title: Pupils with special educational needs in basic education schools and teachers' sickness absences--a register-linkage study.
abstract: OBJECTIVE
  We examined whether having a high percentage of pupils with special educational needs (SEN) in         basic education schools increases the risk of sickness absence among teachers and whether this risk is dependent on the         pupil-teacher ratio (PTR), an indicator of teacher resources at school.
  
  
  METHODS
  We obtained register data on         8089 teachers working in 404 schools in 10 municipalities in Finland during the school year 2004-2005. We used         multilevel multinomial regression models to examine the risk of teachers' short- and long-term sickness absence         in relation to the percentage of SEN pupils and the PTR at school. We tested the equality of trends in groups with high         and low PTR using PTR × SEN interaction term.
  
  
  RESULTS
  After adjustment for teacher and school characteristics,         the risk for long-term absences was higher among teachers at schools with a high percentage of SEN pupils than among         teachers at schools with a low percentage of SEN pupils [odds ratio (OR) 1.5, 95% confidence interval (95% CI)         1.2-1.8). This was also the case for short-term absences (OR 1.4, 95% CI 1.2-1.7). In analyses stratified         by the PTR levels, the association between the percentage of SEN pupils and long-term absences was 15% higher among         teachers with a high PTR than among those with a low PTR (P for interaction=0.10).
  
  
  CONCLUSIONS
  Teachers'         sickness absenteeism seems to increase with a higher percentage of SEN pupils, especially when the PTR is high. Teacher         resources at schools that have a high percentage of SEN pupils should be well maintained to ensure the health of         teachers.
authors.affiliation: Finnish Institute of Occupational Health, Centre of Expertise for Work Organizations, Helsinki, Finland. jenni.ervasti@ttl.fi
authors.forename: Jenni
authors.initials: J
authors.lastname: Ervasti
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Kirsi
authors.initials: K
authors.lastname: Ahola
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.forename: Tiina
authors.initials: T
authors.lastname: Pohjonen
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D016001:Confidence Intervals; D004519:Education, Special / Q000706:statistics & numerical data*; D005178:Faculty / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data*; D016273:Occupational Exposure / Q000009:adverse effects; D016272:Occupational Health / Q000706:statistics & numerical data; D016017:Odds Ratio; D012042:Registries; D012044:Regression Analysis; D018582:Sick Leave / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D013334:Students / Q000706:statistics & numerical data*; D013663:Teaching / Q000706:statistics & numerical data