Ajanhallintaa : Oikeuttamisen logiikat akateemisen työajan kohdentamisjärjestelmän perusteluissa ja kritiikissä

Pro gradu -tutkielman tutkimuskysymyksenä on, mihin oikeuttamisen logiikoihin akateemisen työajan kohdentamisjärjestelmää koskevassa julkisessa keskustelussa vedotaan ja miten nämä perustelut tukeutuvat toiminnan ja toimijoiden arvoa määrittäviin valtapiireihin. Tavoitteena on ymmärtää konfliktia julkisessa keskustelussa erittelemällä, mihin taustaoletuksiin eriävät näkemykset perustuvat, ja kuinka näitä taustalogiikoita käytetään argumentaatiossa kompromissinomaisesti perustelujen ja kritiikin tukena. Erityisesti keskitytään Helsingin yliopiston Sole Time Management -järjestelmään, jossa akateemiset työntekijät jakavat työaikansa projekteille ja tehtäville. Miten siis ajankäyttöä ajetaan itsehallinnoimaan erittelemällä toimintoja niihin käytetyn kellonajan mukaan ja miten tuota logiikkaa vastustetaan julkisessa keskustelussa? Pääasiallisena aineistona ovat SoleTM-työajan kohdentamisjärjestelmään linkittyvää Helsingin yliopiston ohjeistusta sekä järjestelmän taustalta löytyvä valtiovarainministeriön Yhteisrahoitteisen kokonaiskustannusmallin loppuraportti. Tähän aineistopakettiin viittaan termillä hallinnollinen puhe. Toinen aineistopaketti koostuu työajan kohdentamisjärjestelmään liittyvästä julkisesta keskustelusta. Keskusteluaineisto koostuu lähinnä lehtijulkaisuista ja blogikirjoituksista. Menetelmänä on kvalitatiivinen sisällönanalyysi, jossa tulkinta rakentuu teorian ja empirian välisessä dialogissa. Keskeisimpänä analyyttisenä välineenä käytetään Boltanskin ja Thévenot’n teoriaa oikeuttamisen logiikoista ja niille soveltuvista testeistä. Tämän tutkielman tuloksena analysoidaan, miten työajan kohdentamisjärjestelmää implisiittisesti ja eksplisiittisesti perustellaan tukeutumalla paitsi teolliseen myös verkostoiden oikeuttamisen logiikkaan. Järjestelmän esitetään mittaavan sekä todellista aikaa että todellista työtä. Vastuuta järjestelmästä ulkoistetaan esittämällä, että se vastaa kaikkien toimijoiden tarpeisiin. Lisäksi tutkielmassa eritellään, kuinka valtapiirien logiikkaa vastustetaan akateemisella kentällä inspirationaaliseen valtapiiriin tukeutuen. Keskeistä on puhe toimijuuden katoamisesta. Työtä määrittelemään esitetään työajan kohdentamisjärjestelmästä eriävänä teollisena testinä työn tulosten arvioimista. Tutkielma erittelee kontrastia ja myös kompromisseja eri valtapiirien ideaalien välillä: ennen kaikkea luovan vapauden suhdetta ensisijaisesti teolliseen logiikkaan tukeutuvaan työajan kohdentamisjärjestelmään

A detection dog for obstructive sleep apnea : could it work in diagnostics?

Purpose We have previously demonstrated that dogs can be trained to distinguish the urine of patients with obstructive sleep apnea (OSA) from that of healthy controls based on olfaction. Encouraged by these promising results, we wanted to investigate if a detection dog could work as a screening tool for OSA. The objective of this study was to prospectively assess the dogs' ability to identify sleep apnea in patients with OSA suspicion. Methods Urine samples were collected from 50 patients suspected of having OSA. The urine sample was classified as positive for OSA when the patient had a respiratory event index of 5/h or more. The accuracy of two trained dogs in identifying OSA was tested in a prospective blinded setting. Results Both of the dogs correctly detected approximately half of the positive and negative samples. There were no statistically significant differences in the dogs' ability to recognize more severe cases of OSA, as compared to milder cases. Conclusion According to our study, dogs cannot be used to screen for OSA in clinical settings, most likely due to the heterogenic nature of OSA.Peer reviewe

Working hours, on-call shifts, and risk of occupational injuries among hospital physicians : A case-crossover study

Objective To investigate the association of hospital physicians' working hours and on-call shifts with the risk of occupational injuries. Methods In this nested cohort study of 556 Finnish hospital physicians, we linked electronic records from working-hour and on-call duty payroll data to occupational injury data obtained from the Finnish Workers' Compensation Center for the period 2005-2019. We used a case-crossover design with matched intervals for a 7-day 'case window' immediately prior to occupational injury and a 'control window' 7 days prior to the beginning of the case window, and analyzed their associations using conditional logistic regression models. Results We noted 556 occupational injuries, 281 at the workplace and 275 while commuting. Having three to four long (>12 h) work shifts on the preceding 7 days was associated with a higher probability of an occupational injury (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11, 4.09), and the OR for three to four on-call shifts was 3.54 (95%CI 2.11, 5.92) in comparison to having none of these work shift types. A higher number of several consecutive working days was associated with a higher probability of injury in a dose-response manner. Moreover, increasing weekly working hours was associated with an increased likelihood of injury (OR 1.03, 95%CI 1.01, 1.04), whereas the number of normal (24 h) work shifts, may increase the risk of occupational injury among hospital physicians.Peer reviewe

Length of exposure to long working hours and night work and risk of sickness absence : a register-based cohort study

Background There is inconsistent evidence that long working hours and night work are risk factors for sickness absence, but few studies have considered variation in the length of exposure time window as a potential source of mixed findings. We examined whether the association of long working hours and night work with sickness absence is dependent on the length of exposure to the working hour characteristics. Methods We analysed records of working hours, night work and sickness absence for a cohort of 9226 employees in one hospital district in Finland between 2008 and 2019. The exposure time windows ranged from 10 to 180 days, and we used Cox's proportional hazards models with time-dependent exposures to analyse the associations between working-hour characteristics and subsequent sickness absence. Results Longer working hours for a period of 10 to 30 days was not associated with the risk of sickness absence whereas longer working hours for a period of 40 to 180 days was associated with a lower risk of sickness absence. Irrespective of exposure time window, night work was not associated with sickness absence. Conclusions It is important to consider the length of exposure time window when examining associations between long working hours and sickness absence, whereas the association between night work and sickness absence is not similarly sensitive to exposure times.Peer reviewe

Association of working hour characteristics and on-call work with risk of short sickness absence among hospital physicians : A longitudinal cohort study

Publisher Copyright: © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.Physicians often work long hours and on-call shifts, which may expose them to circadian misalignment and negative health outcomes. However, few studies have examined whether these working hour characteristics, ascertained using objective working hour records, are associated with the physicians’ risk of sickness absence. We investigated the associations of 14 characteristics of payroll-based working hours and on-call work with the risk of short sickness absence among hospital physicians. In this cohort study, 2845 physicians from six Finnish hospital districts were linked to electronic payroll-based records of daily working hours, on-call duty and short (1–3 days) sickness absence between 2005 and 2019. A case-crossover design was applied using conditional logistic regression with the 28 day case and control windows to estimate odds ratios (ORs) and 95% confidence intervals (CI) for short sickness absence. After controlling for weekly working hours and the number of normal (≤12 h) shifts, a higher number of long (>12 h) shifts (ORs for ≥5 versus none: 2.54, 95% CI 1.68–3.84), very long (>24 h) shifts (ORs for ≥5 versus none: 2.62, 95%CI 1.61–4.27), and on-call shifts (OR for ≥5 versus none: 2.15, 95% CI 1.44–3.21) and a higher number of short (<11 h) shift intervals (OR for ≥5 versus none: 12.61, 95% CI 8.88–17.90) were all associated with the increased risk of short sickness absence. These associations did not differ between male and female physicians or between age groups. To conclude, the findings from objective working hour records show that long work shifts, on-call shifts and short shift intervals are related to the risk of short (1–3 days) sickness absence among hospital physicians.Peer reviewe

Association of working hour characteristics and on-call work with risk of short sickness absence among hospital physicians : A longitudinal cohort study

Publisher Copyright: © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.Physicians often work long hours and on-call shifts, which may expose them to circadian misalignment and negative health outcomes. However, few studies have examined whether these working hour characteristics, ascertained using objective working hour records, are associated with the physicians’ risk of sickness absence. We investigated the associations of 14 characteristics of payroll-based working hours and on-call work with the risk of short sickness absence among hospital physicians. In this cohort study, 2845 physicians from six Finnish hospital districts were linked to electronic payroll-based records of daily working hours, on-call duty and short (1–3 days) sickness absence between 2005 and 2019. A case-crossover design was applied using conditional logistic regression with the 28 day case and control windows to estimate odds ratios (ORs) and 95% confidence intervals (CI) for short sickness absence. After controlling for weekly working hours and the number of normal (≤12 h) shifts, a higher number of long (>12 h) shifts (ORs for ≥5 versus none: 2.54, 95% CI 1.68–3.84), very long (>24 h) shifts (ORs for ≥5 versus none: 2.62, 95%CI 1.61–4.27), and on-call shifts (OR for ≥5 versus none: 2.15, 95% CI 1.44–3.21) and a higher number of short (<11 h) shift intervals (OR for ≥5 versus none: 12.61, 95% CI 8.88–17.90) were all associated with the increased risk of short sickness absence. These associations did not differ between male and female physicians or between age groups. To conclude, the findings from objective working hour records show that long work shifts, on-call shifts and short shift intervals are related to the risk of short (1–3 days) sickness absence among hospital physicians.Peer reviewe

Concurrent trajectories of self-rated health and working hour patterns in health care shift workers : A longitudinal analysis with 8-year follow-up

BackgroundThe association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (workingPeer reviewe

Labor Market Participation Before and After Long-Term Part-Time Sickness Absence in Finland A Population-Based Cohort Study

Objective: To examine trends in labor market participation among those with long-term part-time or long-term full-time sickness absence. Methods: Finnish population-based cohort study including 3406 individuals with greater than 30-day part-time sickness absence in 2011 and 42,944 individuals with greater than 30-day full-time sickness absence in 2011. Results: Compared to previous years, the rates of sickness absence and vocational rehabilitation increased after 2011 in both groups. Sickness absence rate was higher in 2012 in the full-time sickness absence group than in the part-time sickness absence group. An increasing trend in unemployment after 2011 was observed in both groups, but the absolute level of unemployment was higher in the full-time sickness absence group. Conclusion: Long-term part-time sickness absence seems to mark a decline in labor market participation, but the decline is smaller than that in employees with full-time sickness absence.Peer reviewe

Association of nurse understaffing and limited nursing work experience with in-hospital mortality among patients: A longitudinal register-based study

BACKGROUND: Although nurse understaffing and limited nursing work experience may affect hospital patients' risk of mortality, relatively little longitudinal patient-level evidence on these associations is available. Hospital administrative data could provide important information about the level of staffing, nurses' work experience and patient mortality over time. OBJECTIVE: To examine whether daily exposure to nurse understaffing and limited nursing work experience is associated with patient mortality, using patient-level data with different exposure time windows and accounting for several patient-related characteristics. METHODS: This longitudinal register-based study combined administrative data on patients (clinical database Auria) and employees (Titania® shift-scheduling) from one hospital district in Finland in 2013-2019, covering a total of 254,446 hospital stays in 40 units. We quantified nurse understaffing as the number of days with low nursing hours in relation to target hours (3 years of in-hospital experience, and those aged over 25 (<90 % of the annual unit median). We used two survival model designs to analyze the associations between nurse understaffing and limited nursing work experience and the in-hospital mortality of the patients: we considered these exposures during the first days in hospital and as a cumulative proportion of days with suboptimal staffing during the first 30 days. RESULTS: In total, 1.5 % (N = 3937) of the hospital stays ended in death. A 20 % increase in the proportion of days with nurse understaffing was associated with an increased, 1.05-fold mortality risk at the patient level (95 % confidence interval, 1.01-1.10). The cumulative proportion of days with limited nursing work experience, or the combination of nurse understaffing and limited work experience were not associated with increased risk of death among all patients. However, both indicators of limited nursing work experience were associated with an increased mortality risk among patients with comorbidities (HR 1.05, 95 % CI 1.02-1.08 and HR 1.05, 95 % CI 1.00-1.10, respectively). CONCLUSIONS: Nurse understaffing was associated with a slight, but a potentially critical increase in patient in-hospital mortality. Limited nursing work experience was associated with increased in-hospital mortality in a subgroup of patients with comorbidities. Increased use of administrative data on planned and realized working hours could be a routine tool for reducing avoidable in-hospital mortality

Working hour patterns and risk of occupational accidents : an optimal matching analysis in a hospital employee cohort

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