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  • 1.
    Airaksinen, Jaakko
    et al.
    Medicum, University of Helsinki, Finland.
    Pentti, Jaana
    Clinicum, University of Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland / Turku University Hospital, Finland.
    Kivimäki, Mika
    Clinicum, University of Helsinki, Finland / Department of Epidemiology and Public Health, University College, London, UK.
    An Example of How Immortal Time Bias Can Reverse the Results of an Observational Study2020In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 31, no 2, p. e19-e20Article in journal (Refereed)
  • 2.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). The Research School of Health and Welfare, Jönköping University, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku and Turku University Hospital, Finland.
    Augustine, Lilly
    CHILD, School of Learning and Communication, Jönköping University, Sweden.
    Saarinen, Maiju M.
    Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Aromaa, Minn
    Department of Public Health, University of Turku and Turku University Hospital, Finland ; City of Turku Welfare Division, Finland.
    Rautava, Päivi
    Department of Public Health, University of Turku and Turku University Hospital, Finland ; Clinical Research Centre, Turku University Hospital, Finland.
    Sourander, André
    Department of Child Psychiatry, University of Turku, Finland ; Department of Child Psychiatry, Turku University Hospital, Finland.
    Sillanpää, Matti
    Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Teenagers’ mental health problems predict probable mental diagnosis 3 years later among girls, but what about the boys?2022In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 16, no 1, p. 1-10, article id 41Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of mental disorders is increasing, and there seems to be a gender difference in prevalence, with girls reporting more mental health problems than boys, especially regarding internalizing problems. Most mental disorders debut early but often remain untreated into adulthood. Early detection of mental disorders is essential for successful treatment, which is not always happening. The study aimed to estimate to what extent teenagers’ self-reports predict probable mental diagnosis as they enter adulthood, particularly regarding gender differences. Methods: Self-reported mental health problems, Youth Self-Report (YSR) at 15 years (range 3–110, n = 504) from the ongoing Finnish family competence study (FFC) using modified multivariable Poisson regression analysis for prediction of DAWBA (Development and Wellbeing Assessment) interview outcomes 3 years later. Results: One unit’s increase in YSR was estimated to correspond to an increase in the relative risk of a probable DAWBA-based diagnosis by 3.3% [RR (95% CI) 1.03 (1.03–1.04), p < 0.001]. In gender-specific analysis, the findings applied, particularly to girls. Conclusions: Youth Self-Report (YSR) scores at pubertal age predicted the risk of a probable mental diagnosis at the onset of adulthood, particularly in girls. Further research is needed to explain the lower sensitivity of YSR among boys.

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  • 3.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). The Research School of Health and Welfare, Jönköping University, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Augustine, Lilly
    CHILD, School of Learning and Communication, Jönköping University, Sweden.
    Saarinen, Maiju M.
    Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Aromaa, Minna
    Department of Public Health, University of Turku, Finland ; City of Turku Welfare Division, Finland.
    Rautava, Päivi
    Department of Public Health, University of Turku, Finland ; Turku University Hospital, Clinical Research Centre, Turku, Finland.
    Sourander, André
    Department of Child Psychiatry, University of Turku, Finland ; Department of Child Psychiatry, Turku University Hospital, Finland.
    Sillanpää, Matti
    Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Parental distress rating at the child’s age of 15 years predicts probable mental diagnosis: a three‑year follow‑up2022In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 22, no 1, article id 177Article in journal (Refereed)
    Abstract [en]

    Background: Mental health in adolescence is an increasing global public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, underlining the significance of early detection. The study aimed to investigate whether parental distress rating at the child's age of 15 predicts a probable mental diagnosis in a three-year follow-up.

    Methods: All data was derived from the Finnish Family Competence (FFC) Study. The analysis focused on whether parental CBCL (Child Behavior Checklist) rating (n = 441) at the child's age of 15 years predicted the outcome of the child's standardised DAWBA (Development and Well-Being Assessment) interview at offspring's 18 years.

    Results: Multivariable analysis showed that a one-unit increase in the total CBCL scores increased the relative risk of a DAWBA-based diagnosis by 3% (RR [95% CI] 1.03 [1.02-1.04], p < 0.001).

    Conclusions: Parental CBCL rating in a community sample at the adolescent's age of 15 contributes to early identification of adolescents potentially at risk and thus benefitting from early interventions.

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  • 4.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Augustine, Llilly
    Department of Communication and Behavioral Sciences, School of Education and Communication, Jönköping University, Sweden.
    The association between adolescents’ self-esteem and perceived mental well-being in Sweden in four years of follow-up2023In: BMC Psychology, E-ISSN 2050-7283, Vol. 11, article id 413Article in journal (Refereed)
    Abstract [en]

    Background The situation concerning adolescent mental health is a global public health concern, and the concept includes the ability to cope with problems of everyday life. A person’s approach and attitude towards themselves, i.e., their self-esteem, affects mental health. The study aimed to appraise and deepen the scientific understanding of adolescents’ self-reported self-esteem at age 12−13 from a resource perspective and test its ability to predict subsequent perceived mental well-being at age 17.

    Methods Data from the Longitudinal Research on Development in Adolescence (LoRDIA) prospective follow-up study of adolescents aged 12−13, and 17 (n=654) were analysed using ANCOVA. The outcome variable, perceived mental well-being (MWB), covers the aspects of mental well-being inspired by the “Mental Health Continuum,” representing positive mental health. Covariates were self-esteem (SE) and reported initially perceived MWB at age 12−13. Other independent explanatory variables were gender, the family’s economy, and the mother’s educational level.

    Results Self-esteem appeared relatively stable from 12−13 to 17 years (M=20.7 SD=5.8 vs. M=20.5 SD=1.7). There was a significant but inverted U – shaped association between SE at age 12–13 and perceived MWB at age 17 [F (1, 646)=19.02, β-0.057; CI -0.08−-0.03, Eta=0.03, p=.000]. Intermediate but not strong SE predicted significantly good MWB. When conducting the ANCOVA for boys and girls separately, only the mother’s educational level was significantly positively associated with perceived MWB of girls.

    Conclusions Good self-esteem in early adolescence increases the likelihood of an unchanged favourable development of self-esteem and the probability of good perceived mental well-being. SE explained 18 per cent of the variation of MWB, and even more among girls. However, normal SE rather than high SE at 12 and 13 years is predictive of later mental well-being. Girls reported low self-esteem more often. Therefore, supporting self-esteem early in life can promote mental well-being in adolescence.

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  • 5.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). The Research School of Health and Welfare, Jönköping University, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). University of Turku, Department of Public Health, Finland.
    Lindmark, Ulrika
    School of Health and Welfare, Department of Natural Sciences and Biomedicine, Centre for Oral Health, Jönköping University, Sweden / Department of Health Sciences, Karlstad University, Sweden.
    Saarinen, Maiju M.
    Department of General Practice, University of Turku and Turku University Hospital, Finland.
    Aromaa, Minna
    University of Turku, Department of Public Health, Finland / City of Turku Welfare Division, Finland.
    Rautava, Päivi
    University of Turku, Department of Public Health, Finland / Turku University Hospital, Finland.
    Sillanpää, Matti
    Department of General Practice, University of Turku and Turku University Hospital, Finland.
    Sense of coherence predicts adolescent mental health2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 274, p. 1206-1210Article in journal (Refereed)
    Abstract [en]

    Background: Strong sense of coherence (SOC) has been shown to predict good mental health among adults whereas its predictive value in adolescence is unclear. This life-course oriented prospective study explores whether SOC predicts mental health in a three-year follow-up. Methods: The data is part of the ongoing ‘Finnish Family Competence Study’ launched in 1986 in southwestern Finland (baseline n = 1287). The outcome variable was adolescent's mental health at 18 years of age, measured on the Development and Well-Being Assessment (DAWBA) scale. The main predictor was Antonovsky's SOC score (1987) measured at the age of 15. A total of 498 adolescents were included in the present analyses. Poisson regression was used by univariate and multivariable models using the parents’ age and socioeconomic status and adolescents’ gender as covariates. Results: Multivariable analysis showed that a one-unit increase in SOC decreased the relative risk of a DAWBA-based diagnosis by 4 % (RR [95% CI] 0.96 [0.94–0.98], p < 0.001). Limitations: Typical of very long follow-up, as in our study of nearly two decades, a substantial proportion of the original population-based cohort was lost to follow-up weakening the representability of our cohort. Conclusions: Sense of coherence is a useful and clinically sensitive tool to predict mental health in adolescence. The easily administered, coping-oriented SOC questionnaire is an appropriate instrument in screening for adolescents who would benefit from supportive measures to strengthen their mental well-being. 

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  • 6.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Qatar / College of Medicine, Qatar University, Qatar.
    Salam, Abdul
    Neuroscience Institute, Hamad General Hospital, Qatar.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Is alcohol consumption associated with poor perceived academic performance?: Survey of undergraduates in Finland2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 4, article id 1369Article in journal (Refereed)
    Abstract [en]

    The relationship between academic performance and alcohol consumption among students remains inconsistent. We assessed this relationship, controlling for sociodemographic characteristics across seven faculties at the University of Turku (1177 undergraduates). An online questionnaire assessed: seven sociodemographic characteristics (age, gender, year/discipline of study, accommodation type, being in intimate relationship, parental education, and income sufficiency); two perceived academic performance (students’ subjective importance of achieving good grades and students’ appraisal of their academic performance compared to peers); and six alcohol consumption behaviors (length of time, amount consumed, frequency, heavy episodic drinking, problem drinking, and possible alcohol dependence). Simple logistic regression assessed relationships between sociodemographic and academic variables with alcohol consumption behaviors; multiple logistic regression assessed the same relationships after controlling for all other variables. Students reported long duration and large amount of drinking (46% and 50%), high frequency of drinking (41%), heavy episodic drinking (66%), problem drinking (29%), and possible alcohol dependence (9%). After controlling, gender was associated with all alcohol consumption behaviors, followed by religiosity (associated with four alcohol behaviors), living situation, marital status, age (each associated with two alcohol behaviors), and parental education and year of study (each associated with one alcohol behavior). Study discipline, income sufficiency, importance of achieving good grades, and academic performance compared to peers were not associated with any alcohol behaviors. Universities need to assess problem drinking and alcohol use disorders among students. Prevention strategies are required to reduce risk. Health promotion efforts could focus on beliefs and expectations about alcohol and target student groups at risk for more efficient and successful efforts. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

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  • 7.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha Qatar.
    Salam, Abdul
    Department of Epidemiology and Biostatistics, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Prevalence and socio-demographic, academic, health and lifestyle predictors of illicit drug/s use among university undergraduate students in Finland2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 14, p. 1-20, article id 5094Article in journal (Refereed)
    Abstract [en]

    Illicit drug/s use (IDU) among university students is a public health concern. We assessed the associations between socio-demographic, academic, and health and lifestyle characteristics (independent variables) and regular, occasional or never IDU (dependent variables). Data were collected across seven faculties (1177 students) at the University of Turku (Finland) via an online questionnaire. About 1.5% of the sample had regular IDU, 19% occasional IDU, and 79% never IDU. Independent predictors of ever (lifetime) IDU included males [adjusted odds ratio (AOR) 1.82, P = 0.001], not living with parents (AOR 2.59, P < 0.001), singles (AOR 0.51, P < 0.001), lower religiosity (AOR 1.49, P = 0.022), better self-rated general health (AOR 0.41, P = 0.003), higher health awareness (AOR 1.93, P = 0.014), more depressive symptoms (AOR 1.82, P = 0.004), daily smokers (AOR 3.69, P < 0.001), heavy episodic drinking (AOR 2.38, P < 0.001) and possible alcohol dependency (AOR 2.55, P < 0.001). We observed no independent associations between ever IDU with age, study discipline, perceived stress or academic performance. The 20.5% ever IDU is concerning. The compelling independent predictors of ever IDU included not living with parents, lower religiosity, daily smokers, heavy episodic drinking and possible alcohol dependency (AOR range 2.38–3.69). Education and prevention need to emphasize the negative consequences to reinforce abstinence from IDU. Health promotion could focus on beliefs and expectations about IDU and target students at risk for successful efforts. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

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  • 8.
    El Ansari, Walid
    et al.
    Faculty of Applied Sciences, University of Gloucestershire, Gloucester, United Kingdom.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Berg-Beckhoff, Gabriele
    Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark.
    Is Healthier Nutrition Behaviour Associated with Better Self-Reported Health and Less Health Complaints?: Evidence from Turku, Finland2015In: Nutrients, E-ISSN 2072-6643, Vol. 7, no 10, p. 8478-8490Article in journal (Refereed)
    Abstract [en]

    We examined nutrition behaviour, self-reported health and 20 health complaints of undergraduates in Finland. Students at the University of Turku in Finland participated in a cross-sectional online survey (N = 1189). For nutrition behaviour, we computed two composite food intake pattern scores (sweets, cakes and snacks; and fruits and vegetables), a dietary guideline adherence index and the subjective importance of healthy eating. Multinomial logistic regression assessed the association of students' nutrition behaviour with three levels of self-reported health, controlling for many potential confounders (age, sex, living with partner, economic situation, moderate physical activity, Faculty and BMI). Factor analysis of the 20 health complaints revealed three components (psychological, pains/aches and circulatory/breathing symptoms). Multiple linear regression tested the association of students' eating habits with the three components of health complaints, controlling for the same confounders. Fruits and raw and cooked vegetable consumption, dietary guideline adherence index and subjective importance of healthy eating were highest among students with excellent/very good self-reported health, exhibiting a decreasing trend for those individuals with poor/fair self-reported health. High levels of psychological symptoms were associated with decreased consumption of fruits and vegetables, less dietary guideline adherence and less subjective importance of healthy eating. Pain/aches symptoms were associated with a higher consumption of sweets, cookies and snacks and a lower adherence to dietary guidelines. More healthy nutrition behaviour was consistently associated with better self-reported health and less health complaints. Of the four nutrition behaviour indicators we employed, the dietary guideline adherence index was the best indicator and exhibited the most consistent associations with self-reported health and health complaints.

  • 9.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Doha, Qatar / Faculty of Applied Sciences, University of Gloucestershire, Gloucester, United Kingdom.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Digital Health Research (DHEAR). University of Turku, Department of Public Health, Turku, Finland.
    Draper, Steve
    University Centre Hartpury, Gloucester, United Kingdom.
    Correlates of achieving the guidelines of four forms of physical activity, and the relationship between guidelines achievement and academic performance: Undergraduate students in Finland2017In: Central European Journal of Public Health, ISSN 1210-7778, E-ISSN 1803-1048, Vol. 25, no 2, p. 87-95Article in journal (Refereed)
    Abstract [en]

    Objectives: We surveyed and compared, by gender, the levels and correlates of achieving the international guidelines of four forms of physical activity (PA): moderate PA (MPA), vigorous PA (VPA), moderate or vigorous PA (MVPA), and muscle strengthening PA (MSPA). The study assessed the associations between achieving the guidelines of the four PA forms and a range of socio-demographic, health and academic performance variables. Methods: Data was collected across the seven faculties of the University of Turku (2013-2014 from a representative sample of 1,189 undergraduates). An English language online self-administered questionnaire assessed frequency and duration of PA/week for each form of PA. We employed cut-offs for the guidelines in accordance with the American Heart Association. Chi-square statistic tested the differences in PA, socio-demographic variables and academic performance between males and females. Binary logistic regression examined the factors associated with achieving the four PA guidelines and linear regression examined the association between the frequency of PA and academic performance. Results: Achievement of PA guidelines was relatively low across the sample. Female students were less likely to achieve the VPA or MSPA guidelines, but were more health conscious and in generally exhibited better academic performace than males. High health awareness and excellent/very good self-rated health were the strongest predictors of achieving all forms of PA. Parents' education level was positively related to likelihood of achieving the VPA, MVPA and MSPA guidelines. Achieving the MPA guidelines (but not VPA or MSPA) was positively associated with subjective perceptions of better academic performance. Conclusions: Achievement of PA guidelines was generally low for this sample of Finnish students, and was associated with positive health status and high health awareness. Universities need a holistic approach to improve awareness of health and promote PA in students' lifestyles.

  • 10.
    El Ansari, Walid
    et al.
    Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar ; College of Medicine, Qatar University, Doha, Qatar ; Department of Population Health, Weill Cornell Medicine Qatar, Doha, Qatar.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Wellbeing Services, County of Southwest Finland, Finland.
    El-Ansari, Kareem
    School of Medicine, St. George's University, Grenada, West Indies.
    Šebeňa, René
    Department of Psychology, Faculty of Arts, Pavol Josef Šafárik University, Košice, Slovak Republic.
    Are behavioural risk factors clusters associated with self-reported health complaints?: University students in Finland2023In: Central European Journal of Public Health, ISSN 1210-7778, E-ISSN 1803-1048, Vol. 31, no 4, p. 248-255Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: No previous research of university students in Finland assessed lifestyle behavioural risk factors (BRFs) and categorized students into clusters, explored the associations of the clusters with self-reported health complaints (HCs), whilst controlling for potential confounders. The current study undertook this task. METHODS: Students at the University of Turku (1,177) completed an online well-being questionnaire that assessed socio-demographic variables, 5 BRFs - problematic alcohol consumption, smoking, illicit drug use, food consumption habits, moderate-to-vigorous physical activity (MVPA), and 22 HCs. A food frequency questionnaire assessed students' consumption of a range of foods, and a dietary guideline adherence score was computed based on WHO dietary recommendations for Europe. Three separate regression models appraised the associations between the cluster membership and HCs factors, adjusting for sex, income sufficiency and self-rated health. RESULTS: Mean age was 23 ± 5.2 years, 77% had never smoked and 79% never used illicit drug/s. Factor analysis of HCs resulted in four-factors (psychological, circulatory/breathing, gastro-intestinal, pains/aches); cluster analysis of BRFs identified two distinctive student clusters. Cluster 1 represented more healthy students who never smoked/used illicit drugs, had no problematic drinking, and undertook MVPA on 4.42 ± 3.36 days/week. As for cluster 2 students, half the cluster smoked occasionally/daily, used illicit drug/s, and > 50% had problematic drinking and students undertook MVPA on 4.02 ± 3.12 days/week. More cluster 2 students adhered to healthy eating recommendations, but the difference was not significant between clusters. Regression analysis revealed that females, those with sufficient income, and with excellent/very good self-rated general health were significantly less likely to report all four HCs. Cluster 2 students were significantly more likely to report psychological complaints, circulatory/breathing and gastro-intestinal complaints. There was no significant association between BRFs clusters and pains/aches factor. CONCLUSIONS: Risk taking students with less healthy lifestyles and behaviour were consistently associated with poorer psychological and somatic health.

  • 11.
    Elovainio, Marko
    et al.
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, Helsinki, Finland.
    Komulainen, Kaisla
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, Helsinki, Finland.
    Sipilä, Pyry N.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Pulkki-Råback, Laura
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
    Cachón Alonso, Laura
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Centre of Population Health Research, Turku University Hospital, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland ; Centre of Population Health Research, Turku University Hospital, Finland.
    Lipsanen, Jari
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Hakulinen, Christian
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, Helsinki, Finland.
    Kivimäki, Mika
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Department of Mental Health of Older People, Faculty of Brain Sciences, University College London, United Kingdom.
    Association of social isolation and loneliness with risk of incident hospital-treated infections: an analysis of data from the UK Biobank and Finnish Health and Social Support studies2023In: The Lancet Public Health, ISSN 2468-2667, Vol. 8, no 2, p. e109-e118Article in journal (Refereed)
    Abstract [en]

    Background: Although loneliness and social isolation have been linked to an increased risk of non-communicable diseases such as cardiovascular disease and dementia, their association with the risk of severe infection is uncertain. We aimed to examine the associations between loneliness and social isolation and the risk of hospital-treated infections using data from two independent cohort studies. Methods: We assessed the association between loneliness and social isolation and incident hospital-treated infections using data for participants from the UK Biobank study aged 38–73 years at baseline and participants from the nationwide population-based Finnish Health and Social Support (HeSSup) study aged 20–54 years at baseline. For inclusion in the study, participants had to be linked to national health registries, have no history of hospital-treated infections at or before baseline, and have complete data on loneliness or social isolation. Participants with missing data on hospital-treated infections, loneliness, and social isolation were excluded from both cohorts. The outcome was defined as a hospital admission with a primary diagnosis of infection, ascertained via linkage to electronic health records. Findings: After exclusion of 8·6 million participants for not responding or not providing appropriate consent, the UK Biobank cohort consisted of 456 905 participants (249 586 women and 207 319 men). 26 860 (6·2%) of 436 001 participants with available data were reported as being lonely and 40 428 (9·0%) of 448 114 participants with available data were socially isolated. During a median 8·9 years (IQR 8·0–9·6) of follow-up, 51 361 participants were admitted to hospital due to an infectious disease. After adjustment for age, sex, demographic and lifestyle factors, and morbidities, loneliness was associated with an increased risk of a hospital-treated infection (hazard ratio [HR] 1·12 [95% CI 1·07–1·16]), whereas social isolation was not (HR 1·01 [95% CI 0·97–1·04]). Of 64 797 individuals in the HeSSup cohort, 18 468 (11 367 women and 7101 men) were eligible for inclusion. 4466 (24·4%) of 18 296 were lonely and 1776 (9·7%) of 18 376 socially isolated. During a median follow-up of 10·0 years (IQR 10·0–10·1), 814 (4·4%) participants were admitted to hospital for an infectious disease. The HRs for the HeSSup study replicated those in the UK Biobank (multivariable-adjusted HR for loneliness 1·32 [95% CI 1·06–1·64]; 1·08 [0·87–1·35] for social isolation). Interpretation: Loneliness might increase susceptibility to severe infections, although the magnitude of this effect appears modest and residual confounding cannot be excluded. Interventional studies are required before policy recommendations can advance. Funding: Academy of Finland, the UK Medical Research Council, and Wellcome Trust UK.

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  • 12.
    Entonen, Anitta H.
    et al.
    Department of Public Health, Faculty of Medicine, University of Turku, Finland.
    Suominen, Sakari B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Research Services, Turku University Hospital, Finland.
    Sillanmäki, Lauri H.
    Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Turku University Hospital, Finland ; Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Rautava, Päivi T.
    Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Research Services, Turku University Hospital, Finland.
    Kauniskangas, Katariina
    Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Healthcare Services, City of Turku, Section of Welfare, Turku, Finland.
    Mäntyselkä, Pekka T.
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland and Primary Health Care Unit, Kuopio University Hospital, Finland.
    Sumanen, Markku
    Faculty of Medicine and Health Technology, University of Tampere, Finland.
    Koskenvuo, Markku J.
    Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Prevalent migraine as a predictor of incident hypertension2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 2, p. 297-301Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Migraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013. METHODS: The present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets. RESULTS: A significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20-1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables. CONCLUSION: Extra attention should be paid to prevention and control of hypertension in working-age migraine patients. 

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  • 13.
    Ervasti, Jenni
    et al.
    Finnish Inst Occupat Hlth, Helsinki, Finland / Univ Helsinki, Clinicum, Helsinki, Finland.
    Airaksinen, Jaakko
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Helsinki, Finland.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Finland / Turku Univ Hosp, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Univ Turku, Finland.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland / Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Kivimaki, Mika
    Finnish Inst Occupat Hlth, Helsinki, Finland / Univ Helsinki, Clinicum, Finland / UCL, Dept Epidemiol & Publ Hlth, London, England.
    Does increasing physical activity reduce the excess risk of work disability among overweight individuals?2019In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 45, no 4, p. 376-385Article in journal (Refereed)
    Abstract [en]

    Objectives We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index >= 25kg/m(2)).

    Methods We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (>= 90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption.

    Results The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35-1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31-1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70-0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar.

    Conclusions These findings suggest that the excess risk of work disability among overweight individuals would drop by 3-4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.

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  • 14.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kivimäki, Mika
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Epidemiology and Public Health, University College London, United Kingdom / Clinicum, University of Helsinki, Helsinki, Finland.
    Head, Jenny
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Goldberg, Marcel
    Population-based Cohorts Unit, French National Institute of Health and Medical Research (INSERM), Villejuif, France / Research Unit 1168 Aging and Chronic Diseases—Epidemiological and Public Health Approaches, French National Institute of Health and Medical Research (INSERM), Villejuif, France / Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
    Airagnes, Guillaume
    Université Paris Descartes, Sorbonne Paris Cité, Paris, France / Department of Psychiatry and Addictology, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France.
    Pentti, Jaana
    Clinicum, University of Helsinki, Helsinki, Finland.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Psychology, University of Turku, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Jokela, Markus
    Medicum, University of Helsinki, Helsinki, Finland.
    Vahtera, Jussi
    University of Turku and Turku University Hospital, Turku, Finland.
    Zins, Marie
    Population-based Cohorts Unit, French National Institute of Health and Medical Research (INSERM), Villejuif, France / Research Unit 1168 Aging and Chronic Diseases—Epidemiological and Public Health Approaches, French National Institute of Health and Medical Research (INSERM), Villejuif, France / Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden.
    Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers: consideration of the U-shaped association between alcohol use and sickness absence in four cohort studies2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 9, p. 1633-1642Article in journal (Refereed)
    Abstract [en]

    Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis-specific sickness absence. Design A multi-cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time-points, and were linked to records of sickness absence. Diagnosis-specific sickness absence was followed for 4-7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000-02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985-88 and 1991-94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1-11 and > 11 units per week in women and 0, 1-34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio-economic status, smoking and body mass index. Findings Women who reported drinking 1-11 units and men who reported drinking 1-34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22-1.88], musculoskeletal disorders (1.22, 95% CI = 1.06-1.41), diseases of the digestive system (1.35, 95% CI = 1.02-1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29-1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13-1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at-risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.

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  • 15.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kivimäki, Mika
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Epidemiology and Public Health, University College London, London, United Kingdom / Clinicum, University of Helsinki, Helsinki, Finland.
    Head, Jenny
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Goldberg, Marcel
    French National Institute of Health and Medical Research (INSERM), Population-based Cohorts Unit, INSERM, Paris, Villejuif, France / French National Institute of Health and Medical Research (INSERM), Research Unit 1168 Aging and Chronic Diseases—Epidemiological and Public Health Approaches, INSERM, Paris, Villejuif, France.
    Airagnes, Guillaume
    Faculty of Medicine, Universite Paris Descartes, Paris, France / Department of Psychiatry and Addictology, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France.
    Pentti, Jaana
    Clinicum, University of Helsinki, Helsinki, Finland.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. University of Turku, Turku, Finland.
    Jokela, Markus
    Medicum, University of Helsinki, Helsinki, Finland.
    Vahtera, Jussi
    University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Zins, Marie
    French National Institute of Health and Medical Research (INSERM), Population-based Cohorts Unit, INSERM, Paris, Villejuif, France / French National Institute of Health and Medical Research (INSERM), Research Unit 1168 Aging and Chronic Diseases—Epidemiological and Public Health Approaches, INSERM, Paris, Villejuif, France / University Versailles Saint Quentin en Yvelines, Paris, France.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Sociodemographic Differences Between Alcohol Use and Sickness Absence: Pooled Analysis of Four Cohort Studies2018In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 53, no 1, p. 95-103Article in journal (Refereed)
    Abstract [en]

    Aims: We examined differences in sickness absence in relation to at-risk drinking and abstinence, taking into account potential changes in consumption.& para;& para;Methods: We used individual-participant data (n = 46,514) from four prospective cohort studies from Finland, France and the UK. Participants responded to a survey on alcohol use at two time points 4-6 years apart, and were linked to records of sickness absence for an similar to 6-year follow-up after the latter survey. Abstainers were those reporting no alcohol use in either survey. At-risk drinkers at T1 were labelled as 'former', at-risk drinkers at T2 as 'current' and at-risk drinkers at both times as 'consistent' at-risk drinkers. The reference group was low-risk drinkers at both times. Study-specific analyses were stratified by sex and socioeconomic status (SES) and the estimates were pooled using meta-analysis.& para;& para;Results: Among men (n = 17,285), abstainers (6%), former (5%), current (5%) and consistent (7%) at-risk drinkers had an increased risk of sickness absence compared with consistent low-risk drinkers (77%). Among women (n = 29,229), only abstainers (12%) had a higher risk of sickness absence compared to consistent low-risk drinkers (74%). After adjustment for lifestyle and health, abstaining from alcohol was associated with sickness absence among people with intermediate and high SES, but not among people with low SES.& para;& para;Conclusions: The U-shaped alcohol use-sickness absence association is more consistent in men than women. Abstinence is a risk factor for sickness absence among people with higher rather than lower SES. Healthy worker effect and health selection may partly explain the observed differences.& para;& para;Short summary: In a pooled analysis from four cohort studies from three European countries, we demonstrated a U-shaped association between alcohol use and sickness absence, particularly among men. Abstinence from alcohol was associated with increased sickness absenteeism among both sexes and across socioeconomic strata, except those with low SES.

  • 16.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Finland.
    Nyberg, Solja T.
    Finnish Institute of Occupational Health, Helsinki, Finland ; Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, UK.
    Leineweber, Constanze
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Sørensen, Jeppe K.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Centre for Occupational and Environmental Medicine, Region Stockholm, Sweden.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Bispebjerg University Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health, Berlin, Germany.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Magnusson Hanson, Linda L.
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Oksanen, Tuula
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
    Pejtersen, Jan H.
    VIVE–The Danish Center for Social Science Research, Copenhagen, Denmark.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark ; Department of Public Health, University of Copenhagen, Denmark ; Department of Psychology, University of Copenhagen, Denmark.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Finland.
    Theorell, Töres
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Westerlund, Hugo
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Vahtera, Jussi
    Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Finland.
    Virtanen, Marianna
    School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland ; Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, UK.
    Kivimäki, Mika
    Finnish Institute of Occupational Health, Helsinki, Finland ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Department of Epidemiology and Public Health, University College London, UK.
    Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries2021In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 11, article id 100212Article in journal (Refereed)
    Abstract [en]

    Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints. Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers. Findings: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality. Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality. Funding: NordForsk, the Medical Research Council, the National Institute on Aging, the Wellcome Trust, Academy of Finland, and Finnish Work Environment Fund. 

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  • 17.
    Ferrie, Jane E.
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Community and Social Medicine, University of Bristol, Bristol, United Kingdom.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Jokela, Markus
    Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Heikkilä, Katriina
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin), Berlin, Germany.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Elovainio, Marko
    National Institute for Health and Welfare, Helsinki, Finland.
    Fransson, Eleonor I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / School of Health Sciences, Jönköping University, Jönköping, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Kouvonen, Anne
    Department of Social Research, University of Helsinki, Helsinki, Finland.
    Kumari, Meena
    Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom.
    Nielsen, Martin L.
    Unit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
    Nordin, Maria
    Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Pahkin, Krista
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Pejtersen, Jan H.
    The Danish National Centre for Social Research, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland / Department of Psychology, University of Turku, Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Tabák, Adam
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.
    Suominen, Sakari B.
    University of Skövde, Health and Education. University of Skövde, School of Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Theorell, Töres
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Westerholm, Peter J. M.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark / Departments of Public Health and Psychology, University of Copenhagen, Copenhagen, Denmark.
    Nyberg, Solja T.
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Kivimäki, Mika
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland / Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
    Job insecurity and risk of diabetes: a meta-analysis of individual participant data2016In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 188, no 17-18, p. E447-E455Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.

    METHODS: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.

    RESULTS: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I(2) = 24%, p = 0.2; multivariable-adjusted model: I(2) = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35).

    INTERPRETATION: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.

  • 18.
    Hagquist, Curt
    et al.
    Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Välimaa, Raili
    Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Simonsen, Nina
    Department of Public Health, University of Helsinki, Helsinki, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. University of Turku, Turku, Finland.
    Differential Item Functioning in Trend Analyses of Adolescent Mental Health: Illustrative Examples Using HBSC-Data from Finland2017In: Child Indicators Research, ISSN 1874-897X, E-ISSN 1874-8988, Vol. 10, no 3, p. 673-691Article in journal (Refereed)
    Abstract [en]

    Although there is an increasing focus on trend analyses of adolescent mental health, yet too little attention is paid to the methodological challenges and pitfalls inherent in this type of analyses. The purpose of the study is to analyse the psychometric properties of a Finnish instrument on psychosomatic problems, with a major focus on Differential Item Functioning (DIF) across time. Questionnaire data collected in 1994, 1998, 2006 and 2014 among Finnish schoolchildren in grade 9 (15-year-olds) as part of the Health Behaviour in School-aged Children (HBSC) study were utilised. The polytomous Rasch model was used to examine the psychometric properties of a composite measure of psychosomatic problems. The results clearly indicate that the composite measure on psychosomatic problems consisting of nine items does not work invariantly over time. In particular, the item depressed shows DIF across years of investigations. This item works quite differently at the first year of investigation compared to the last year showing higher expected values 2014 (=less frequent problems) than 1994. This DIF affects the person measure of change in psychosomatic problems between 1994 and 2014. Resolving the item depressed for year of investigation DIF, or removing it, increases the difference in person mean values between the two years, implying increasing psychosomatic problems over time. Since the DIF affects the trend results, different options to address the problems need to be considered. Removing the item depressed would bring the Finnish measure of psychosomatic problems in better accordance with the content of the questions on psychosomatic problems in the international HBSC protocol in which the item depressed is not included.

  • 19.
    Halme, Marie
    et al.
    Department of Psychology, University of Turku, Finland.
    Rautava, Päivi
    Department of Public Health, University of Turku, Finland ; Turku Clinical Research Centre, Turku University Hospital, Finland.
    Sillanmäki, Lauri
    Department of Public Health, University of Turku, Finland ; Turku Clinical Research Centre, Turku University Hospital, Finland ; Department of Public Health, University of Helsinki, Finland.
    Sumanen, Markku
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Turku Clinical Research Centre, Turku University Hospital, Finland.
    Vahtera, Jussi
    Department of Public Health and Centre for Population Health Research, University of Turku, Finland.
    Virtanen, Pekka
    Faculty of Social Sciences, Tampere University, Finland.
    Salo, Paula
    Department of Psychology, University of Turku, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Educational level and the use of mental health services, psychotropic medication and psychotherapy among adults with a history of physician diagnosed mental disorders2023In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 69, no 2, p. 493-502Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of mental disorders is increased among people of low socioeconomic status or educational level, but it remains unclear whether their access to treatment matches their increased need.

    Aims: Our objective was to examine whether educational level as an indicator of socioeconomic status is associated with use of mental health services, psychotropic medication and psychotherapy in Finland.

    Method: Cross-sectional data from a follow-up survey of a longitudinal, population-based cohort study were used to form a sample of 3,053 men and women aged 24 to 68 with a current or previous physician diagnosed mental disorder. The prevalence of mental disorders, mental health service use and educational level were assessed with self-report questionnaire. Educational level was determined by the highest educational attainment and grouped into three levels: high, intermediate and low. The associations between educational level and mental health service -related outcomes were assessed with binary logistic regression. Covariates in the fully adjusted model were age, gender and number of somatic diseases.

    Results: Compared to high educational level, low educational level was associated with higher odds of using antidepressants (OR 1.35, 95% CI [1.09, 1.66]), hypnotics (OR 1.33, 95% CI [1.07, 1.66]) and sedatives (OR 2.17, 95% CI [1.69, 2.78]), and lower odds of using mental health services (OR 0.80, 95% CI [0.65, 0.98]). No associations were found between educational level and use of psychotherapy.

    Conclusions: The results do not suggest a general socioeconomic status related mismatch. A pharmacological emphasis was observed in the treatment of low educational background participants, whereas overall mental health service use was emphasized among high educational background participants. 

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  • 20.
    Hamari, Lotta
    et al.
    Department of Nursing Science, University of Turku, Finland / Turku University Hospital, Turku, Finland.
    Heinonen, Olli J.
    Paavo Nurmi Centre & Department of Physical Activity and Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Aromaa, Minna
    Children and Adolescents Out-patient Clinic, Turku, Finland / Department of Public Health, University of Turku, Finland.
    Asanti, Riitta
    Department of Teacher Education, University of Turku, Finland.
    Koivusilta, Leena
    University Consortium of Seinajoki, School of Health Sciences, University of Tampere, Seinäjoki, Finland.
    Koski, Pasi
    Department of Teacher Education, Rauma Unit, University of Turku, Rauma, Finland.
    Laaksonen, Camilla
    Turku University of Applied Sciences, Health and Well-being, Turku, Finland.
    Matomäki, Jaakko
    Turku University Hospital, Clinical Research Centre, Turku, Finland.
    Pahkala, Katja
    Paavo Nurmi Centre & Department of Health and Physical Activity, University of Turku, Finland / Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
    Pakarinen, Anni
    Department of Nursing Science, University of Turku, Finland / Turku University Hospital, Turku, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Finland.
    Salanterä, Sanna
    Department of Nursing Science, University of Turku, Finland / Turku University Hospital, Turku, Finland.
    Association of Self-Perceived Physical Competence and Leisure-Time Physical Activity in Childhood: A Follow-Up Study2017In: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 87, no 4, p. 236-243Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDThe basis of self-perceived physical competence is built in childhood and school personnel have an important role in this developmental process. We investigated the association between initial self-perceived physical competence and reported leisure-time physical activity (LTPA) longitudinally in 10-, 12-, and 15-year-old children.

    METHODSThis longitudinal follow-up study comprises pupils from an elementary school cohort (N = 1346) in the city of Turku, Finland (175,000 inhabitants). The self-perceived physical competence (fitness and appearance) and LTPA data were collected with questionnaires. The full longitudinal data were available from 571 pupils based on repeated studies at the ages of 10, 12, and 15 years in 2004, 2006, and 2010. We analyzed the association of self-perceived physical competence and LTPA using regression models.

    RESULTSSelf-perceived physical competence was positively associated with LTPA at all ages (10 years p < .05, 12 years p < .0001, 15 years p < .0001). Increase in the self-perceived physical fitness scores was likely to associate with higher LTPA at each age point (10 years [odds ratio, OR] = 1.18, 95% confidence interval, CI: 1.09-1.27; 12 years [OR] = 1.27, 95% CI: 1.18-1.37; and 15 years [OR] = 1.28, 95% CI: 1.19-1.38).

    CONCLUSIONSSelf-perceived physical competence is associated with LTPA in children and adolescents, and the association is strengthened with age.

  • 21.
    Hawajri, Omar
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lindberg, Jennifer
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Turku University Hospital, Finland.
    Virtual Reality Exposure Therapy as a Treatment Method Against Anxiety Disorders and Depression: A Structured Literature Review2023In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 44, no 4, p. 245-269Article, review/survey (Refereed)
    Abstract [en]

    Mental illness is a growing global health problem affecting individuals and society. In Sweden, the number of people suffering from mental health illnesses, such as anxiety and depression, is increasing and is expected to be one of the largest public health challenges in 2030. As mental illness increases, the area also needs effective forms of treatment. This study aims to investigate if Virtual Reality Exposure Therapy (VRET) works as a treatment method for adults suffering from anxiety disorders and depression. A structured literature review based on 24 articles found in the databases PubMed, MEDLINE, CINAHL and PsycInfo. Two reviewers independently reviewed and collectively extracted data from the included articles. The articles have been analyzed by using thematic analysis. The results suggest that Virtual reality exposure therapy can work as an effective treatment method for adults with anxiety disorders. It also indicates that VRET may act as a health-promoting intervention to reduce anxiety disorders, phobias, and depression symptoms. Virtual reality exposure therapy can be an effective treatment method and health-promoting effort against anxiety disorders in adults. An essential factor for the patients who accept VRET as a treatment is the initial information therapists give. 

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  • 22.
    Heikkilä, Katriina
    et al.
    Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London United Kingdom / Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Pentti, Jaana
    Department of Public Health University of Turku and Turku University Hospital Turku Finland / Department of Public Health University of Helsinki Finland.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment Copenhagen Denmark.
    Lallukka, Tea
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland / Department of Public Health University of Helsinki Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland / Department of Public Health and Caring Sciences University of Uppsala Sweden / Stress Research Institute University of Stockholm Sweden.
    Alfredsson, Lars
    Centre for Occupational and Environmental Medicine Stockholm County Council Stockholm Sweden / Institute of Environmental Medicine Karolinska Institute Stockholm Sweden.
    Bjorner, Jakob
    National Research Centre for the Working Environment Copenhagen Denmark.
    Borritz, Marianne
    Department of Occupational and Environmental Medicine Bispebjerg Hospital Copenhagen University Copenhagen Denmark.
    Brunner, Eric
    Department of Epidemiology and Public Health University College London London United Kingdom.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health Berlin Germany.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health University College London London United Kingdom / Bristol Medical School: Population Health Sciences University of Bristol United Kingdom.
    Knutsson, Anders
    Department of Health Sciences Mid Sweden University Sundsvall Sweden.
    Koskinen, Aki
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Leineweber, Constanze
    Stress Research Institute University of Stockholm Sweden.
    Magnusson Hanson, Linda L.
    Stress Research Institute University of Stockholm Sweden.
    Nielsen, Martin L.
    Lægekonsulenten AS3 Companies Århus Denmark.
    Nyberg, Solja T.
    Department of Public Health University of Helsinki Finland.
    Oksanen, Tuula
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Pejtersen, Jan H.
    VIVE The Danish Center for Social Science Research Copenhagen Denmark.
    Pietiläinen, Olli
    Department of Public Health University of Helsinki Finland.
    Rahkonen, Ossi
    Department of Public Health University of Helsinki Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment Copenhagen Denmark / Department of Public Health and Department of Psychology University of Copenhagen Denmark.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health University College London London United Kingdom.
    Steptoe, Andrew
    Department of Epidemiology and Public Health University College London London United Kingdom.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health University of Turku and Turku University Hospital Turku Finland.
    Theorell, Töres
    Stress Research Institute University of Stockholm Sweden.
    Vahtera, Jussi
    Department of Public Health University of Turku and Turku University Hospital Turku Finland.
    Väänänen, Ari
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Westerlund, Hugo
    Stress Research Institute University of Stockholm Sweden.
    Kivimäki, Mika
    Department of Public Health University of Helsinki Finland / Department of Epidemiology and Public Health University College London London United Kingdom.
    Job Strain as a Risk Factor for Peripheral Artery Disease: A Multi-Cohort Study2020In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 9, no 9, article id e013538Article in journal (Refereed)
    Abstract [en]

    Background Job strain is implicated in many atherosclerotic diseases, but its role in peripheral artery disease (PAD) is unclear. We investigated the association of job strain with hospital records of PAD, using individual-level data from 11 prospective cohort studies from Finland, Sweden, Denmark, and the United Kingdom. Methods and Results Job strain (high demands and low control at work) was self-reported at baseline (1985-2008). PAD records were ascertained from national hospitalization data. We used Cox regression to examine the associations of job strain with PAD in each study, and combined the study-specific estimates in random effects meta-analyses. We used τ2, I2, and subgroup analyses to examine heterogeneity. Of the 139 132 participants with no previous hospitalization with PAD, 32 489 (23.4%) reported job strain at baseline. During 1 718 132 person-years at risk (mean follow-up 12.8 years), 667 individuals had a hospital record of PAD (3.88 per 10 000 person-years). Job strain was associated with a 1.41-fold (95% CI, 1.11-1.80) increased average risk of hospitalization with PAD. The study-specific estimates were moderately heterogeneous (τ2=0.0427, I2: 26.9%). Despite variation in their magnitude, the estimates were consistent in both sexes, across the socioeconomic hierarchy and by baseline smoking status. Additional adjustment for baseline diabetes mellitus did not change the direction or magnitude of the observed associations. Conclusions Job strain was associated with small but consistent increase in the risk of hospitalization with PAD, with the relative risks on par with those for coronary heart disease and ischemic stroke.

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  • 23.
    Hult, Marja
    et al.
    Department of Nursing Science, Faculty of Medicine, University of Turku, Finland.
    Halminen, Olli
    Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management andArchitecture (HEMA), Aalto University, Espoo, Finland.
    Linna, Miika
    Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management andArchitecture (HEMA), Aalto University, Espoo, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Department of Public Health, Turku University Hospital, Finland.
    Kangasniemi, Mari
    Department of Nursing Science, Faculty of Medicine, University of Turku, Finland.
    Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no 5, p. 997-1003Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety. METHODS: Our systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis. RESULTS: The searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used. CONCLUSION: This review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies. 

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  • 24.
    Hult, Marja
    et al.
    Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
    Kallio, Hanna
    Department of Nursing Science, University of Turku, Finland.
    Halminen, Olli
    Department of Industrial Engineering and Management, Aalto University, Espoo, Finland.
    Linna, Miika
    Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Research Services, Turku University Hospital, Finland.
    Kangasniemi, Mari
    Department of Nursing Science, University of Turku, Finland.
    Cost-effectiveness calculators on health and social services planning and evaluation: an explorative interview study of key informants2022In: International Journal of Health Promotion and Education, ISSN 1463-5240, E-ISSN 2164-9545, p. 1-12Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine the views of key experts on developing and using cost-effectiveness calculators to plan and evaluate health and wellbeing promotion interventions in health and social services. Data for this qualitative interview study were collected from 14 Finnish experts in health and wellbeing coordination, health and social service management and research and health economics in spring 2021. A semi-structured interview method with thematic analysis was used. The experts said that there is a need for cost-effectiveness evaluation tools that support local evidence-based decision-making. This would enable organizations to plan and allocate scarce resources for interventions that promote equitable and effective health and wellbeing. However, practical tools and calculators that enable users to make decisions based on the best available evidence are not widely used. Local decision-makers, researchers and service providers all need to be involved in agreeing goals and selecting the right target groups and measures. They also need to make decisions about the best available data sources and how to use calculators to define and evaluate outcomes. Cost-effectiveness calculators are needed for local evidence-based decision-making, so that municipalities can allocate scarce resources to effective services that increase the wellbeing and equality of residents. This requires key stakeholders to work together to plan, develop and evaluate comprehensive, easy-to-use cost-effectiveness calculators.

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  • 25.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, UK ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, UK.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland ; Department of Public Health, University of Turku, Finland ; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Lindbohm, Joni V.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Gonzales-Inca, Carlos
    Department of Geography and Geology, Turku, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Stenholm, Sari
    Department of Public Health, University of Turku, Finland ; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Sipilä, Pyry N.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Dadvand, Payam
    Barcelona Institute for Global Health, Spain ; Universitat Pompeu Fabra, Barcelona, Spain ; CIBER Epidemiología y Salud Pública, Madrid, Spain.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland ; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study2021In: The Lancet Public Health, ISSN 2468-2667, Vol. 6, no 6, p. e396-e407, article id S2468-2667(21)00066-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Observational studies have identified a link between unfavourable neighbourhood characteristics and increased risk of morbidity, but it is unclear whether changes in neighbourhoods affect future disease risk. We used a data-driven approach to assess the impact of neighbourhood modification on 79 health outcomes.

    METHODS: In this prospective cohort study, we used pooled, individual-level data from two Finnish cohort studies: the Health and Social Support study and the Finnish Public Sector study. Neighbourhood characteristics (mean educational level, median income, and employment rate of residents, and neighbourhood green space) and individual lifestyle factors of community-dwelling individuals were assessed at baseline (at different waves starting between 1998 and 2013). We repeated assessment of neighbourhood characteristics and lifestyle factors approximately 5 years from each baseline assessment, after which follow-up began for health conditions diagnosed according to the WHO International Classification of Diseases for 79 common health conditions using linkage to electronic health records. We used Cox proportional hazard regression models to compute adjusted hazard ratios (HRs) of incident disease associated with neighbourhood characteristics and changes in neighbourhood characteristics over time and logistic regression analysis to compute adjusted odds of association between changes in neighbourhood characteristics and individual lifestyle factors.

    FINDINGS: 114 786 individuals (87 012 [75·8%] women; mean age 44·4 years [SD 11·1]) had complete data and were included in this cohort study. During 1·17 million person-years at risk, we recorded 164 368 new-onset health conditions and 3438 deaths. Favourable changes in neighbourhood characteristics were associated with reduced risk of all-cause mortality and incidence of 19 specific health conditions. Unfavourable changes were correspondingly associated with increased risk of mortality and 27 specific health conditions. Among participants who did not move residence during the observation period, relative to individuals who continually lived in disadvantaged neighbourhoods, those who experienced favourable modifications in neighbourhood characteristics had a lower risk of future diabetes (HR 0·84, 95% CI 0·75-0·93), stroke (0·49, 0·29-0·83), skin disease (0·72, 0·53-0·97), and osteoarthritis (0·87, 0·77-0·99). Living in a neighbourhood with improving characteristics was also associated with improvements in individual-level health-related lifestyle factors. Among participants who lived in advantaged residential environments at baseline, unfavourable changes in neighbourhood characteristics were associated with an increased risk of diabetes, stroke, skin disease, and osteoarthritis compared with individuals who lived in advantaged neighbourhoods throughout the study period.

    INTERPRETATION: Favourable modifications to residential neighbourhoods showed robust, longitudinal associations with a range of improvements in health outcomes, including improved health behaviours and reduced risk of cardiometabolic, infectious, and orthopaedic conditions.

    FUNDING: UK Medical Research Council, US National Institute on Aging, NordForsk, and Academy of Finland.

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  • 26.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, United Kingdom / School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, United States.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland / Department of Public Health, University of Turku, Finland / Centre for Population Health Research, University of Turku, Finland / Turku University Hospital, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Sipilä, Pyry N.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Suominen, Sakari B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Stenholm, Sari
    Department of Public Health, University of Turku, Finland / Centre for Population Health Research, University of Turku, Finland / Turku University Hospital, Finland.
    Virtanen, Marianna
    School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
    Marmot, Michael G.
    Institute of Health Equity, University College London, United Kingdom.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, United Kingdom / INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, France.
    Brunner, Eric J.
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Lindbohm, Joni V.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, United Kingdom / School of Community and Social Medicine, University of Bristol, United Kingdom.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland / Centre for Population Health Research, University of Turku, Finland / Turku University Hospital, Finland.
    Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study2020In: The Lancet Public Health, ISSN 2468-2667, Vol. 5, no 3, p. e140-e149Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic disadvantage is a risk factor for many diseases. We characterised cascades of these conditions by using a data-driven approach to examine the association between socioeconomic status and temporal sequences in the development of 56 common diseases and health conditions. Methods: In this multi-cohort study, we used data from two Finnish prospective cohort studies: the Health and Social Support study and the Finnish Public Sector study. Our pooled prospective primary analysis data comprised 109 246 Finnish adults aged 17–77 years at study entry. We captured socioeconomic status using area deprivation and education at baseline (1998–2013). Participants were followed up for health conditions diagnosed according to the WHO International Classification of Diseases until 2016 using linkage to national health records. We tested the generalisability of our findings with an independent UK cohort study—the Whitehall II study (9838 people, baseline in 1997, follow-up to 2017)—using a further socioeconomic status indicator, occupational position. Findings: During 1 110 831 person-years at risk, we recorded 245 573 hospitalisations in the Finnish cohorts; the corresponding numbers in the UK study were 60 946 hospitalisations in 186 572 person-years. Across the three socioeconomic position indicators and after adjustment for lifestyle factors, compared with more advantaged groups, low socioeconomic status was associated with increased risk for 18 (32·1%) of the 56 conditions. 16 diseases formed a cascade of inter-related health conditions with a hazard ratio greater than 5. This sequence began with psychiatric disorders, substance abuse, and self-harm, which were associated with later liver and renal diseases, ischaemic heart disease, cerebral infarction, chronic obstructive bronchitis, lung cancer, and dementia. Interpretation: Our findings highlight the importance of mental health and behavioural problems in setting in motion the development of a range of socioeconomically patterned physical illnesses. Policy and health-care practice addressing psychological health issues in social context and early in the life course could be effective strategies for reducing health inequalities. Funding: UK Medical Research Council, US National Institute on Aging, NordForsk, British Heart Foundation, Academy of Finland, and Helsinki Institute of Life Science.

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  • 27.
    Kivimäki, Mika
    et al.
    University College London (UCL) Brain Sciences, UCL, London, United Kingdom ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Batty, G. David
    University College London (UCL) Brain Sciences, UCL, London, United Kingdom.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland ; Department of Public Health, University of Turku (UTU), Finland ; Centre for Population Health Research, UTU, Turku, Finland.
    Suomi, Juuso
    Department of Geography and Geology, UTU, Turku, Finland.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Merikanto, Joonas
    Finnish Meteorological Institute, Helsinki, Finland.
    Nordling, Kalle
    Finnish Meteorological Institute, Helsinki, Finland ; Centre for International Climate and Environmental Research, Oslo, Norway.
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Suominen, Sakari B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku (UTU), Finland ; Turku University Hospital, Finland.
    Partanen, Antti-Ilari
    Finnish Meteorological Institute, Helsinki, Finland.
    Stenholm, Sari
    Department of Public Health, University of Turku (UTU), Finland ; Centre for Population Health Research, UTU, Turku, Finland.
    Käyhkö, Jukka
    Department of Geography and Geology, UTU, Turku, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku (UTU), Finland ; Centre for Population Health Research, UTU, Turku, Finland ; Turku University Hospital, Finland.
    Climate Change, Summer Temperature, and Heat-Related Mortality in Finland: Multicohort Study with Projections for a Sustainable vs. Fossil-Fueled Future to 20502023In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 131, no 12, p. 1270201-1-1270201-16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Climate change scenarios illustrate various pathways in terms of global warming ranging from "sustainable development" (Shared Socioeconomic Pathway SSP1-1.9), the best-case scenario, to 'fossil-fueled development' (SSP5-8.5), the worst-case scenario. OBJECTIVES: We examined the extent to which increase in daily average urban summer temperature is associated with future cause-specific mortality and projected heat-related mortality burden for the current warming trend and these two scenarios. METHODS: We did an observational cohort study of 363,754 participants living in six cities in Finland. Using residential addresses, participants were linked to daily temperature records and electronic death records from national registries during summers (1 May to 30 September) 2000 to 2018. For each day of observation, heat index (average daily air temperature weighted by humidity) for the preceding 7 d was calculated for participants' residential area using a geographic grid at a spatial resolution of formula presented . We examined associations of the summer heat index with risk of death by cause for all participants adjusting for a wide range of individual-level covariates and in subsidiary analyses using case-crossover design, computed the related period population attributable fraction (PAF), and projected change in PAF from summers 2000-2018 compared with those in 2030-2050. RESULTS: During a cohort total exposure period of 582,111,979 summer days (3,880,746 person-summers), we recorded 4,094 deaths, including 949 from cardiovascular disease. The multivariable-adjusted rate ratio (RR) for high (formula presented ) vs. reference (formula presented ) heat index was 1.70 (95% CI: 1.28, 2.27) for cardiovascular mortality, but it did not reach statistical significance for noncardiovascular deaths, formula presented (95% CI: 0.96, 1.36), a finding replicated in case-crossover analysis. According to projections for 2030-2050, PAF of summertime cardiovascular mortality attributable to high heat will be 4.4% (1.8%-7.3%) under the sustainable development scenario, but 7.6% (3.2%-12.3%) under the fossil-fueled development scenario. In the six cities, the estimated annual number of summertime heat-related cardiovascular deaths under the two scenarios will be 174 and 298 for a total population of 1,759,468 people. DISCUSSION: The increase in average urban summer temperature will raise heat-related cardiovascular mortality burden. The estimated magnitude of this burden is formula presented times greater if future climate change is driven by fossil fuels rather than sustainable development. https://doi.org/10.1289/EHP12080.

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  • 28.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Nyberg, Solja T.
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Fransson, Eleonor I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / School of Health Sciences, Jönköping University, Jönköping, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Department of Occupational Medicine, Koege Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    Casini, Annalisa
    School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
    Clays, Els
    Department of Public Health, Ghent University, Ghent, Belgium.
    De Bacquer, Dirk
    Department of Public Health, Ghent University, Ghent, Belgium.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Erbel, Raimund
    Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
    Geuskens, Goedele A.
    TNO, Hoofddorp, Netherlands.
    Hamer, Mark
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Hooftman, Wendela E.
    TNO, Hoofddorp, Netherlands.
    Houtman, Irene L.
    TNO, Hoofddorp, Netherlands.
    Jöckel, Karl-Heinz
    Institute for Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
    Kittel, France
    School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Lunau, Thorsten
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nielsen, Martin L.
    Unit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
    Nordin, Maria
    Stress Research Institute, Stockholm University, Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Pejtersen, Jan H.
    The Danish National Centre for Social Research, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark / Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland / Department of Psychology, University of Turku, Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Siegrist, Johannes
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Suominen, Sakari B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Vahtera, Jussi
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland / Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    O'Reilly, Dermot
    Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
    Kumari, Meena
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Centre for Cognitive Ageing and Cognitive Epidemiology and Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Community and Social Medicine, University of Bristol, Bristol, United Kingdom.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10005, p. 1739-1746Article in journal (Refereed)
    Abstract [en]

    Background Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5.1 million person-years (mean 8.5 years), in which 4768 events were recorded, and for stroke was 3.8 million person-years (mean 7.2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (>= 55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1.13, 95% CI 1.02-1.26; p=0.02) and incident stroke (1.33, 1.11-1.61; p=0.002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1.30-1.42). We recorded a dose-response association for stroke, with RR estimates of 1.10 (95% CI 0.94-1.28; p=0.24) for 41-48 working hours, 1.27 (1.03-1.56; p=0.03) for 49-54 working hours, and 1.33 (1.11-1.61; p=0.002) for 55 working hours or more per week compared with standard working hours (p(trend)<0.0001). Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. 

  • 29.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki, Finland.
    Kuosma, Eeva
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Luukkonen, Ritva
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland .
    Nyberg, Solja T.
    Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland .
    Alfredsson, Lars
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden / Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Batty, G David.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Brunner, Eric J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fransson, Eleonor
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden / School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Goldberg, Marcel
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Nordin, Maria
    Stress Research Institute, Stockholm University, Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland .
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland .
    Rugulies, Reiner
    Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark / National Research Centre for the Working Environment, Copenhagen, Denmark.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Suominen, Sakari B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Theorell, Töres
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Westerholm, Peter
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Hamer, Mark
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.
    Bell, Joshua A.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom.
    Tabak, Adam G.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe2017In: The Lancet Public Health, ISSN 2468-2667, Vol. 2, no 6, p. e277-e285Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight.

    METHODS: ) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis.

    FINDINGS: Participants were 120  813 adults (mean age 51·4 years, range 35-103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973-2012). During a mean follow-up of 10·7 years (1995-2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7-2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5-5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1-21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9-2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1-17·9) for vascular disease followed by diabetes, 18·6 (16·6-20·9) for diabetes only, and 29·8 (21·7-40·8) for diabetes followed by vascular disease.

    INTERPRETATION: The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes.

    FUNDING: NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.

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  • 30.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Luukkonen, Ritva
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Centre for Cognitive Ageing and Cognitive Epidemiology, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
    Ferrie, Jane E.
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Pentti, Jaana
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Nyberg, Solja T.
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Fransson, Eleonor I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / School of Health Sciences and Welfare, Jönköping University, Jönköping, Sweden / Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm.
    Goldberg, Marcel
    Population-based Epidemiologic Cohort Unit, Villejuif, France.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Kuosma, Eeva
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Nordin, Maria
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Folkhälsan Research Center, Folkhälsan, Helsinki, Finland / Turku University Hospital, Turku, Finland.
    Theorell, Töres
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Vuoksimaa, Eero
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
    Westerholm, Peter
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Population-based Epidemiologic Cohort Unit, France.
    Kivipelto, Miia
    Department of Neurobiology, Karolinska Institute, Stockholm, Sweden / National Institute for Health and Welfare, Helsinki, Finland.
    Vahtera, Jussi
    Turku University Hospital, Turku, Finland / University of Turku, Turku, Finland.
    Kaprio, Jaakko
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Population-based Epidemiologic Cohort Unit, France / Department of Psychology, Umeå University, Umeå, Sweden.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland / Department of Psychology, Umeå University, Umeå, Sweden.
    Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals2018In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 5, p. 601-609Article in journal (Refereed)
    Abstract [en]

    Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association.

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  • 31.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, United Kingdom / Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland / Finnish Inst Occupat Hlth, Helsinki, Finland.
    Nyberg, Solja T.
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London, United Kingdom / Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Scotland, United Kingdom.
    Kawachi, Ichiro
    Harvard TH Chan Sch Publ Hlth, Dept Social & Behav Sci, Boston, USA.
    Jokela, Markus
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden / Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Borritz, Marianne
    Bispebjerg Univ Hosp Copenhagen, Dept Occupat & Environm Med, Copenhagen, Denmark.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany.
    Dragano, Nico
    Univ Düsseldorf, Inst Med Sociol, Fac Med, Düsseldorf, Germany.
    Fransson, Eleonor I.
    Jönköping Univ, Sch Hlth & Welf, Jönköping, Sweden / Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Heikkilä, Katriina
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London, United Kingdom / Royal Coll Surgeons England, Clin Effectiveness Unit, London, United Kingdom.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Kumari, Meena
    Univ Essex, Inst Social & Econ Res, Wivenhoe Pk, Colchester, Essex, England, United Kingdom.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Nielsen, Martin L.
    AS3 Co, AS3 Employment, Viby, Denmark.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden / Umeå Univ, Dept Psychol, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark.
    Pentti, Jaana
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark / Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark / Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland / Univ Turku, Dept Psychol, Turku, Finland.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Univ Turku, Dept Publ Hlth, Turku, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland / Turku Univ Hosp, Turku, Finland.
    Westerholm, Peter
    Uppsala Univ, Dept Med Sci, Akad Sjukhuset, Uppsala, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom.
    Singh-Manoux, Archana
    Hop Paul Brousse, INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, Villejuif, France.
    Hamer, Mark
    Loughborough Univ Technol, Natl Ctr Sport & Exercise Med, Sch Sport Exercise & Hlth Sci, Loughborough, Leics, England, United Kingdom.
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England, United Kingdom.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Tabak, Adam G.
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom / Semmelweis Univ, Fac Med, Dept Med 1, Budapest, Hungary.
    Long working hours as a risk factor for atrial fibrillation: a multi-cohort study2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed)
    Abstract [en]

    Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week. Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

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  • 32.
    Kivimäki, Mika
    et al.
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland / Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland / Department of Public Health, University of Turku, Turku, Finland.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Batty, G David.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
    Jokela, Markus
    Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
    Virtanen, Marianna
    Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden.
    Alfredsson, Lars
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden / Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Fransson, Eleonor I.
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden / School of Health and Welfare, Jönköping University, Jönköping, Sweden / Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Goldberg, Marcel
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France / Versailles St-Quentin University, UMS 011, Villejuif, France.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kouvonen, Anne
    Faculty of Social Sciences, University of Helsinki, Helsinki, Finland / Division of Health Psychology, SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland / Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
    Luukkonen, Ritva
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark / Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
    Siegrist, Johannes
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Inserm UMR 1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland / School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, United Kingdom.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Westerholm, Peter J. M.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France / Versailles St-Quentin University, UMS 011, Villejuif, France.
    Strandberg, Timo
    Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland / Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland / Center for Life Course Health Research, University of Oulu, Oulu, Finland.
    Steptoe, Andrew
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Deanfield, John
    National Centre for Cardiovascular Prevention and Outcomes, University College London, London, United Kingdom.
    Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study2018In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 9, p. 705-713, article id S2213-8587(18)30140-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

    METHODS: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

    RESULTS: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19-2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9-44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18-3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74-21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06-1·41).

    INTERPRETATION: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

    FUNDING: NordForsk, UK Medical Research Council, and Academy of Finland.

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  • 33.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, United Kingdom / Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, United Kingdom / Epidemiology of Ageing and Neurodegenerative Diseases, INSERM U1153, Université de Paris, France.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, United Kingdom / Oregon State University School of Biological and Population Health Sciences, Corvallis, Oregon.
    Sabia, Severine
    Epidemiology of Ageing and Neurodegenerative Diseases, INSERM U1153, Université de Paris, France.
    Sommerlad, Andrew
    Division of Psychiatry, University College London, United Kingdom / Camden and Islington NHS Foundation Trust, London, United Kingdom.
    Floud, Sarah
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
    Jokela, Marcus
    Department of Psychology and Logopedics, University of Helsinki, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland / Centre for Population Health Research, Turku University Hospital, University of Turku, Finland.
    Beydoun, May A.
    Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
    Suominen, Sakari B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Goldberg, Marcel
    Population-Based Epidemiological Cohorts Unit, INSERM UMS 011, Villejuif, France.
    Zins, Marie
    Population-Based Epidemiological Cohorts Unit, INSERM UMS 011, Villejuif, France.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Region Stockholm, Sweden.
    Westerholm, Peter J. M.
    Department of Medical Sciences, Uppsala University, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki, Finland.
    Sipilä, Pyry N.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Lindbohm, Joni V.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland / Department of Public Health, University of Turku, Finland / Finnish Institute of Occupational Health, Helsinki, Finland.
    Livingston, Gill
    Division of Psychiatry, University College London, United Kingdom / Camden and Islington NHS Foundation Trust, London, United Kingdom.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, United Kingdom / Bristol Medical School, Population Health Sciences, University of Bristol, United Kingdom.
    Strandberg, Timo
    Clinicum, Faculty of Medicine, University of Helsinki, Finland / Department of Medicine, Helsinki University Hospital, Finland / Center for Life Course Health Research, University of Oulu, Finland.
    Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia2020In: JAMA Network Open, E-ISSN 2574-3805, Vol. 3, no 9, article id e2016084Article in journal (Refereed)
    Abstract [en]

    Importance: Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain. Objective: To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers. Design, Setting, and Participants: Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020. Exposures: Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week. Main Outcomes and Measures: Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records. Results: Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 (95% CI, 0.98-1.37) for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22 (95% CI, 1.01-1.48) for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men (HR, 2.86; 95% CI, 1.77-4.63) and women (HR, 2.09; 95% CI, 1.34-3.25) during the first 10 years of follow-up (HR, 2.72; 95% CI, 1.78-4.15), after excluding the first 10 years of follow-up (HR, 1.86; 95% CI, 1.16-2.99), and for early-onset (<65 y: HR, 2.21; 95% CI, 1.46-3.34) and late-onset (≥65 y: HR, 2.25; 95% CI, 1.38-3.66) dementia, Alzheimer disease (HR, 1.98; 95% CI, 1.28-3.07), and dementia with features of atherosclerotic cardiovascular disease (HR, 4.18; 95% CI, 1.86-9.37). The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate (HR, 2.19; 95% CI, 1.42-3.37) or heavy (HR, 2.36; 95% CI, 1.57-3.54). Conclusions and Relevance: The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.

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  • 34.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, England / Univ Helsinki, Clinicum, Finland / Univ Helsinki, Helsinki Inst Life Sci, Finland.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, England / INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Finland / Univ Turku, Dept Publ Hlth, Finland.
    Sabia, Séverine
    UCL, Dept Epidemiol & Publ Hlth, England / INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Nyberg, Solja T.
    Univ Helsinki, Clinicum, Finland.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Goldberg, Marcel
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Clinicum, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Fac Social Sci, Finland / SWPS Univ Social Sci & Humanities Wroclaw, Poland / Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Sweden / Umea Univ, Dept Psychol, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Strandberg, Timo
    Univ Helsinki, Clinicum, Finland / Helsinki Univ Hosp, Finland / Univ Oulu, Ctr Life Course Hlth Res, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Univ Turku, Dept Publ Hlth, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Sweden.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Finland / Turku Univ Hosp, Finland.
    Väänanen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Virtanen, Marianna
    Univ Eastern Finland, Sch Educ Sci & Psychol, Joensuu, Finland.
    Westerholm, Peter
    Uppsala Univ, Dept Med Sci, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Sweden.
    Zins, Marie
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Seshadri, Sudha
    Univ Texas Hlth Sci Ctr San Antonio, Glenn Biggs Inst Alzheimers & Neurodegenerat Dis, San Antonio, TX 78229 USA / Framingham Heart Dis Epidemiol Study, Framingham, MA USA.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Sipilä, Pyry N.
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Lindbohm, Joni V.
    Univ Helsinki, Clinicum, Finland.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England / Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Jokela, Markus
    Univ Helsinki, Biomedicum, Fac Med, Finland.
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019In: The BMJ, E-ISSN 1756-1833, Vol. 365, article id l1495Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

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  • 35.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, United Kingdom ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Strandberg, Timo
    Department of Medicine, University of Helsinki and Helsinki University Hospital, Finland ; Center for Life Course Health Research, University of Oulu, Finland.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Department of Public Health, University of Turku, Finland ; Centre for Population Health Research, University of Turku, Finland.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Frank, Philipp
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Jokela, Markus
    Department of Psychology and Logopedics, University of Helsinki, Finland.
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Suominen, Sakari B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Turku University Hospital, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland ; Centre for Population Health Research, University of Turku, Finland ; Turku University Hospital, Finland.
    Sipilä, Pyry N.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Lindbohm, Joni V.
    Department of Epidemiology and Public Health, University College London, United Kingdom ; Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, United Kingdom ; Bristol Medical School, University of Bristol, United Kingdom.
    Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study2022In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 10, no 4, p. 253-263Article in journal (Refereed)
    Abstract [en]

    Background: The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases). Methods: We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16–78 years at study entry (1998–2013). A cohort of 499 357 adults (aged 38–73 years at study entry; 2006–10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (≥30·0 kg/m2), overweight (25·0–29·9 kg/m2), healthy weight (18·5–24·9 kg/m2), and underweight (&lt;18·5 kg/m2). Via linkage to national health records, participants were followed-up for death and diseases diagnosed according to the International Classification of Diseases 10th Revision (ICD-10). Hazard ratios (HRs) with 95% CIs and population attributable fractions (PAFs) for associations between BMI and multimorbidity were calculated. Findings: Mean follow-up duration was 12·1 years (SD 3·8) in the Finnish cohorts and 11·8 years (1·7) in the UK Biobank cohort. Obesity was associated with 21 non-overlapping cardiometabolic, digestive, respiratory, neurological, musculoskeletal, and infectious diseases after Bonferroni multiple testing adjustment and ignoring HRs of less than 1·50. Compared with healthy weight, the confounder-adjusted HR for obesity was 2·83 (95% CI 2·74–2·93; PAF 19·9% [95% CI 19·3–20·5]) for developing at least one obesity-related disease, 5·17 (4·84–5·53; 34·4% [33·2–35·5]) for two diseases, and 12·39 (9·26–16·58; 55·2% [50·9–57·5]) for complex multimorbidity. The proportion of participants of healthy weight with complex multimorbidity by age 75 years was observed by age 55 years in participants with obesity, and degree of obesity was associated with complex multimorbidity in a dose–response relationship. Compared with obesity, the association between overweight and complex multimorbidity was more modest (HR 2·67, 95% CI 1·94–3·68; PAF 13·3% [95% CI 9·6–16·3]). The same pattern of results was observed in the UK Biobank cohort. Interpretation: Obesity is associated with diverse, increasing disease burdens, and might represent an important target for multimorbidity prevention that avoids the complexities of multitarget preventive regimens. Funding: Wellcome Trust, Medical Research Council, National Institute on Aging.

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  • 36.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, UK ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Walker, Keenan A.
    Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA ; Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland ; Department of Public Health, University of Turku, Finland.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Mars, Nina
    Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland ; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Lallukka, Tea
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Rahkonen, Ossi
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Pietiläinen, Olli
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kalsi, Jatinderpal K.
    Department of Epidemiology and Public Health, University College London, UK.
    Goldberg, Marcel
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France ; Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.
    Zins, Marie
    Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France ; Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Centre for Occupational and Environmental Medicine, Region Stockholm, Sweden.
    Westerholm, Peter J. M.
    Department of Medical Sciences, Uppsala University, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Sweden.
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Oksanen, Tuula
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
    Sipilä, Pyry N.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Tabak, Adam G.
    Department of Epidemiology and Public Health, University College London, UK ; Department of Internal Medicine and Oncology and Department of Public Health, Semmelweis University, Budapest, Hungary.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, UK ; Bristol Medical School, University of Bristol, UK.
    Williams, Stephen A.
    SomaLogic, Boulder, CO, USA.
    Livingston, Gill
    Division of Psychiatry, University College London, UK ; Camden and Islington NHS Foundation Trust, London, UK.
    Gottesman, Rebecca F.
    Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, UK ; Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.
    Zetterberg, Henrik
    Department of Neurodegenerative Disease and UK Dementia Research Institute, University College London, UK ; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, and Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
    Lindbohm, Joni V.
    Department of Epidemiology and Public Health, University College London, UK ; Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies2021In: The BMJ, E-ISSN 1756-1833, Vol. 374, article id n1804Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association.

    DESIGN: Multicohort study with three sets of analyses.

    SETTING: United Kingdom, Europe, and the United States.

    PARTICIPANTS: Three associations were examined: cognitive stimulation and dementia risk in 107 896 participants from seven population based prospective cohort studies from the IPD-Work consortium (individual participant data meta-analysis in working populations); cognitive stimulation and proteins in a random sample of 2261 participants from one cohort study; and proteins and dementia risk in 13 656 participants from two cohort studies.

    MAIN OUTCOME MEASURES: Cognitive stimulation was measured at baseline using standard questionnaire instruments on active versus passive jobs and at baseline and over time using a job exposure matrix indicator. 4953 proteins in plasma samples were scanned. Follow-up of incident dementia varied between 13.7 to 30.1 years depending on the cohort. People with dementia were identified through linked electronic health records and repeated clinical examinations.

    RESULTS: During 1.8 million person years at risk, 1143 people with dementia were recorded. The risk of dementia was found to be lower for participants with high compared with low cognitive stimulation at work (crude incidence of dementia per 10 000 person years 4.8 in the high stimulation group and 7.3 in the low stimulation group, age and sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 to 0.92, heterogeneity in cohort specific estimates I2=0%, P=0.99). This association was robust to additional adjustment for education, risk factors for dementia in adulthood (smoking, heavy alcohol consumption, physical inactivity, job strain, obesity, hypertension, and prevalent diabetes at baseline), and cardiometabolic diseases (diabetes, coronary heart disease, stroke) before dementia diagnosis (fully adjusted hazard ratio 0.82, 95% confidence interval 0.68 to 0.98). The risk of dementia was also observed during the first 10 years of follow-up (hazard ratio 0.60, 95% confidence interval 0.37 to 0.95) and from year 10 onwards (0.79, 0.66 to 0.95) and replicated using a repeated job exposure matrix indicator of cognitive stimulation (hazard ratio per 1 standard deviation increase 0.77, 95% confidence interval 0.69 to 0.86). In analysis controlling for multiple testing, higher cognitive stimulation at work was associated with lower levels of proteins that inhibit central nervous system axonogenesis and synaptogenesis: slit homologue 2 (SLIT2, fully adjusted β -0.34, P<0.001), carbohydrate sulfotransferase 12 (CHSTC, fully adjusted β -0.33, P<0.001), and peptidyl-glycine α-amidating monooxygenase (AMD, fully adjusted β -0.32, P<0.001). These proteins were associated with increased dementia risk, with the fully adjusted hazard ratio per 1 SD being 1.16 (95% confidence interval 1.05 to 1.28) for SLIT2, 1.13 (1.00 to 1.27) for CHSTC, and 1.04 (0.97 to 1.13) for AMD.

    CONCLUSIONS: The risk of dementia in old age was found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs. The findings that cognitive stimulation is associated with lower levels of plasma proteins that potentially inhibit axonogenesis and synaptogenesis and increase the risk of dementia might provide clues to underlying biological mechanisms.

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  • 37.
    Koponen, Anne M.
    et al.
    University of Helsinki, Finland / Folkhälsan Research Center, Finland.
    Simonsen, Nina
    University of Helsinki, Finland / Folkhälsan Research Center, Finland.
    Laamanen, Ritva
    University of Helsinki, Finland / Folkhälsan Research Center, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Folkhälsan Research Center, Finland / University of Turku, Finland.
    Health-care climate, perceived self-care competence, and glycemic control among patients with type 2 diabetes in primary care2015In: Health Psychology Open, ISSN 2055-1029, Vol. 2, no 1Article in journal (Refereed)
    Abstract [en]

    This study showed, in line with self-determination theory, that glycemic control among patients with type 2 diabetes (n=2866) was strongly associated with perceived self-care competence, which in turn was associated with autonomous motivation and autonomy-supportive health-care climate. These associations remained after adjusting for the effect of important life-context factors. Autonomous motivation partially mediated the effect of health-care climate on perceived competence, which fully mediated the effect of autonomous motivation on glycemic control. The results of the study emphasize health-care personnel's important role in supporting patients' autonomous motivation and perceived self-care competence.

  • 38.
    Koponen, Anne M.
    et al.
    Folkhälsan Research Center, Finland / University of Helsinki, Finland.
    Simonsen, Nina
    Folkhälsan Research Center, Finland / University of Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. University of Turku, Finland.
    How to promote fruits, vegetables, and berries intake among patients with type 2 diabetes in primary care?: A self-determination theory perspective2019In: Health Psychology Open, E-ISSN 2055-1029, Vol. 6, no 1Article in journal (Refereed)
    Abstract [en]

    The results of this study showed the importance of autonomous motivation for healthy eating. Autonomous motivation and female gender were the determinants most strongly associated with fruits, vegetables, and berries intake among patients with type 2 diabetes. Other determinants of fruits, vegetables, and berries intake were high education, high social support, high age, and a strong sense of coherence. Autonomous motivation and self-care competence mediated the effect of perceived autonomy support from a physician on fruits, vegetables, and berries intake. Thus, physicians can promote patients’ fruits, vegetables, and berries intake by supporting their autonomous motivation and self-care competence. The results are in line with self-determination theory.

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  • 39.
    Koponen, Anne M.
    et al.
    Folkhälsan Research Center and Department of Public Health, University of Helsinki, Finland.
    Simonsen, Nina
    Folkhälsan Research Center and Department of Public Health, University of Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Finland.
    Success in increasing physical activity (PA) among patients with type 2 diabetes: a self-determination theory perspective2018In: Health Psychology and Behavioral Medicine, ISSN 2164-2850, Vol. 6, no 1, p. 104-119Article in journal (Refereed)
    Abstract [en]

    Background: Increased physical activity (PA) is crucial for achieving and maintaining glycemic control and is beneficial for overall well-being of patients with type 2 diabetes as well. Despite that, many patients fail to make changes in their exercise behavior. Self-determination theory (SDT) addresses this problem and suggests that perceived autonomy support, autonomous motivation and self-care competence play a key role in the process of health behavior change. This study investigated the impact of these three factors on success in increasing PA among patients with type 2 diabetes but considered also the role of other important life-context factors, such as mental health, stress and social support. The effect of these other factors may outweigh the effect of SDT constructs; however, previous studies based on SDT have largely overlooked them. Methods: This cross-sectional mail survey was carried out in 2011. Out of 2866 respondents, those who had been over 2 years in care in their present and principal primary care health center and had during the past two years tried to increase PA either with or without success (n = 1256, mean age 63 years, 52% men), were included in this study. Logistic regression and mediation analyses were the main methods used in the data analysis. Results: Autonomous motivation predicted success in increasing PA even after controlling for the effect of other important life-context factors. Other predictors of success were felt energy, good perceived health, younger age and less social support. Autonomous motivation mediated the effect of perceived autonomy support from a doctor on success in increasing PA. Conclusion: The results were in line with SDT showing the importance of autonomous motivation for success in increasing PA. Doctor-patient relationships and lifestyle interventions should focus on promoting self-motivated reasons for health behavior change.

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  • 40.
    Krettek, Alexandra
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Folkhälsovetenskaplig utbildning på distans med unik profil för framtiden2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 3, p. 327-339Article in journal (Refereed)
    Abstract [en]

    Public Health at University of Skövde is expanding as a strategic effort by the University. The ambition is to provide unique public health education that gives students preparedness to work with current and future public health challenges. To date, University of Skövde offers three educational programmes in public health; the two-year Health Coach, the three-year Public Health Sciences Study Programme and the master’s programme in Public Health Science: Infection Prevention and Control. The latter is unique and one-of-a-kind in both Sweden and the Nordic countries. All educational programmes are given as distance education with a few gatherings on campus. The article therefore also highlights challenges and possibilities with distance education and provides advice on how to make students successfully progress through such educational programmes.

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  • 41.
    Lagström, Hanna
    et al.
    Department of Public Health, University of Turku, Finland / Turku University Hospital, Finland.
    Halonen, Jaana I.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kawachi, Ichiro
    Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA.
    Stenholm, Sari
    Department of Public Health, University of Turku, Finland / Turku University Hospital, Finland.
    Pentti, Jaana
    Department of Public Health, University of Turku, Finland / Turku University Hospital, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Finland / Turku University Hospital, Finland.
    Kivimäki, Mika
    Clinicum, Faculty of Medicine, University of Helsinki, Finland / Department of Epidemiology and Public Health, University College London, UK.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland / Turku University Hospital, Turku, Finland.
    Neighborhood socioeconomic status and adherence to dietary recommendations among Finnish adults: A retrospective follow-up study2019In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 55, p. 43-50Article in journal (Refereed)
    Abstract [en]

    Neighborhood socioeconomic status (SES) is associated with dietary habits among the residents, but few studies have examined this association separately among long-term residents and movers. We calculated cumulative neighborhood SES score weighted by residential time in each address over 6 years for non-movers (n = 7704) and movers (n = 8818) using national grid database. Increase in average neighborhood SES was associated with higher adherence to dietary recommendations in both groups. Among the movers, an upward trajectory from low to high neighborhood SES was also associated with better adherence. Our findings suggest high SES areas might offer healthier food environments than low SES areas.

  • 42.
    Lagström, Hanna
    et al.
    Department of Public Health, University of Turku and Turku University Hospital, Finland / Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Halonen, Jaana I.
    Health Security, Finnish Institute for Health and Welfare, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku and Turku University Hospital, Finland.
    Pentti, Jaana
    Department of Public Health, University of Turku and Turku University Hospital, Finland.
    Stenholm, Sari
    Department of Public Health, University of Turku and Turku University Hospital, Finland / Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Kivimäki, Mika
    Clinicum, University of Helsinki, Finland / Department of Epidemiology and Public Health, University College London, United Kingdom.
    Vahtera, Jussi
    Department of Public Health, University of Turku and Turku University Hospital, Finland / Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Neighbourhood characteristics as a predictor of adherence to dietary recommendations: A population-based cohort study of Finnish adults2021In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 2, p. 245-249Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the association of six-year cumulative level of socioeconomic neighbourhood disadvantage and population density with subsequent adherence to dietary recommendations, controlling for preceding dietary adherence, in adults in Finland. Methods: Population-based Health and Social Support (HeSSup) study participants from four age groups (20–24, 30–34, 40–44 and 50–54 years at baseline in 1998). Data on diet and alcohol consumption were obtained from the 2003 and 2012 surveys and information on neighbourhoods from Statistics Finland Grid database (n = 10,414 men and women). Participants diet was measured as adherence to Nordic Nutrition recommendation (score range 0–100). Neighbourhood disadvantage was measured by median household income, proportion of those with primary education only and unemployment rate, and population density by the number of adult population between years 2007 and 2012. Linear models were used to assess the associations of neighbourhood characteristics with the score for adherence to dietary recommendations in 2012. Results: Cumulative neighbourhood socioeconomic disadvantage was associated with slightly weaker (1.49 (95% confidence interval (CI) −1.89 to −1.09) point decrease in dietary score) adherence while higher population density was associated with better (0.70 (95% CI 0.38−1.01) point increase in dietary score) adherence to dietary recommendations. These associations remained after controlling for prior dietary habits, sociodemographic, chronic cardio-metabolic diseases, and severe life events. Conclusions: These longitudinal findings support the hypothesis that neighbourhood characteristics affect dietary habits. 

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  • 43.
    Lassander, Maarit
    et al.
    Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland.
    Hintsanen, Mirka
    Unit of Psychology, University of Oulu, Finland.
    Ravaja, Niklas
    Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland.
    Määttänen, Ilmari
    Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Turku University Hospital, Finland.
    Mullola, Sari
    Faculty of Education and Culture, University of Tampere, Finland ; Teachers College, National Center for Children and Families (NCCF), Columbia University, United States.
    Makkonen, Tommi
    Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland.
    Vahlberg, Tero
    Department of Biostatistics, University of Turku, Finland.
    Volanen, Salla-Maarit
    Folkhälsan Research Center, Helsinki, Finland.
    Pilot study on students’ stress reactivity after mindfulness intervention compared to relaxation control group2022In: International Journal of Stress Management, ISSN 1072-5245, E-ISSN 1573-3424, Vol. 29, no 3, p. 306-317Article in journal (Refereed)
    Abstract [en]

    The current pilot study examines the effects of a mindfulness intervention versus relaxation-based active control on psychophysiological reactivity measured by heart rate (HR), high-frequency heart rate variability (HF-HRV), skin conductance level (SCL), and number of skin conductance responses (SCR) in adolescents. A total of 110 students, ages 12 and 15, participated from four schools. The conditions of a 9-week mindfulness intervention or a relaxation-based active control were randomly assigned to schools. At the baseline (preintervention), participants completed a test protocol with three different tasks: an arithmetic task, a minimal stress task, and a social stress-inducing speech task, divided into argue, oppose, and comment subtasks. The test protocol was repeated postintervention at 9 weeks and followed up at 26 weeks. For the speech task (oppose), the number of SCRs increased in the control group during both (9-week and 26-week) follow-ups, but stayed at the same level in the intervention group (i.e., the stress response in the control group increased). Additionally, HR and SCL reactivity were close to significance, demonstrating an increase in the control group and increased stress. There were no significant differences in HR, HF-HRV, and SCL between the intervention and control groups. The results of this pilot study suggest that in a highly stressful social situation, mindfulness, compared to the active control, might have a subtle effect in lowering sympathetically driven physiological stress reactivity. Other measures show either no effects or tentative findings that should be addressed in future studies with larger samples.

  • 44.
    Lassander, Maarit
    et al.
    Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland.
    Hintsanen, Mirka
    Unit of Psychology, University of Oulu, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Mullola, Sari
    Faculty of Educational Sciences, University of Helsinki, Finland / Teachers College, National Center for Children and Families (NCCF), Columbia University, NY, USA.
    Fagerlund, Åse
    Public Health Research Programme, Folkhälsan Research Center, Helsinki, Finland.
    Vahlberg, Tero
    Department of Biostatistics, University of Turku, Finland.
    Volanen, Salla-Maarit
    Public Health Research Programme, Folkhälsan Research Center, Helsinki, Finland / Faculty of Medicine, Department of Public Health, University of Helsinki, Finland.
    The Effects of School-based Mindfulness Intervention on Executive Functioning in a Cluster Randomized Controlled Trial2020In: Developmental Neuropsychology, ISSN 8756-5641, E-ISSN 1532-6942, Vol. 45, no 7-8, p. 469-484Article in journal (Refereed)
    Abstract [en]

    Executive functions (EFs) are essential for student's learning and classroom functioning. The current cluster randomized controlled trial examines the effects of mindfulness intervention vs. active control program (i.e., relaxation) focusing on the main EFs (i.e., working memory, response inhibition, cognitive processing, cognitive flexibility and verbal fluency). A total of 131 students from 6th grade and 8th grade (median age 12 and 15) from four comprehensive schools participated. The schools were to equal shares randomized to intervention and active control groups, i.e., groups who underwent a 9-week mindfulness practice or relaxation program, respectively. Participants completed a cognitive test-package at baseline/pre-intervention, post-intervention at 9 weeks and follow-up at 6 months. Both intervention and active relaxation-based control groups improved on a majority of EF measures at both 9 weeks and 6 months. There was no significant difference between the mindfulness intervention group and the active control program in EFs. The current study suggests that mindfulness intervention and active control program do not differ in their effects to EFs, although both may have positive outcomes. Further research with both active and inactive control groups is needed to map the potential benefits of similar programs for cognitive functioning.

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  • 45.
    Lassander, Maarit
    et al.
    Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland.
    Hintsanen, Mirka
    Unit of Psychology, University of Oulu, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Mullola, Sari
    Faculty of Educational Sciences, University of Helsinki, Finland ; Teachers College, National Center for Children and Families (NCCF), Columbia University, New York, USA.
    Vahlberg, Tero
    Department of Biostatistics, University of Turku, Finland.
    Volanen, Salla-Maarit
    Folkhälsan Research Center, Helsinki, Finland ; Faculty of Medicine, Department of Public Health, University of Helsinki, Finland.
    Effects of school-based mindfulness intervention on health-related quality of life: moderating effect of gender, grade, and independent practice in cluster randomized controlled trial2021In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 30, p. 3407-3419Article in journal (Refereed)
    Abstract [en]

    OBJECT: We investigated the impact of a school-based 9-week mindfulness program vs. active control program (relaxation) and inactive control group on children's self-reported Health-Related Quality of Life (HRQoL) moderated by gender, grade, and independent practice.

    METHOD: In total 3519 (50/50% boys/girls) Finnish students aged 12-15 years from 56 schools were randomized into mindfulness intervention, active, and inactive control groups. HRQoL was measured at baseline, at 9 weeks, and at 26 weeks and analyzed with multilevel linear modeling.

    RESULTS: Significant improvement on HRQoL was found (β = mean difference) (β = 1.587, 95% CI 0.672-2.502, p < 0.001) after 9 weeks and at 26 weeks of follow-up among students in the mindfulness group as compared to the active control group. Moderating effects on HRQoL were found for gender, grade, and independent practice: girls, 7th and 8th grade students, and students with regular independent mindfulness practice benefited most.

    CONCLUSIONS: Gender and developmental stage may moderate the effects of mindfulness interventions on HRQoL and offer guidance in designing effective promotive interventions for children and adolescents.

    TRIAL REGISTRATION INFORMATION: Healthy Learning Mind-a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial (RCT) ISRCTN18642659 retrospectively registered on 13 October 2015. The full trial protocol can be accessed at http://rdcu.be/t57S .

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  • 46.
    Lassander, Maarit
    et al.
    Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland.
    Saarinen, Tapio
    Aalto University, Helsinki, Finland.
    Simonsen-Rehn, Nina
    Folkhälsan Research Center, Helsinki, Finland ; Faculty of Medicine, Department of Public Health, University of Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Vahlberg, Tero
    Department of Biostatistics, University of Turku, Finland.
    Volanen, Salla-Maarit
    Folkhälsan Research Center, Helsinki, Finland ; Faculty of Medicine, Department of Public Health, University of Helsinki, Finland.
    Healthy Learning Mind (HLM): Cluster Randomized Controlled Trial on A Mindfulness Intervention, Moderators and Association with Perceived Socioeconomic Status, and Comparison to Other National Data2023In: Child and Youth Care Forum, ISSN 1053-1890, E-ISSN 1573-3319, Vol. 52, no 1, p. 157-176Article in journal (Refereed)
    Abstract [en]

    Background: This paper presents the baseline characteristics and their moderators in the Healthy Learning Mind (HLM)– school-based cluster-randomized controlled trial. Objectives: The paper evaluates the state of various measures of well-being, their moderators and how these results compare to national and global norms/population studies. Methods: Data were collected from all participants prior to the intervention and further analyzed by gender, grade and perceived socioeconomic status, including standardized measures for resilience, depressive symptoms and socioemotional functioning; health-related quality of life, dispositional mindfulness, satisfaction with life, compassion/self-kindness, self-rated health and morning tiredness. Results: Participating 2793 students (1425 girls, 1368 boys), ages 12 to 15 years, filled in the questionnaires. The outcomes were in line with previous research, demonstrating gender differentiation and lower wellbeing among older children and adolescents. Conclusions: All outcomes were associated with perceived socioeconomic status, suggesting that perceived low socioeconomic status should be addressed as a serious risk factor and included as a moderator in similar trials. 

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  • 47.
    Lautamatti, Emmi
    et al.
    Faculty of Medicine and Health Technology, Tampere University, Finland ; The Wellbeing Services County of Pirkanmaa, Tampere, Finland.
    Mattila, Kari J.
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; The Wellbeing Services County of Southwest Finland, Research Centre, Turku, Finland.
    Sillanmäki, Lauri
    The Wellbeing Services County of Southwest Finland, Research Centre, Turku, Finland ; University of Turku, Finland ; Department of Public Health, University of Helsinki, Finland.
    Sumanen, Markku
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1178Article in journal (Refereed)
    Abstract [en]

    Background: Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. Objectives: The aim of the study was to determine whether having a named GP is associated with hospital service use. Methods: The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). Results: A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. Conclusion: A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized. 

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  • 48.
    Lautamatti, Emmi
    et al.
    Faculty of Medicine and Health Technology, Tampere University, Finland ; Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland.
    Mattila, Kari
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health and Clinical Research Centre, University of Turku, Turku University Hospital, Finland.
    Sillanmäki, Lauri
    Turku University Hospital and University of Turku, Finland ; Department of Public Health, University of Helsinki, Finland.
    Sumanen, Markku
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    A named GP increases self-reported access to health care services2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 1262Article in journal (Refereed)
    Abstract [en]

    Background: Continuity of care strengthens health promotion and decreases mortality, although the mechanisms of these effects are still unclear. In recent decades, continuity of care and accessibility of health care services have both decreased in Finland. Objectives: The aim of the study was to investigate whether a named and assigned GP representing continuity of care is associated with the use of primary and hospital health care services and to create knowledge on the state of continuity of care in a changing health care system in Finland. Methods: The data are part of the Health and Social Support (HeSSup) mail survey based on a random Finnish working age population sample of 64,797 individuals drawn in 1998 and follow-up surveys in 2003 and 2012. The response rate in 1998 was 40% (n = 25,898). Continuity of care was derived from the 2003 and 2012 data sets, other variables from the 2012 survey (n = 11,924). The principal outcome variables were primary health care and hospital service use reported by participants. The association of the explanatory variables (gender, age, education, reported chronic diseases, health status, smoking, obesity, NYHA class of any functional limitation, depressive mood and continuity of care) with the outcome variables was analysed by binomial logistic regression analysis. Results: A named and assigned GP was independently and significantly associated with more frequent use of primary and hospital care in the adjusted logistic regression analysis (ORs 1.53 (95% CI 1.35–1.72) and 1.19 (95% CI 1.08–1.32), p < 0.001). Conclusion: A named GPs is associated with an increased use of primary care and hospital services. A named GP assures access to health care services especially to the chronically ill population. The results depict the state of continuity of care in Finland. All benefits of continuity of care are not enabled although it still assures treatment of population in the most vulnerable position. 

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  • 49.
    Lietzén, Raija
    et al.
    Department of Public Health, University of Turku and Turku University Hospital, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku and Turku University Hospital, Finland.
    Sillanmäki, Lauri
    Department of Public Health, University of Turku and Turku University Hospital, Finland ; Department of Public Health, University of Helsinki, Finland.
    Virtanen, Pekka
    Faculty of Social Sciences, Tampere University, Finland.
    Virtanen, Marianna
    School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku and Turku University Hospital, Finland ; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators2021In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 143, article id 110388Article in journal (Refereed)
    Abstract [en]

    Objective: This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood. Methods: Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators). Results: Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE–asthma association were ‘severe financial difficulties’ (24%), ‘emotional, physical or sexual violence’ (15%), ‘major increase in marital problems’ (8%), ‘severe conflicts with supervisor’ (7%), and ‘divorce or separation’ (5%). Conclusions: Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset. 

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  • 50.
    Lietzén, Raija
    et al.
    Department of Public Health, University of Turku, Turku, Finland.
    Virtanen, Pekka
    School of Health Sciences, University of Tampere, Tampere, Finland.
    Kivimäki, Mika
    Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom.
    Korkeila, Jyrki
    Department of Psychiatry, University of Turku and Harjavalta Hospital, Satakunta Hospital District, Harjavalta, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland.
    Sillanmäki, Lauri
    Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Koskenvuo, Markku
    Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
    Change in β2-agonist use after severe life events in adults with asthma: A population-based cohort study Life events and bronchodilator usage among adults with asthma2017In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 100, p. 46-52Article in journal (Refereed)
    Abstract [en]

    Objective: This prospective, population-based cohort study of 1102 Finnish adults with asthma, examined whether exposure to stressful life events is associated with the intensity of usage of inhaled short-acting β2- agonists. Methods: Survey data was collected by two postal questionnaires. Baseline characteristics were obtained in 1998 and data on 19 specific stressful events (e.g. death of a child or spouse or divorce) within the six preceding months in 2003. Exposure to life events was indicated by a sum score weighted by mean severity of the events. Participants were linked to records of filled prescriptions for inhaled short-acting β2-agonists from national registers from 2000 through 2006. The rates of purchases of short-acting β2-agonists before (2000−2001), during (2002−2003) and after (2004–2006) the event exposure were estimated using repeated-measures Poisson regression analyses with the generalized estimating equation. Results: Of the 1102 participants, 162 (15%) were exposed to highly stressful events, 205 (19%) to less stressful events. During the 7-year observation period, 5955 purchases of filled prescription for inhaled short-acting β2- agonists were recorded. After exposure to highly stressful events, the rate of purchases of β2-agonists was 1.50 times higher (95% confidence interval (CI): 1.05, 2.13) than before the stressful event occurred. Among those with low or no exposure to life events, the corresponding rate ratios were not elevated (rate ratio 0.81, 95% CI: 0.66, 0.99 and 0.95, 95% CI: 0.83, 1.09 respectively). Conclusion: An increase in β2-agonist usage after severe life events suggests that stressful experiences may worsen asthma symptoms

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