating equations logistic regression models with predicted marginal probabilities were used to examine change in the treatment use rates over time for income quartiles.

RESULTS

Treatment rates increased during the follow-up, with men having lower rates than women. There were no significant differences in psychotherapy use rates between the income quartiles during the follow-up in men. A small income gradient in women (the wealthiest group with the highest use rate) remained stable throughout the follow-up. As for psychotropic drug purchases, the rates increased more among the poorest income quartile compared to the wealthiest quartile in both men and women. In the last year of the follow-up, the initial income gradient (wealthiest group having the highest psychotropic drug purchase rate) had become reversed, and the poorest group had the highest psychotropic drug purchase rate.

CONCLUSION

In psychotherapy use, no income gradient was found in men, while a stable income gradient was found in women. Psychotropic drug purchases have previously been more common in the wealthiest groups, but more recently among the poorest. The findings indicate that gender and income have distinct relationships with the treatment modality over time.

The association between the use of shift schedule evaluation tool with ergonomics recommendations and occupational injuries: A 4-year prospective cohort study among healthcare workers

OBJECTIVE

This study aimed to find out whether utilizing a shift schedule evaluation tool with ergonomics recommendations for working hours has favorable effects on the incidence of occupational injuries.

METHODS

This 4-year prospective cohort study (2015-2018) consisted of a dynamic cohort of healthcare shift workers (N=29 237) from ten hospital districts and six cities in Finland. Working hour characteristics and occupational injuries were measured with daily registry data. Multilevel generalized linear model was used for the analyses, and the estimates were controlled for hierarchical structure of the data and confounders.

RESULTS

Ward heads of the cities used the shift schedule evaluation tool 3.2 times more often than ward heads of the hospital districts. Overall incidence of workplace and commuting injuries did not differ between users and non-users of the evaluation tool. The incidence of dislocations, sprains, and strains was lower in the users than non-users [adjusted odds ratio (OR) 0.88, 95% confidence interval (CI) 0.78-0.99]. Approximately 13% of this association was mediated by increase in realized shift wishes and 10% by increase in single days off. In subgroup analyses, the incidence of workplace injury (OR 0.83, 95% CI 0.69-0.99), and among types of injuries, the incidence of dislocations, sprains, and strains (OR 0.69, 95% CI 0.55-0.85) and falling, slipping, tripping, or overturning (OR 0.75, 95% CI 0.58-0.99) were lower in users than non-users among employees of the cities, but no association was found among employees of the hospital districts.

CONCLUSION

The use of ergonomics recommendations for working hours is associated with a reduced risk of occupational injuries.

Participatory Ergonomics Intervention to Prevent Work Disability Among Workers with Low Back Pain: A Randomized Clinical Trial in Workplace Setting

Purpose In order to support people with low back pain (LBP) to stay at work, work arrangements are regarded important. This study aimed to evaluate the effectiveness of a workplace intervention using a participatory approach on work disability of workers with ongoing or recurrent LBP. Methods A total of 107 workers with LBP, with duration of pain for at least two consecutive weeks or recurrent pain of any duration during the last year, were randomized either to the intervention (n = 51) or control group (n = 56). The intervention included arrangements at the workplace, along with individual guidance provided by an occupational physiotherapist (OPT). The randomized intervention study used standard counselling and guidance by an OPT without workplace intervention as a comparison. Surveys were completed at baseline, and 6 and 12 months after baseline. Results There were no statistically significant differences between the intervention and control groups on the primary outcome measure, i.e. self-assessed work ability. We found no between-group differences in perceived health, self-assessed work productivity, number of sickness absence days and severity of back pain. However, there were significant positive within-group changes in the intervention group in the intensity of LBP, perceived health and the number of sickness absence days due to LBP. Conclusion Workplace arrangements are feasible using participatory ergonomics, but more quantitative and qualitative research is needed on its utilization and effectiveness among workers with LBP.

The Time-Varying Effect of Participatory Shift Scheduling on Working Hour Characteristics and Sickness Absence: Evidence from a Quasi-Experiment in Hospitals

Participatory shift scheduling for irregular working hours can influence shift schedules and sickness absence. We investigated the effects of using participatory shift scheduling and shift schedule evaluation tools on working hour characteristics and sickness absence. We utilized a panel data for 2015-2019 with 16,557 hospital employees (6143 in the intervention and 10,345 in the control group). Difference-in-differences regression with ward-level clustered standard errors was used to estimate the average treatment effect on the treated coefficients relative to timing of the intervention with 95% confidence intervals (CI). Using participatory scheduling tool increased long working hours and weekend work and had delayed effects on the short (1-3 days) sickness absences. Increased effects were observed: 0.2 [95% CI 0.0-0.4] days for the second, and 0.8 [95% CI 0.5-1.0] for the third year after the onset of intervention. An average increase of 0.5 [95% CI 0.1-0.9] episodes on all sickness absence episodes was observed for the third year. Using the shift schedule evaluation tool with the participatory shift scheduling tool attenuated the adverse effects. To conclude, participatory shift scheduling increased some potentially harmful working hour characteristics but its effects on sickness absence were negligible, and further attenuated by using the shift schedule evaluation tool.

Psychotherapy and change in mental health-related work disability - A prospective population level register-based study in Finland

Introduction

Mental disorders are a major cause of work disability among working age population. Psychotherapy has been shown to be an effective treatment for mental disorders, but the evidence mainly comes from small scale randomised trials with a relatively short follow-up.

Objectives

We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety related work disability using a quasi-experimental interrupted time series analysis.

Methods

All those who started rehabilitative psychotherapy in 2011-2014 comprised the study group. The study group included 10436 participants who were followed from three years prior to four years after the onset of rehabilitative psychotherapy, resulting in 83488 observations. Annual total number of mental health related work disability months was calculated based on total number of annual compensated sickness absence and disability pension days.

Results

The onset of rehabilitative psychotherapy marked a decline in depression or anxiety related work disability as compared to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76-0.85) as well as a 48% decrease in the slope (IRR 0.52; 95% CI 0.50-0.54) of work disability was detected. The decline was steepest in the oldest age-group

Conclusions

Providing statutory psychotherapy may decrease work disability at the population level. Further evidence for causal inference and the potential heterogeneity of the association is required.

Psychotherapy – A Sound Investments In (Mental) Health Capital?

Introduction

The concept of health capital views health as a form of capital that produces healthy time to individual. This stock of capital - health that is - can decrease or increase. The potential of psychotherapy as individual's investment to (mental) health capital has been rarely studied in population level.

Objectives

The aim of our study is to shed light on the returns on individual-level investments in health capital. We consider the use of psychotherapy as an investment in health capital. This investment offers potential returns for individual as a higher level of subsequent income. However, these returns are potentially heterogenous: we aim to show to whom the use of psychotherapy is a sound investment in health capital.

Methods

We model the effects of mental health, and subsequent treatments such as the use of psychotropics and psychotherapy on income using two-way fixed effects regression.

Results

Preliminary results show that different parts of working-age population seem to have different potential returns related to the use of psychotherapy. These heterogenous effects are related to previously reported socioeconomic status related disparities: the level of human capital i.e. income and education play a role in the profitability of the individual level investment made in the health capital by the use of psychotherapy.

Conclusions

The use of psychotherapy has heterogenous effects on the income of individuals. The potential of this investment to produce health capital varies with education, the level of income prior to the use of psychotherapy.

Socioeconomic factors affecting psychotherapy use rates

Objectives

Previous studies indicate socioeconomic inequalities in psychotherapy utilization. The aim of this study was to assess the associations of individual annual incomes with the utilization of long-term rehabilitative psychotherapy during nine-year follow-up in men and women. As secondary analyses we assessed the association of main activity with the utilization of psychotherapy.

Methods

For this study, we selected those from a random sample of the working-age population (18-55 years) with information about income at each time point during the follow-up from 2011 to 2019 (N = 736 613). Psychotherapy usa during the follow-up period served as dependent variable and sosiodemographic variables, annual incomes and main activity (employed, unemployed, studying, other) were used as independent variables. To examine change in the psychotherapy use rates over time, we used sex-stratified generalized estimating equations logistic regression models with predicted marginal probabilities.

Results

Psychotherapy use rate was constantly higher among women than in men (in 2011 0.8% and 0.2%) and increased from 2011 to 2019 among both genders and income quartiles (among women 174% - 231% and among men 213% - 248% increase between quartiles). Among men, psychotherapy use rate was highest among lowest income quartile throughout the study interval. Among women such difference was not observed. Among women, studentś psychotherapy use increased significantly when compared to other groups from 2011 to 2019 (299% increase vs 89% - 210% increase among other groups). A similar pattern was seen among studying men versus other groups.

Conclusions

Between 2011 and 2019 the probability of having psychotherapy increased among both genders. Unexpectedly, pro-rich psychotherapy use rate was not observed. The highest probability to use psychotherapy in lowest income quartile might be linked with differences in health care systems for students and for other.

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

BACKGROUND

Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability.

METHODS

We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied.

RESULTS

The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group.

CONCLUSIONS

This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.

The Effect of Employee-Oriented Flexible Work on Mental Health: A Systematic Review

The effect of flexible work on mental health is not well known. The aim of this systematic review was to assess the effects of employee-oriented flexible work on mental health problems and associated disability. Literature searches were conducted in the PubMed, Scopus, Web of Sciences, Cochrane Library, PsycINFO, ProQuest and EconPapers databases from their inception through October-November 2020. Sixteen studies on the associations of worktime control, working from home, or flexible working arrangements with mental health related outcomes were included in the review: one cluster randomized controlled trial, two non-randomized controlled trials, two cross-over studies, and 11 prospective cohort studies. Three reviewers independently assessed the met-hodological quality of the included studies and extracted the data. The included studies differed in design, intervention/exposure, and outcome, so meta-analysis was not carried out and qualitative results were reported. A few prospective cohort studies found that low employees’ control over worktime increases the risk of depressive symptoms, psychological distress, burnout, and accumulated fatigue. One cross-over and a few cohort studies found small beneficial effects of working partly from home on depressive symptoms, stress, and emotional exhaustion. A small number of controlled trials, cross-over or cohort studies found that flexible working arrangements increase employees’ control over working hours, but have only modest beneficial effects on psychological distress, burnout, and emotional exhaustion. This systematic review suggests that employee-oriented flexible work may have small beneficial effects on mental health. However, randomized controlled trials and quasi-experimental studies are needed to identify the health effects of flexible work.

Risk Assessment of Gypsum Amendment on Agricultural Fields: Effects of Sulfate on Riverine Biota

Gypsum (CaSO₄ ∙2H₂ O) amendment is a promising way of decreasing the phosphorus loading of arable lands, and thus preventing aquatic eutrophication. However, in freshwaters with low sulfate concentrations, gypsum-released sulfate may pose a threat to the biota. To assess such risks, we performed a series of sulfate toxicity tests in the laboratory and conducted field surveys. These field surveys were associated with a large-scale pilot exercise involving spreading gypsum on agricultural fields covering 18% of the Savijoki River (Finland) catchment area. The gypsum amendment in such fields resulted in approximately a four-fold increase in the mean sulfate concentration for a 2-month period, and a transient, early peak reaching approximately 220 mg/L. The sulfate concentration gradually decreased almost to the pregypsum level after 3 years. Laboratory experiments with Unio crassus mussels and gypsum-spiked river water showed significant effects on foot movement activity, which was more intense with the highest sulfate concentration (1100 mg/L) than with the control. Survival of the glochidia after 24 and 48 h of exposure was not significantly affected by sulfate concentrations up to 1000 mg/L, nor was the length growth of the moss Fontinalis antipyretica affected. The field studies on benthic algal biomass accrual, mussel and fish density, and Salmo trutta embryo survival did not show gypsum amendment effects. Gypsum treatment did not raise the sulfate concentrations even to a level just close to critical for the biota studied. However, because the effects of sulfate are dependent on both the spatial and the temporal contexts, we advocate water quality and biota monitoring with proper temporal and spatial control in rivers within gypsum treatment areas. Environ Toxicol Chem 2022;41:108-121. © 2021 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

The Effect of Using Participatory Working Time Scheduling Software on Employee Well-Being and Workability: A Cohort Study Analysed as a Pseudo-Experiment

Shift workers are at increased risk of health problems. Effective preventive measures are needed to reduce the unfavourable effects of shift work. In this study we explored whether use of digital participatory working time scheduling software improves employee well-being and perceived workability by analysing an observational cohort study as a pseudo-experiment. Participants of the Finnish Public Sector cohort study with payroll records available between 2015 and 2019 were included (N = 2427). After estimating the propensity score of using the participatory working time scheduling software on the baseline characteristics using multilevel mixed-effects logistic regression and assigning inverse probability of treatment weights for each participant, we used generalised linear model to estimate the effect of using the participatory working time scheduling software on employees’ control over scheduling of shifts, perceived workability, self-rated health, work-life conflict, psychological distress and short sleep (≤ 6 h). During a 2-year follow-up, using the participatory working time scheduling software reduced the risk of employees’ low control over scheduling of shifts (risk ratio [RR] 0.34; 95% CI 0.25–0.46), short sleep (RR 0.70; 95% CI 0.52–0.95) and poor workability (RR 0.74; 95% CI 0.55–0.99). The use of the software was not associated with changes in psychological distress, self-rated health and work-life conflict. In this observational study, we analysed as a pseudo-experiment, the use of participatory working time scheduling software was associated with increased employees’ perceived control over scheduling of shifts and improved sleep and self-rated workability.

The power of metabarcoding: Can we improve bioassessment and biodiversity surveys of stream macroinvertebrate communities?

Most stream bioassessment and biodiversity surveys are currently based on morphological identification of communities. However, DNA metabarcoding is emerging as a fast and cost-effective alternative for species identification. We compared both methods in a survey of benthic macroinvertebrate communities across 36 stream sites in northern Finland. We identified 291 taxa of which 62% were identified only by DNA metabarcoding. DNA metabarcoding produced extensive species level inventories for groups (Oligochaeta, Chironomidae, Simuliidae, Limoniidae and Limnephilidae), for which morphological identification was not feasible due to the high level of expertise needed. Metabarcoding also provided more insightful taxonomic information on the occurrence of three red-listed vulnerable or data deficient species, the discovery of two likely cryptic and potentially new species to Finland and species information of insect genera at an early larval stage that could not be separated morphologically. However, it systematically failed to reliably detect the occurrence of gastropods that were easily identified morphologically. The impact of mining on community structure could only be shown using DNA metabarcoding data which suggests that the finer taxonomic detail can improve detection of subtle impacts. Both methods generally exhibited similar strength of community-environment relationships, but DNA metabarcoding showed better performance with presence/absence data than with relative DNA sequence abundances. Our results suggest that DNA metabarcoding holds a promise for future anthropogenic impact assessments, although, in our case, the performance did not improve much from the morphological species identification. The key advantage of DNA metabarcoding lies in efficient biodiversity surveys, taxonomical studies and applications in conservation biology.

Measuring therapeutic engagement in finnish adult acute psychiatric in-patient care units using the finnish version of therapeutic engagement questionnaire (TEQ)

Introduction

The Therapeutic Engagement Questionnaire (TEQ) has been developed and validated in partnership with service users (SUs), registered mental health nurses (RMHNs) and nurse academics in the UK in accordance with psychometric theory. The TEQ is highly relevant and useful to clinical practice. The TEQ measures therapeutic engagement (TE) in two contexts - 1-1 interactions between SUs and RMHNs, as well as the overall environment and atmosphere of the units - from the perspective of both SUs and RMHNs. The TEQ has been translated into Finnish by two expert panels and was pre-tested and validated in ten adult acute psychiatric in-patient units in two hospitals in Finland.

Objectives

To measure TE in Finnish adult acute in-patient psychiatric settings from the perspectives of both SUs and RMHNs.

Methods

The Finnish version of the TEQ (Hoidollinen yhteistyö) will be completed by RMHNs and SUs in 15 adult acute psychiatric in-patient units. Nine of the units are within the University Hospital and six in a municipal psychiatric hospital. The data will be collected within a 3-month period (October - December 2020). The coordinating nurse of each unit will organise the operational side of the study including obtaining consent from SUs. The nurses will participate in the survey via Webropol which includes nurses’ consent. Sociodemographic information will be collected from the SUs and nurses.

Results

The results of the measurement study will be reported at the 29th European Congress of Psychiatry.

Conclusions

The conclusions of the measurement study will be reported at the 29th European Congress of Psychiatry.

Conflict of interest

This study is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London).

Assessing mining impacts: The influence of background geochemical conditions on diatom and macroinvertebrate communities in subarctic streams

Mining has changed landscapes locally in northern Fennoscandia and there is an increasing pressure for exploitation of the remaining mineral deposits of the region. Mineral deposits, even if unmined, can strongly influence stream water chemistry, stream biological communities and the ability of organisms to tolerate stressors. Using data sampled from six mining areas with three active (gold and chrome), two closed (gold) and one planned mine (phosphate), we examined how mineral deposits and mining influence water chemistry and diatom and macroinvertebrate communities in subarctic streams in Finnish Lapland. We supplemented the data by additional samples compiled from databases and further assessed how variation in background geological conditions influences bioassessments of the impacts arising from mining. We found that water specific conductivity was elevated in our study streams draining through catchments with a high mineral potential. Mining effects were mainly seen as increased concentration of nitrogen. Influence of mineral deposits was detected in composition of diatom and macroinvertebrate communities, but communities in streams in areas with a high mineral potential were as diverse as those in streams in areas with a low mineral potential. Mining impacts were better detected for diatoms using a reference condition based on sites with a high than low mineral potential, while for macroinvertebrates, the responses were generally less evident, likely because of only minor effects of mining on water chemistry. Community composition and frequencies of occurrence of macroinvertebrate taxa were, however, highly similar between mine-influenced streams and reference streams with a high potential for minerals indicating that the communities are strongly structured by the natural influence of mineral deposits. Incorporating geochemistry into the reference condition would likely improve bioassessments of both taxonomic groups. Replicated monitoring in potentially impacted sites and reference sites would be the most efficient framework for detecting environmental impacts in streams draining through mineral-rich catchments.

The effects of using participatory working time scheduling software on working hour characteristics and wellbeing: A quasi-experimental study of irregular shift work

BACKGROUND

Studies in the health care sector indicate that good work time control is associated with better perceived wellbeing but also with non-ergonomic work schedules, such as compressed work schedules. Participatory working time scheduling is a collaborative approach to scheduling shift work. Currently, there is a lack of information on whether working hour characteristics and employees' wellbeing in irregular shift work change after implementing participatory working time scheduling.

OBJECTIVE

To investigate the effects of using digital participatory working time scheduling software on working hour characteristics and well-being among Finnish hospital employees.

PARTICIPANTS AND METHODS

We compared changes in objective working hour characteristics and wellbeing between 2015 and 2017 among employees (n = 677, mainly nurses and practical nurses) when using participatory working time scheduling software (participatory scheduling, n = 283) and traditional shift scheduling (traditional scheduling, n = 394). The statistical analyses were conducted using the repeated measures general linear model and the generalized logit model for binomial and multinomial variables adjusted for age, sex, education, shift work experience, control over scheduling of shifts at baseline (where applicable) and hospital district.

RESULTS

The proportion of long work shifts (≥ 12 h) increased to a greater extent (F = 4.642, p = 0.032) with the participatory scheduling than with the traditional scheduling. In comparison to traditional scheduling, the perceived control over scheduling of shifts increased (OR 3.24, 95% CI 1.73-6.06) and excessive sleepiness in connection with evening shifts decreased (OR 0.40, 95% CI 0.16-0.99) significantly with participatory scheduling. None of the other wellbeing variables showed statistically significant changes in the adjusted models.

CONCLUSIONS

The proportion of long work shifts and perceived control over scheduling of shifts increased more among employees using participatory working time scheduling than among those using traditional scheduling. Otherwise, using participatory working time scheduling software had little effect on both objectively measured working hour characteristics and perceived wellbeing in comparison to traditional scheduling. The results merit confirmation in a larger sample with a longer follow-up. Tweetable abstract Participatory working time scheduling combines individual flexibility and staffing requirements in shift work.

Labor market outcomes before and after first episode of part-time sickness absence

Background

Previous research suggests that part-time sickness absence (PTSA) results in better work participation compared to full-time sickness absence (FTSA), but few studies have examined trends in FTSA and unemployment before and after PTSA.

Methods

This Finnish population-based cohort study included 3406 individuals with first episode (&gt;30 days) of PTSA in 2011 (=PTSA group), 42 510 individuals with FTSA (&gt;30 days) in 2011 (=FTSA group), and 25 167 individuals with no sickness absence (&gt;30 days) in 2011 from the general working-age population. Annual days of FTSA from 2007 to 2015 and unemployment from 2012 to 2015 were measured for the participants of each group. We modeled trends and relative risks for these labor market outcomes using negative binomial regression with generalized estimation equations.

Results

For the PTSA group, the adjusted mean annual number of FTSA days was 3 in the beginning of the follow-up, 15 a year before the index year, and 8-10 after the index year. The adjusted risk ratio (RR) of FTSA days after versus before PTSA was 1.95 (95% CI 1.75-2.17). For the FTSA group, mean of sickness absence days was 4 in the beginning, 13 a year before the index year and 9-19 after the index year. The mean of FTSA was 1-2 throughout the follow-up in the general population. An increasing slope in unemployment after the index year was observed in all groups, the absolute level of unemployment being highest among FTSA group and lowest among the general population group.

Conclusions

Long-term PTSA marks a decline in labour market participation. In absolute terms this decline is smaller than that in employees with long-term FTSA.

Key messages

Part-time sickness absence lasting &gt;30 days marked an increase in full-time sickness absence although the absence levels did not reach those observed after full-time sickness absence of &gt; 30 days. Our results show smaller impairment in labour market outcomes in employees granted a long-term part-time sickness absence than in those with long-term full-time sickness absence.

Riparian forests mitigate harmful ecological effects of agricultural diffuse pollution in medium-sized streams

Agricultural pollution persists as a significant environmental problem for stream ecosystems. Uncultivated buffer zones or reforestation of riparian zones are advocated as a key management option that could compensate the harmful land use impacts. The effectiveness of riparian forests to protect ecological conditions of agricultural streams is yet inconclusive, particularly regarding the benefit of riparian buffers in streams suffering from uninterrupted agricultural diffuse pollution. We studied the effects of riparian land use on periphyton production and diatom, macrophyte and benthic macroinvertebrate communities in medium-sized agricultural streams by a) comparing 18 open field and forested agricultural stream reach pairs that only differed by the extent of riparian forest cover, and b) comparing the agricultural reaches to 15 near-natural streams. We found that periphyton abundance was higher in open reaches than in the forested reaches, but diatom community structure did not respond to the riparian forest cover. Macrophyte and macroinvertebrate communities were clearly affected by the riparian forest cover. Graminoids dominated in open reaches, whereas bryophytes were more abundant in forested reaches. Shredding invertebrates were more abundant in forested reaches compared to open reaches, but grazers did not differ between the reach types. Macrophyte trait composition and macroinvertebrate community difference between the reaches were positively related to the difference in riparian forest cover. The community structure of all three groups in the agricultural streams differed distinctly from the near-natural streams. However, only macrophyte communities in forested agricultural reaches showed resemblance to near-natural composition. Our results suggest that riparian forests provide ecological benefits that can partly compensate the impacts of agricultural diffuse pollution. However, community structure of forested agricultural reaches did not match the near-natural composition in any organism group indicating that catchment-scale management and mitigation of diffuse pollution need to be still advocated to achieve ecological goals in stream management and restoration.

Combined effects of local habitat, anthropogenic stress, and dispersal on stream ecosystems: a mesocosm experiment

The effects of anthropogenic stressors on community structure and ecosystem functioning can be strongly influenced by local habitat structure and dispersal from source communities. Catchment land uses increase the input of fine sediments into stream channels, clogging the interstitial spaces of benthic habitats. Aquatic macrophytes enhance habitat heterogeneity and mediate important ecosystem functions, being thus a key component of habitat structure in many streams. Therefore, the recovery of macrophytes following in-stream habitat modification may be prerequisite for successful stream restoration. Restoration success is also affected by dispersal of organisms from the source community, with potentially the strongest responses in relatively isolated headwater sites that receive a limited amount of dispersing individuals. We used a factorial design in a set of stream mesocosms to study the independent and combined effects of an anthropogenic stressor (sand sedimentation), local habitat (macrophytes, i.e., moss transplants), and enhanced dispersal (two levels: high vs. low) on organic matter retention, algal accrual rate, leaf decomposition, and macroinvertebrate community structure. Overall, all responses were simple additive effects with no interactions between treatments. Sand reduced algal accumulation, total invertebrate density, and density of a few individual taxa. Mosses reduced algal accrual rate and algae-grazing invertebrates, but enhanced organic matter retention and the number of detritus and filter feeders. Mosses also reduced macroinvertebrate diversity by increasing the dominance by a few taxa. Mosses reduced leaf mass loss, possibly because the organic matter retained by mosses provided an additional food source for leaf-shredding invertebrates and thus reduced shredder aggregation into leaf packs. The effect of mosses on macroinvertebrate communities and ecosystem functioning was distinct irrespective of the level of dispersal, suggesting strong environmental control of community structure. The strong environmental control of macroinvertebrate community composition even under enhanced dispersal suggests that re-establishing key habitat features, such as natural stream vegetation, could aid ecosystem recovery in boreal streams.

Percutaneous transcatheter renal embolization with absolute ethanol for uncontrolled nephrotic syndrome: Case reports

Purpose: To retrospectively evaluate renal ethanol embolization in 2 patients with uncontrolled nephrotic syndrome.

Material and Methods: Three kidneys in 2 patients with uncontrolled nephrotic syndrome were embolized with absolute ethanol. The embolization technique, patient outcome and complications were analyzed retrospectively.

Results: The treatment was successful in both patients, with angiography-verified exclusion of blood flow to the renal arteries. Elimination of proteinuria was achieved in both patients and their body weight decreased by 25 and 10 kg, respectively. Hospitalization and protein substitution were no longer needed. No complications occurred.

Conclusion: Permanent bilateral ethanol embolization of the renal arteries is a feasible method of managing a treatment-resistant nephrotic syndrome in selected patients. Non-target embolization can be avoided by using a balloon occlusion catheter.

Disentangling the responses of boreal stream assemblages to low stressor levels of diffuse pollution and altered channel morphology

Non-point diffuse pollution from land use and alteration of hydromorphology are among the most detrimental stressors to stream ecosystems. We explored the independent and interactive effects of morphological channel alteration (channelization for water transport of timber) and diffuse pollution on species richness and community structure of four organism groups in boreal streams: diatoms, macrophytes, macroinvertebrates, and fish. Furthermore, the effect of these stressors on stream condition was evaluated by Ecological Quality Ratios (EQR) from the national Water Framework Directive (WFD) assessment system. We grouped 91 study sites into four groups that were impacted by either diffuse pollution or hydromorphological alteration, by both stressors, or by neither one. Macroinvertebrate richness was reduced by diffuse pollution, whereas other biological groups were unaltered. Hydromorphological modification had no effect on taxon richness of any of the assemblages. Community structure of all groups was significantly affected by diffuse pollution but not by hydromorphology. Similarly, EQRs indicated negative response by diatoms, macroinvertebrates and fish to diffuse pollution, but not to hydromorphological alteration. Agricultural diffuse pollution thus affected species identities and abundances rather than taxonomic richness. Our results suggest that channelization of boreal streams for timber transport has not altered hydromorphological conditions sufficiently to have a strong impact on stream biota, whereas even moderate nutrient enrichment may be ecologically harmful. Controlling diffuse pollution and associated land use stressors should be prioritized over restoration of in-stream habitat structure to improve the ecological condition of boreal streams.

Conversion electron spectrometry of Pu isotopes with a silicon drift detector

An electron spectrometry set-up was built at IRMM consisting of a vacuum chamber with a moveable source holder and windowless Peltier-cooled silicon drift detector (SDD). The SDD is well suited for measuring low-energy x rays and electrons emitted from thin radioactive sources with low self-absorption. The attainable energy resolution is better than 0.5keV for electrons of 30keV. It has been used to measure the conversion electron spectra of three plutonium isotopes, i.e. (238)Pu, (239)Pu, (240)Pu, as well as (241)Am (being a decay product of (241)Pu). The obtained mixed x-ray and electron spectra are compared with spectra obtained with a close-geometry set-up using another SDD in STUK and spectra measured with a Si(Li) detector at IRMM. The potential of conversion electron spectrometry for isotopic analysis of mixed plutonium samples is investigated. With respect to the (240)Pu/(239)Pu isotopic ratio, the conversion electron peaks of both isotopes are more clearly separated than their largely overlapping peaks in alpha spectra.

Production of pure samples of 131mXe and 135Xe

Pure samples of (131m)Xe, (133m)Xe, (133)Xe and (135)Xe facilitate the calibration and testing of noble gas sampler stations and related laboratory instrumentation. We have earlier reported a Penning trap-based production method for pure (133m)Xe and (133)Xe samples. Here we complete the work by reporting the successful production of pure (131m)Xe and (135)Xe samples using the same technique. In addition, we present data on xenon release from graphite.

Towards athermal organic-inorganic guided mode resonance filters

We demonstrate guided-mode resonance filters featuring an amorphous TiO(2) layer fabricated by atomic layer deposition on a polymeric substrate. The thermal properties of such filters are studied in detail by taking into account both thermal expansion of the structure and thermo-optic coefficients of the materials. We show both theoretically and experimentally that these two effects partially compensate for each other, leading to nearly athermal devices. The wavelength shift of the resonance reflectance peak (< 1 nm) is a small fraction of the peak width (~11 nm) up to temperatures exceeding the room temperature by tens of degrees centigrade.

Generating hypergeometric laser beams with a diffractive optical element

We derive explicit analytical relations to describe paraxial light beams that represent a particular case of the hypergeometric (HyG) laser beams [J. Opt. Soc. Am. A25, 262-270 (2008)JOAOD60740-323210.1364/JOSAA.25.000262]. Among these are modified quadratic Bessel-Gaussian beams, hollow Gaussian optical vortices, modified elegant Laguerre-Gaussian beams, and gamma-HyG beams. Using e-beam microlithography, a binary diffractive optical element capable of producing near-HyG beams is synthesized. Theory and experiment are in sufficient agreement. We experimentally demonstrate the ability to rotate dielectric microparticles using the bright diffraction ring of a HyG beam.

Design and investigation of color separation diffraction gratings

Color separation gratings (CSGs) are designed within the framework of the rigorous electromagnetic theory using a gradient method. The optimality of the scalar-theory-based solutions is estimated. The results of the experimental study of a CSG to separate three wavelengths are presented.

Diffraction of a plane, finite-radius wave by a spiral phase plate

We derive analytical expressions containing a hypergeometric function to describe the Fresnel and Fraunhofer diffraction of a plane wave of circular and ringlike cross section by a spiral phase plate (SPP) of an arbitrary integer order. Experimental diffraction patterns generated by an SPP fabricated in resist through direct e-beam writing are in good agreement with the theoretical intensity distribution.

UV-absorbing compounds in subarctic herbarium bryophytes

The UV-B-absorbing compounds of herbarium specimens of 10 subarctic bryophyte species collected during the years 1926-1996 and available at the Botanical Museum, University of Oulu, were studied. We studied whether herbarium specimens reflect changes in the past radiation climate through their methanol-extractable compounds. The order of gametophytes based on the average amount of total compounds (sum of A280-320 nm) per mass from the lowest to the highest was Polytrichum commune, Pleurozium schreberi, Hylocomium splendens, Sphagnum angustifolium, Dicranum scoparium, Funaria hygrometrica, Sphagnum fuscum, Sphagnum warnstorfii, Sphagnum capillifolium and Polytrichastrum alpinum, and the amount of UV-B-absorbing compounds per specific surface area correlated with the summertime daily global radiation and latitude. P. alpinum, F. hygrometrica and three Sphagnum species seem to be good indicators for further studies. The amount of UV-B-absorbing compounds revealed no significant trends from the 1920s till the 1990s, with the exception of S. capillifolium, which showed a significant decreasing trend.

Effects of abrupt surface-profile transitions in nonparaxial diffractive optics

It is shown that the failure of the thin-element approximation of diffractive optics may, in the first approximation, be attributed to local diffraction effects caused by the abrupt vertical transitions in binary surface-relief profiles. We determine the field disturbance caused by a single-step transition (of given height) by rigorous diffraction theory. Associating such a disturbance with each individual transition point in the profile, we obtain a computationally efficient refinement of the thin-element approximation for the analysis and design of diffractive elements in the nonparaxial domain. The results agree well with those obtained by global application of rigorous diffraction theory, provided that the smallest features in the binary profile are larger than approximately one optical wavelength.

Deterministic diffractive diffusers for displays

A LCD backlighting device that uses a diffractive light extractor has been developed for applications in which pointlike light sources are employed. The novel system eliminates the images of light sources, which appear as bright lines emanating from each source in the conventional diffractive approach. In addition, the system illuminates the LCD uniformly: Modulation of the diffractive structure as a function of position is used to control the output field of this extended planar light source.

Percutaneous transcatheter renal embolization with absolute ethanol for uncontrolled nephrotic syndrome. Case reports

PURPOSE

To retrospectively evaluate renal ethanol embolization in 2 patients with uncontrolled nephrotic syndrome.

MATERIAL AND METHODS

Three kidneys in 2 patients with uncontrolled nephrotic syndrome were embolized with absolute ethanol. The embolization technique, patient outcome and complications were analyzed retrospectively.

RESULTS

The treatment was successful in both patients, with angiography-verified exclusion of blood flow to the renal arteries. Elimination of proteinuria was achieved in both patients and their body weight decreased by 25 and 10 kg, respectively. Hospitalization and protein substitution were no longer needed. No complications occurred.

CONCLUSION

Permanent bilateral ethanol embolization of the renal arteries is a feasible method of managing a treatment-resistant nephrotic syndrome in selected patients. Non-target embolization can be avoided by using a balloon occlusion catheter.

High-efficiency production of propagation-invariant spot arrays

Tailoring of the transverse intensity profiles of propagation-invariant optical fields is considered. The design of diffractive elements capable of realizing such fields by Fourier synthesis is discussed. High-efficiency realization of finite-aperture approximations of the constructed fields is demonstrated in a system consisting of two multilevel diffractive elements. The first element is a diffractive toroidal lens, which focuses the incident field into a ring pattern. The second diffractive element, located at the focal plane of the first element, introduces the phase modulation necessary to realize the desired transverse intensity profile behind a separate collimating lens. The influence of the fabrication errors of the diffractive elements on the fidelity of the propagation-invariant spot array is simulated, and system-integration aspects based on substrate-mode planar-integrated optics are considered.

Electron-beam-fabricated asymmetric transmission gratings for microspectroscopy

Asymmetric transmission gratings operating in the resonance domain are designed by modeling of the dose-controlled electron-beam lithography process with Gaussian convolution. We aim to exceed some efficiency limit eta(s) over a specified spectral range and to maximize eta(s). The resultant continuous-profile gratings are fabricated by electron-beam lithography and proportional reactive-ion etching into SiO(2). We demonstrate gratings with good signal-to-noise ratio and a diffraction efficiency greater than 40% for wavelengths from 400 to 750 nm.

Paraxial-domain diffractive elements with 100% efficiency based on polarization gratings

The concept of polarization freedom is employed to design diffraction gratings that are capable of transforming an electromagnetic plane wave into two or three diffraction orders with an arbitrary efficiency distribution among them, such that the combined efficiency of the signal orders is always equal to 100%. As a special case we consider paraxial-domain duplicators and triplicators with 100% efficiency, which is not possible for illumination by scalar waves: Diffractive elements that are capable of performing the required wave transformation must modulate the state of polarization of the incident field.