Cancer survivors at work : Work-related problems and factors associated with their employment, work ability and social support from the work community

Due to the improved prognosis of many forms of cancer, an increasing number of cancer survivors are willing to return to work after their treatment. It is generally believed, however, that people with cancer are either unemployed, stay at home, or retire more often than people without cancer. This study investigated the problems that cancer survivors experience on the labour market, as well as the disease-related, sociodemographic and psychosocial factors at work that are associated with the employment and work ability of cancer survivors. The impact of cancer on employment was studied combining the data of Finnish Cancer Registry and census data of the years 1985, 1990, 1995 or 1997 of Statistics Finland. There were two data sets containing 46 312 and 12 542 people with cancer. The results showed that cancer survivors were slightly less often employed than their referents. Two to three years after the diagnosis the employment rate of the cancer survivors was 9% lower than that of their referents (64% vs. 73%), whereas the employment rate was the same before the diagnosis (78%). The employment rate varied greatly according to the cancer type and education. The probability of being employed was greater in the lower than in the higher educational groups. People with cancer were less often employed than people without cancer mainly because of their higher retirement rate (34% vs. 27%). As well as employment, retirement varied by cancer type. The risk of retirement was twofold for people having cancer of the nervous system or people with leukaemia compared to their referents, whereas people with skin cancer, for example, did not have an increased risk of retirement. The aim of the questionnaire study was to investigate whether the work ability of cancer survivors differs from that of people without cancer and whether cancer had impaired their work ability. There were 591 cancer survivors and 757 referents in the data. Even though current work ability of cancer survivors did not differ between the survivors and their referents, 26% of cancer survivors reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organization, or a good social climate at work, reported impairment less frequently. The aim of the other questionnaire study containing 640 people with the history of cancer was to examine extent of social support that cancer survivors needed, and had received from their work community. The cancer survivors had received most support from their co-workers, and they hoped for more support especially from the occupational health care personnel (39% of women and 29% of men). More support was especially needed by men who had lymphoma, had received chemotherapy or had a low education level. The results of this study show that the majority of the survivors are able to return to work. There is, however, a group of cancer survivors who leave work life early, have impaired work ability due to their illness, and suffer from lack of support from their work place and the occupational health services. Treatment-related, as well as sociodemographic factors play an important role in survivors' work-related problems, and presumably their possibilities to continue working.

Microeconometric Studies on Unemployment and Business Cycles

Väitöskirja koostuu neljästä esseestä, joissa tutkitaan empiirisen työntaloustieteen kysymyksiä. Ensimmäinen essee tarkastelee työttömyysturvan tason vaikutusta työllistymiseen Suomessa. Vuonna 2003 ansiosidonnaista työttömyysturvaa korotettiin työntekijöille, joilla on pitkä työhistoria. Korotus oli keskimäärin 15 % ja se koski ensimmäistä 150 työttömyyspäivää. Tutkimuksessa arvioidaan korotuksen vaikutus vertailemalla työllistymisen todennäköisyyksiä korotuksen saaneen ryhmän ja vertailuryhmän välillä ennen uudistusta ja sen jälkeen. Tuloksien perusteella työttömyysturvan korotus laski työllistymisen todennäköisyyttä merkittävästi, keskimäärin noin 16 %. Korotuksen vaikutus on suurin työttömyyden alussa ja se katoaa kun oikeus korotettuun ansiosidonnaiseen päättyy. Toinen essee tutkii työttömyyden pitkän aikavälin kustannuksia Suomessa keskittyen vuosien 1991 – 1993 syvään lamaan. Laman aikana toimipaikkojen sulkeminen lisääntyi paljon ja työttömyysaste nousi yli 13 prosenttiyksikköä. Tutkimuksessa verrataan laman aikana toimipaikan sulkemisen vuoksi työttömäksi jääneitä parhaassa työiässä olevia miehiä työllisinä pysyneisiin. Työttömyyden vaikutusta tarkastellaan kuuden vuoden seurantajaksolla. Vuonna 1999 työttömyyttä laman aikana kokeneen ryhmän vuosiansiot olivat keskimäärin 25 % alemmat kuin vertailuryhmässä. Tulojen menetys johtui sekä alhaisemmasta työllisyydestä että palkkatasosta. Kolmannessa esseessä tarkastellaan Suomen 1990-luvun alun laman aiheuttamaa työttömyysongelmaa tutkimalla työttömyyden kestoon vaikuttavia tekijöitä yksilötasolla. Kiinnostuksen kohteena on työttömyyden rakenteen ja työn kysynnän muutoksien vaikutus keskimääräiseen kestoon. Usein oletetaan, että laman seurauksena työttömäksi jää keskimääräistä huonommin työllistyviä henkilöitä, jolloin se itsessään pidentäisi keskimääräistä työttömyyden kestoa. Tuloksien perusteella makrotason kysyntävaikutus oli keskeinen työttömyyden keston kannalta ja rakenteen muutoksilla oli vain pieni kestoa lisäävä vaikutus laman aikana. Viimeisessä esseessä tutkitaan suhdannevaihtelun vaikutusta työpaikkaonnettomuuksien esiintymiseen. Tutkimuksessa käytetään ruotsalaista yksilötason sairaalahoitoaineistoa, joka on yhdistetty populaatiotietokantaan. Aineiston avulla voidaan tutkia vaihtoehtoisia selityksiä onnettomuuksien lisääntymiselle noususuhdanteessa, minkä on esitetty johtuvan esim. stressin tai kiireen vaikutuksesta. Tuloksien perusteella työpaikkaonnettomuudet ovat syklisiä, mutta vain tiettyjen ryhmien kohdalla. Työvoiman rakenteen vaihtelu saattaa selittää osan naisten onnettomuuksien syklisyydestä. Miesten kohdalla vain vähemmän vakavat onnettomuudet ovat syklisiä, mikä saattaa johtua strategisesta käyttäytymisestä.

Studies on Wage Differentials and Labour Market Transitions

This thesis consists of four studies. The first study examines wage differentials between women and men in the Finnish manufacturing sector. A matched employer-employee data set is used to decompose the overall gender wage gap into the contributions of sex differences in human capital, labour market segregation, and residual within-job wage differentials. The topic of the second study is the relationship between the extended unemployment benefits and labour market transitions of older workers. The analysis exploits a quasi-experimental setting caused by a change in the law that raised the eligibility age of workers benefiting from extended benefits. Roughly half of the unemployed workers with extended benefits are estimated to be effectively withdrawn from labour market search. The risk of unemployment declined and the re-employment probability increased among the age groups directly affected by the reform. The third study provides an empirical analysis of a structural equilibrium search model. Estimation results from various model specifications are compared and discussed. The last study is a methodological study where the difficulties of interpreting the results of competing risks hazard models are discussed and a solution for a particular class of models is proposed. It is argued that a common practice of reporting the results of qualitative response models in terms of marginal effects is also useful in the context of competing risks duration models.

Not in all Walks of Life? : Social Differences in Suicide Mortality

In Finland, the suicide mortality trend has been decreasing during the last decade and a half, yet suicide was the fourth most common cause of death among both Finnish men and women aged 15 64 years in 2006. However, suicide does not occur equally among population sub-groups. Two notable social factors that position people at different risk of suicide are socioeconomic and employment status: those with low education, employed in manual occupations, having low income and those who are unemployed have been found to have an elevated suicide risk. The purpose of this study was to provide a systematic analysis of these social differences in suicide mortality in Finland. Besides studying socioeconomic trends and differences in suicide according to age and sex, different indicators for socioeconomic status were used simultaneously, taking account of their pathways and mutual associations while also paying attention to confounding and mediatory effects of living arrangements and employment status. Register data obtained from Statistics Finland were used in this study. In some analyses suicides were divided into two groups according to contributory causes of death: the first group consisted of suicide deaths that had alcohol intoxication as one of the contributory causes, and the other group is comprised of all other suicide deaths. Methods included Poisson and Cox regression models. Despite the decrease in suicide mortality trend, social differences still exist. Low occupation-based social class proved to be an important determinant of suicide risk among both men and women, but the strong independent effect of education on alcohol-associated suicide indicates that the roots of these differences are probably established in early adulthood when educational qualifications are obtained and health-behavioural patterns set. High relative suicide mortality among the unemployed during times of economic boom suggests that selective processes may be responsible for some of the employment status differences in suicide. However, long-term unemployment seems to have causal effects on suicide, which, especially among men, partly stem from low income. In conclusion, the results in this study suggest that education, occupation-based social class and employment status have causal effects on suicide risk, but to some extent selection into low education and unemployment are also involved in the explanations for excess suicide mortality among the socially deprived. It is also conceivable that alcohol use is to some extent behind social differences in suicide. In addition to those with low education, manual workers and the unemployed, young people, whose health-related behaviour is still to be adopted, would most probably benefit from suicide prevention programmes.

Women and their Agency in the Neo-Assyrian Empire

Tämä pro gradu-työ käsittelee naisten toimijuutta uusassyrialaisessa imperiumissa. Toisin sanoen työssä tutkitaan naisten vaikutusmahdollisuuksia assyrialaisessa, patriarkaalisessa yhteiskunnassa – aihe, johon ei aiemmin ole juurikaan kiinnitetty huomiota. Täydennän työssä assyriologista näkökantaa kulttuuritieteiden ja antropologian käsitteistöllä ja teorioilla. Työn teoreettinen viitekehys liittyy yksilön, yhteiskunnan ja vallan välisiin suhteisiin, jotka kohtaavat toimijuuden käsitteessä. Vaikka työssä esittelen toimijuuden käsitettä laajemminkin, päädyin aineiston asettamien rajoitusten takia määrittelemään toimijuuden seuraavasti: toimijoita ovat ne naiset, jotka toimivat aktiivisina subjekteina yhteiskunnassa. Näin määritellyt toimijat jaoin vielä kahteen ryhmään, eksplisiittisiin (explicit agents) ja implisiittisiin (implicit agents) toimijoihin. Ensimmäisen ryhmän jäsenet selkeästi toimivat teksteissä jollain tavalla, jälkimmäisen ryhmän jäsenten toimijuus on pääteltävä asiayhteydestä. Pro graduni perustuu laajan tekstiaineiston analyysiin. Jaan imperiumin toimijanaiset kolmeen laajaan ryhmään: palatsissa, temppelissä ja niiden ulkopuolella toimineisiin naisiin. Jokaisen näistä kolmesta ryhmästä jaan vielä useisiin alaryhmiin, useimmiten ammattinimikkeen tai arvonimen mukaan. Suurimmaksi ryhmäksi osoittautuivat palatsissa toimineet naiset. Heistä erityisen aktiivisia olivat šakintut, jotka hoitivat vastuullisia hallinnollisia tehtäviä palatseissa. Myös kuningatarten ja muiden kuninkaallisten naisten rooli toimijoina oli uusassyrialaisella kaudella merkittävä. Temppeleissä toimineista naisista merkittävin ryhmä toimijuuden kannalta olivat naispuoliset profeetat, jotka toimivat aktiivisissa rooleissa ainakin toimittaessaan jumalallisia sanomia. Palatsien ja temppelien ulkopuolelle jäi vain vähän naistoimijoita: omaksi selkeäksi ryhmäkseen erottuivat ainoastaan harimtut, prostituoidut. Lopuksi pohdin jokaisen ryhmän toimijuutta ensin taulukkomuodossa (taulukot 9, 10 ja 11) sitten lyhyessä analyysikappaleessa.

Playing "Nordic": The Women of Niskavuori, Agri/Culture, and Imagining Finland on the Third Reich Stage

The theatrical censorship of the Third Reich considered the playwright's race and politics alongside the content of the drama. Given the political stigma of its "leftist" author, it is rather surprising that Hella Wuolijoki's Niskavuoren naiset opened in 1938 at the Staatliches Schauspielhaus in Hamburg. The play ran for fourteen performances before being closed by the Reichsdramaturgie, apparently at the instigation of Finnish critics. Yet this was not the end of the play's or its author's fortunes in the Third Reich, as the possibility of staging the play was raised several times over the next four years, coming to a close in 1942. Playing "Nordic" examines the ideological and theatrical background of this extended "cultural performance," as a means to reopening and reconstructing the work of the 1938 Die Frauen auf Niskavuori. Written by a Finnish, northern, "Nordic" author, and preoccupied with the dynamics of rural culture in an increasingly urbanized world, Niskavuoren naiset was understood in the Third Reich to illustrate and reinforce the racial, agri/cultural themes of Blut und Boden ("veri ja maa"). Playing "Nordic" examines this thematic relationship in three phases. The first phase uses archival materials to investigate the Reichsdramaturgie's understanding of the play and its author, and its ongoing discussion of Wuolijoki from 1937 to 1942. Play evaluator Sigmund Graff's description of Niskavuoren naiset as hamsunartig, or "Hamsun-esque," inspires the second phase of the dissertation, which first elaborates the meanings of Blut und Boden through a reading of contemporary "racial" theory and anthropology, and then assesses the representation of Finland within this discourse, one of the dominant cultural paradigms of the Third Reich. Imaging Finland for German audiences, the play stood among analogous, continued efforts to represent Finland and the rural life in the Third Reich, colored by Blut und Boden: art and agricultural exhibitions, essays and propaganda literature, mass demonstrations of the peasantry. This wider framework for the performance of "Finland" materializes the abstract or theoretical program of Blut und Boden in its everyday performed meanings; as such it provides the essential background for reading the Hamburg production of Die Frauen auf Niskavuori, which sustains the third and final phase. The German translation and the Hamburg photographic record are compared with the Helsinki premiere to assess the impact of Blut und Boden on the representation of Wuolijoki's play in the Third Reich. The journalistic critical response illuminates the effect that the dramatic complex of rural and racial values - generically identified as Bauerndrama in the Third Reich - had on the reception of the play; at the same time, both visual and critical documents also suggest possible moments of theatrical dissent in the Hamburg production. Playing "Nordic" undertakes a documentary and cultural reading of the changing theatrical meanings of Wuolijoki's Niskavuoren naiset as it crossed the frontier from Finland to the stage of the Third Reich. It also provides a model for the ways theatrical signification operates within a network of cultural and ideological meanings, suggesting the ideological work of theatrical production depends on, reinforces, and contests that tissue of values. Although Finnish criticism of Niskavuoren naiset has assumed the play's Blut und Boden resonance contributed to Wuolijoki's success in the Third Reich, this study shows a considerably more complex situation. This revealing production dramatizes the changing uses of plays in a politicized national and transnational context. As part of the framing of "Nordic" identity on the wider stage of the Third Reich, Die Frauen auf Niskavuori exemplifies the conjunction of concurrent - sometimes independent, sometimes interlocking - "racial" and national ideologies.

Sovelletun rentoutuksen vaikutus psyykkiseen työhyvinvointiin ja sykevaihteluun

Research reveals that more than every fourth Finn experiences work-related exhaustion to some degree. Stress and exhaustion have psychological and physical expressions. The main physical factor in stress is the overloading of the autonomic nervous system, which can be measured for instance by variations of heart rate. Studies show that the work field, management and authority of the work, skill developmental possibilities, and social support inhibit stress overload. The practising of self-relaxation techniques possible inhibits working stress and exhaustion. In this study of preventive rehabilitation, the focus was on the effects of the training of applied relaxation on psychological and physiological variables of stress and empowerment of resources. Participants (n=73) were basically healthy and capable of working, 25-40 of age, workers from the field of mental work. They practised applied relaxation under group conduction for seven weeks. The aim was to learn to relax easily even in everyday occasions. The subjects were tested thirdly. After the first measurement, they were grouped into two groups, of which the first group started the relaxation training. The second group began practising half a year after the second measurement. The third measurement was done one year after the beginning of the study. It was hypothesised that the training of applied relaxation would significantly reduce stress on both psychological and physiological variables and that these variables would correlate positively. Results revealed that the training of applied relaxation reduced psychological stress symptoms rather modestly. The changes were more significant in women, who experienced a slight increase in self-directivity. Physical changes were slight decreases of the sympathetic activation. The correlations of psychological and physiological variables were modest. Some changes were reduced after the active training. There was a positive interrelation between experienced work-related demands of efficiency, insufficient social support and exhaustion. There was a tendency to significance between skill developmental possibilities and psychological stress symptoms. Further implications of the results were discussed.

Gone with the Wind? : Immigrant Women and Transnational Everyday Life in Finland

Increased mass migration, as a result of economic hardship, natural disasters and wars, forces many people to arrive on the shores of cultures very different from those they left. How do they manage the legacy of the past and the challenges of their new everyday life? This is a study of immigrant women living in transnational families that act and communicate across national borders on a near-daily basis. The research was carried out amongst immigrant women who were currently living in Finland. The research asks how transnational everyday life is constructed. As everyday life, due to its mundane nature, is difficult to operationalise for research purposes, mixed data collection methods were needed to capture the passing moments that easily become invisible. Thus, the data were obtained from photographic diaries (459 photographs) taken by the research participants themselves. Additionally, stimulated recall discussions, structured questionnaires and participant observation notes were used to complement the photographic data. A tool for analysing the activities devealed in the data was created on the assumption that a family is an active unit that accommodates the current situation in which it is embedded. Everyday life activities were analysed emphasizing social, modal and spatial dimensions. Important daily moments were placed on a continuum: for me , for immediate others and with immediate others . They portrayed everyday routines and exceptions to it. The data matrix was developed as part of this study. The spatial dimensions formed seven units of activity settings: space for friendship, food, resting, childhood, caring, space to learn and an orderly space. Attention was also paid to the accommodative nature of activities; how women maintain traditions and adapt to Finnish life or re-create new activity patterns. Women s narrations revealed the importance of everyday life. The transnational chain of women across generations and countries, comprised of the daughters, mothers and grandmothers was important. The women showed the need for information technology in their transnational lives. They had an active relationship to religion; the denial or importance of it was obvious. Also arranging one s life in Finnish society was central to their narrations. The analysis exposed everyday activities, showed the importance of social networks and the uniqueness of each woman and family. It revealed everyday life in a structured way. The method of analysis that evolved in this study together with the research findings are of potential use to professionals, allowing the targeting of interventions to improve the everyday lives of immigrants.