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  • 1.
    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, ISSN 2072-6643, 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.

  • 2.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. 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, Health and Education. 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.

  • 3.
    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.

  • 4.
    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.

  • 5.
    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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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. 

  • 10.
    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 2468-3667, 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.

  • 11.
    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, 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.

  • 12.
    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.

  • 13.
    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.

  • 14.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, 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: BMJ. British Medical Journal, 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.

  • 15.
    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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    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.

  • 19.
    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.

  • 20.
    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

  • 21.
    Magnusson Hanson, Linda L.
    et al.
    Stress Research Institute, Stockholm University, Sweden.
    Rod, Naja Hulvej
    Section of Epidemiology, Department of Public Health, University of Copenhagen, Social Medicine Section, Copenhagen, Denmark / National Research Centre for the Working Environment, Copenhagen, Denmark.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland / Turku University Hospital, Finland.
    Peristera, Paraskevi
    Stress Research Institute, Stockholm University, Sweden.
    Pentti, Jaana
    Department of Public Health, University of Turku, Finland.
    Rugulies, Reiner
    Section of Epidemiology, Department of Public Health, University of Copenhagen, Social Medicine Section, Copenhagen, Denmark / National Research Centre for the Working Environment, Copenhagen, Denmark / Department of Psychology, University of Copenhagen, Denmark.
    Madsen, Ida Elisabeth Huitfeldt
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Lamontagne, Anthony D.
    McCaughey Centre, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia / Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia.
    Milner, Allison
    Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
    Lange, Theis
    Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Finland.
    Stenholm, Sari
    Department of Public Health, University of Turku, Finland.
    Xu, Tianwei
    Section of Epidemiology, Department of Public Health, University of Copenhagen, Social Medicine Section, Copenhagen, Denmark / National Research Centre for the Working Environment, Copenhagen, Denmark.
    Kivimäki, Mika
    Clinicum, Faculty of Medicine, University of Helsinki, Finland / Department of Epidemiology and Public Health, University College London, UK.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Sweden.
    Multicohort study of change in job strain, poor mental health and incident cardiometabolic disease2019In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 76, p. 785-792Article in journal (Refereed)
    Abstract [en]

    Objectives: Several recent large-scale studies have indicated a prospective association between job strain and coronary heart disease, stroke and diabetes. Job strain is also associated with poorer mental health, a risk factor for cardiometabolic disease. This study investigates the prospective relationships between change in job strain, poor mental health and cardiometabolic disease, and whether poor mental health is a potential mediator of the relationship between job strain and cardiometabolic disease. Methods: We used data from five cohort studies from Australia, Finland, Sweden and UK, including 47 757 men and women. Data on job strain across two measurements 1-5 years apart (time 1 (T1)-time 2 (T2)) were used to define increase or decrease in job strain. Poor mental health (symptoms in the top 25% of the distribution of the scales) at T2 was considered a potential mediator in relation to incident cardiometabolic disease, including cardiovascular disease and diabetes, following T2 for a mean of 5-18 years. Results: An increase in job strain was associated with poor mental health (HR 1.56, 95% CI 1.38 to 1.76), and a decrease in job strain was associated with lower risk in women (HR 0.70, 95% CI 0.60-0.84). However, no clear association was observed between poor mental health and incident cardiometabolic disease (HR 1.08, 95% CI 0.96-1.23), nor between increase (HR 1.01, 95% CI 0.90-1.14) and decrease (HR 1.08, 95% CI 0.96-1.22) in job strain and cardiometabolic disease. Conclusions: The results did not support that change in job strain is a risk factor for cardiometabolic disease and yielded no support for poor mental health as a mediator.

  • 22.
    Nyberg, Solja T.
    et al.
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Batty, George David
    Department of Epidemiology and Public Health, University College London, UK.
    Pentti, Jaana
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Finland / Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland / Institute of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden / Stress Research Institute, University of Stockholm, Sweden.
    Alfredsson, Lars S.
    Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden / Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fransson, Eleonor I.
    Stress Research Institute, University of Stockholm, Sweden / School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Goldberg, Marcel
    Paris Descartes University, Paris, France / Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Heikkilä, Katriina V.
    Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom / Clinical Effectiveness Unit, The Royal College of Surgeons, London, United Kingdom.
    Jokela, Markus
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
    Knutsson, Anders K.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku J.
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Lallukka, Tea
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Finland / Finnish Institute of Occupational Health, Finland.
    Leineweber, Constanze
    Stress Research Institute, University of Stockholm, Sweden.
    Lindbohm, Joni Valdemar
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Magnusson Hanson, Linda L.
    Stress Research Institute, University of Stockholm, Sweden.
    Nordin, Maria
    Stress Research Institute, University of Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Pietiläinen, Olli
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Rahkonen, Ossi
    Clinicum, Department of Public Health, Faculty of Medicine, 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.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, UK.
    Stenholm, Sari
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Faculty of Social Sciences (Health Sciences), University of Tampere, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. 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.
    Westerholm, Peter J. M.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Stress Research Institute, University of Stockholm, Stockholm, Sweden.
    Zins, Marie
    Paris Descartes University, Paris, France / Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France.
    Hamer, Mark
    National Centre for Sport and Exercise Medicine, Loughborough University, UK.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, UK / Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Bell, Jousha A.
    MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health, University College London, London, UK / Bristol Medical School: Population Health Sciences, University of Bristol, UK.
    Kivimäki, Mika
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Department of Epidemiology and Public Health, University College London, UK.
    Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study2018In: The Lancet Public Health, ISSN 2468-2667, Vol. 3, no 10, p. e490-e497Article in journal (Refereed)
    Abstract [en]

    Background: Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight. Methods: We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991–2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI &lt;18·5 kg/m2), overweight (≥25 kg/m2 to &lt;30 kg/m2), and obesity (class I [mild] ≥30 kg/m2 to &lt;35 kg/m2; class II–III [severe] ≥35 kg/m2) compared with normal weight (≥18·5 kg/m2 to &lt;25 kg/m2) were estimated. Findings: Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0·4%) were underweight, 21 468 (45·6%) normal weight, 20 738 (44·0%) overweight, 3982 (8·4%) class I obese, and 728 (1·5%) class II–III obese. The corresponding numbers among the 73 054 women were 1493 (2·0%), 44 760 (61·3%), 19 553 (26·8%), 5670 (7·8%), and 1578 (2·2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11·5 years [range 6·3–18·6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29·3 (95% CI 28·8–29·8) in normal-weight men and 29·4 (28·7–30·0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1·8 (95% CI −1·3 to 4·9) for underweight, 1·1 (0·7 to 1·5) for overweight, 3·9 (2·9 to 4·9) for class I obese, and 8·5 (7·1 to 9·8) for class II–III obese. The corresponding estimates for women were 0·0 (−1·4 to 1·4) for underweight, 1·1 (0·6 to 1·5) for overweight, 2·7 (1·5 to 3·9) for class I obese, and 7·3 (6·1 to 8·6) for class II–III obese. The loss of disease-free years associated with class II–III obesity varied between 7·1 and 10·0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit. Interpretation: Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy. Funding: NordForsk, UK Medical Research Council, US National Institute on Aging, Academy of Finland, Helsinki Institute of Life Science, and Cancer Research UK. 

  • 23.
    Prättälä, Ritva
    et al.
    National Institute for Health and Welfare, Helsinki, Finland.
    Levälahti, Esko
    National Institute for Health and Welfare, Helsinki, Finland.
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland.
    Männistö, Satu
    National Institute for Health and Welfare, Helsinki, Finland.
    Paalanen, Laura
    National Institute for Health and Welfare, Helsinki, Finland.
    Raulio, Susanna
    National Institute for Health and Welfare, Helsinki, Finland.
    Roos, Eva
    Department of Public Health, University of Helsinki, Helsinki, Finland / Folkhälsan Research Center, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Folkhälsan Research Center, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland / Department of Public Health, University of Turku, Turku, Finland.
    Mäki-Opas, Tomi
    National Institute for Health and Welfare, Helsinki, Finland.
    From margarine to butter: predictors of changing bread spread in an 11-year population follow-up2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 9, p. 1707-1717Article in journal (Refereed)
    Abstract [en]

    Objective: Finland is known for a sharp decrease in the intake of saturated fat and cardiovascular mortality. Since 2000, however, the consumption of butter-containing spreads - an important source of saturated fats - has increased. We examined social and health-related predictors of the increase among Finnish men and women. Design: An 11-year population follow-up. Setting: A representative random sample of adult Finns, invited to a health survey in 2000. Subjects: Altogether 5414 persons aged 30-64 years at baseline in 2000 were re-invited in 2011. Of men 1529 (59 %) and of women 1853 (66 %) answered the questions on bread spreads at both time points. Respondents reported the use of bread spreads by choosing one of the following alternatives: no fat, soft margarine, butter-vegetable oil mixture and butter, which were later categorized into margarine/no spread and butter/butter-vegetable oil mixture (= butter). The predictors included gender, age, marital status, education, employment status, place of residence, health behaviours, BMI and health. Multinomial regression models were fitted. Results: Of the 2582 baseline margarine/no spread users, 24.6% shifted to butter. Only a few of the baseline sociodemographic or health-related determinants predicted the change. Finnish women were more likely to change to butter than men. Living with a spouse predicted the change among men. Conclusions: The change from margarine to butter between 2000 and 2011 seemed not to be a matter of compliance with official nutrition recommendations. Further longitudinal studies on social, behavioural and motivational predictors of dietary changes are needed.

  • 24.
    Salakari, Minna
    et al.
    Department of Public Health, University of Turku, 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, Turku, Finland.
    Nurminen, Raija
    University of Applied Science Turku, Turku, Finland.
    Sillanmäki, Lauri
    Department of Occupational Health, University of Helsinki, Helsinki, Finland.
    Pylkkänen, Liisa
    Cancer Society of Finland, Helsinki, Finland.
    Rautava, Päivi
    Turku University Hospital, Turku, Finland.
    Koskenvuo, Markku
    Department of Occupational Health, University of Helsinki, Helsinki, Finland.
    Life satisfaction and sense of coherence of breast cancer survivors compared to women with mental depression, arterial hypertension and healthy controls2016In: Building Sustainable Health Ecosystems: 6th International Conference on Well-Being in the Information Society, WIS 2016, Tampere, Finland, September 16-18, 2016, Proceedings / [ed] Hongxiu Li, Pirkko Nykänen, Reima Suomi, Nilmini Wickramasinghe, Gunilla Widén, Ming Zhan, Springer, 2016, p. 253-265Conference paper (Refereed)
    Abstract [en]

    The purpose of the study was to compare the life satisfaction (LS) and sense of coherence (SOC) of women recovering from breast cancer (BC) to LS and SOC of women with depression or hypertension and of healthy controls. Finnish Health and Social Support (HeSSup) follow-up survey data in 2003 was linked with national health registries. BC patients were followed up for mortality until the end of 2012. The statistical computations were carried out with SAS®. There were no significant differences in LS and SOC between the groups with BC, arterial hypertension or healthy controls. Women recovering from BC are as satisfied with their life as healthy controls, and their perceived LS is better and SOC is stronger compared to women with depression. SOC correlated positively (r2 = 0.36, p &lt; 0.001) with LS. However, more studies on determinants of the LS are needed for designing and organizing health care services for BC survivors. 

  • 25.
    Simonsen, Nina
    et al.
    Folkhälsan Research Center, Helsinki, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koponen, Anne M.
    Folkhälsan Research Center, Helsinki, Finland / Department of Public Health, University of Helsinki, 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, Turku, Finland.
    Patients' assessment of chronic illness care: a validation study among patients with type 2 diabetes in Finland2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 412Article in journal (Refereed)
    Abstract [en]

    Background: To meet the challenges of the rising prevalence of chronic diseases, such as type 2 diabetes, new approaches to healthcare delivery have been initiated; among these the influential Chronic Care Model (CCM). Valid instruments are needed to evaluate the public health impact of these frameworks in different countries. The Patient Assessment of Chronic Illness Care (PACIC) is a 20-item quality of care measure that, from the perspective of the patient, measures the extent to which care is congruent with the CCM. The aim of this study was to evaluate the psychometric properties of the Finnish translation of the PACIC questionnaire, in terms of validity and reliability, in a large register-based sample of patients with type 2 diabetes.

    Method: The PACIC items were translated into Finnish in a standardized forward-backward procedure, followed by a cross-sectional survey among patients with type 2 diabetes (response rate 56%; n = 2866). We assessed the Finnish version of the PACIC scale for the following psychometric properties: content validity, internal consistency reliability, convergent and construct validity. We also present descriptive data on total scale as well as predetermined subscale levels.

    Results: The item-response on the PACIC scale was high with only small numbers of missing data (0.5-1.1%). Ceiling effects were low (0.3-5.3%) whereas floor effects were over 20% for two of the predetermined subscales (problem solving and follow-up/coordination). The total PACIC scale showed a reasonable distribution and excellent internal consistency (alpha 0.94) while the internal consistency of the subscales were at least acceptable (0.74-0.86). The principal component analysis identified a two-or three-factor solution instead of the proposed five-dimensional. In other respects, the PACIC scale showed the hypothesized relationships with quality of care and outcome measures, thus demonstrating convergent and construct validity.

    Conclusion: A Finnish version of the PACIC scale is now validated in the primary care setting among patients with type 2 diabetes. The findings suggest comparable psychometric properties of the Finnish scale as of the original English instrument and earlier translations, and reasonable levels of validity and reliability.

  • 26.
    Tilles-Tirkkonen, Tanja
    et al.
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
    Nuutinen, Outi
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, 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.
    Liukkonen, Jarmo
    Department of Sport Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Poutanen, Kaisa
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland / VTT—Technical Research Centre of Finland, Finland.
    Karhunen, Leila
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland / Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, Kuopio, Finland.
    Preliminary Finnish measures of eating competence suggest association with health-promoting eating patterns and related psychobehavioral factors in 10-17 year old adolescents2015In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 7, no 5, p. 3828-3846Article in journal (Refereed)
    Abstract [en]

    Eating competence is an attitudinal and behavioral concept, based on The Satter Eating Competence Model. In adults, it has been shown to be associated with a higher quality of diet. Eating competence or its association with the quality of diet has not been studied in adolescents. The aim of the current study was to explore the utility of using a preliminary Finnish translation of the ecSI 2.0 for evaluating presumed eating competence and its association with food selection, meal patterns and related psychobehavioral factors in 10-17 year old adolescents. Altogether 976 10-17 years old Finnish adolescents filled in the study questionnaire. When exploring the construct validity of ecSI 2.0, the confirmatory factor analysis (CFA) indicated acceptable model fit and all four components of the ecSI 2.0 (eating attitudes, food acceptance, internal regulation of food intake, management of eating context) correlated with each other and were internally consistent. Over half (58%) of the adolescents scored 32 or higher and were thus classified as presumably eating competent (pEC). Eating competence was associated with greater meal frequency, more frequent consumption of vegetables and fruits, and more health-promoting family eating patterns. In addition the pEC, adolescents more often perceived their body size as appropriate, had less often tried to lose weight and had a higher self-esteem and a stronger sense of coherence than the not pEC ones. Family eating patterns and self-esteem were the main underlying factors of eating competence. In conclusion, this preliminary study suggests eating competence could be a useful concept to characterize eating patterns and related behaviors and attitudes in adolescents. However, these preliminary findings need to be confirmed in further studies with an instrument fully validated for this age group.

  • 27.
    Varinen, Aleksi
    et al.
    Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland / Nokia Health Centre, Nokia, Finland.
    Kosunen, Elise
    Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland / Pirkanmaa Hospital District, Centre for General Practice, Finland.
    Mattila, Kari
    Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, 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 University Hospital, Finland.
    Sillanmäki, Lauri
    Department of Public Health, University of Turku, Turku University Hospital, Finland / Health care services, Welfare Division, Turku, Finland.
    Sumanen, Markku
    Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland.
    The association between bullying victimization in childhood and fibromyalgia: Data from the nationwide Finnish health and social support (HeSSup) study based on a sample of 64,797 individuals2019In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 117, p. 48-53Article in journal (Refereed)
    Abstract [en]

    Background: Fibromyalgia is a functional pain syndrome presenting with various psychological symptoms. Several studies have shown that adverse life events are associated with fibromyalgia. The aim of the current study is to explore the association between self-reported bullying victimization in childhood and self-reported fibromyalgia in adulthood. Methods: The basic study setting is cross-sectional - with focused use of retrospective data - derived from a large on-going postal follow up survey (sample N = 64,797) initiated in Finland in 1998. Only respondents having answered the questions on fibromyalgia in both follow ups in 2003 and 2012 were included (N = 11,924). Severity of bullying was divided into three groups starting from no bullying followed by minor and severe bullying. Covariates having shown statistically significant associations with fibromyalgia in cross tabulation using Pearson's chi-squared test were included in the final multiple logistic regression analyses. Results: In our study, 50.6% of the respondents reported victimization of minor and 19.6% of severe bullying in childhood. Participants reporting fibromyalgia in adulthood reported more bullying, and in females alone this association was statistically significant (p =.027). In multiple logistic regression analysis statistically significant associations between bullying victimization in childhood (reference: no bullying) and fibromyalgia were found: adjusted odds ratio (OR) for minor bullying was 1.35 (95% CI 1.09–1.67) and for severe bullying 1.58 (95% CI 1.21–2.06). However, in log-linear and logistic regression interaction models the association between bullying and fibromyalgia was not statistically significant when depression was included in the models. Conclusions: Our results suggest that peer bullying victimization might be associated with fibromyalgia. However, in logistic log linear and logistic interaction models there was no statistically significant association when depression was included. As a result, there is need for further, preferably prospective cohort studies. The findings also emphasize the importance of actions to prevent childhood bullying. 

  • 28.
    Virtanen, Marianna
    et al.
    Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Head, Jenny
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland / Department of Psychology, University of Turku, Turku, Finland.
    Pentti, Jaana
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
    Kouvonen, Anne
    Faculty of Social Sciences, University of Helsinki, Helsinki, Finland / SWPS University of Social Sciences and Humanities, Wroclaw, Poland.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland / School of Social Policy, Sociology and Social Research, University of Kent, 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 and Turku University Hospital, Turku, Finland / Folkhälsan Research Center, Helsinki, Finland.
    Koskenvuo, Markku
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
    Elovainio, Marko
    Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland / National Institute for Health and Welfare, Helsinki, Finland.
    Zins, Marie
    Inserm, Population-based Epidemiologic Cohorts Unit UMS 011, Villejuif, France / Paris Descartes University, Paris, France.
    Goldberg, Marcel
    Inserm, Population-based Epidemiologic Cohorts Unit UMS 011, Villejuif, France / Paris Descartes University, Paris, France.
    Kivimäki, Mika
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Lifestyle factors and risk of sickness absence from work: a multicohort study2018In: Lancet Public Health, ISSN 2468-2667, Vol. 3, no 11, p. E545-E554Article in journal (Refereed)
    Abstract [en]

    Background Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence. Methods We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAF external). Findings For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70.9 days per 10 person-years), depressive disorders (26.5 days per 10 person-years), and external causes (such as injuries and poisonings; 12.8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1.30, 95% CI 1.21-1.40; PAF external 8.9%) and low physical activity (1.23, 1.14-1.34; 7.8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1.90, 1.41-2.56; 15.2%), smoking (1.70, 1.42-2.03; 11.8%), low physical activity (1.67, 1.42-1.96; 19.8%), and obesity (1.38, 1.11-1.71; 5.6%) were associated with absences due to depressive disorders; heavy episodic drinking (1.64, 1.33-2.03; 11.3%), obesity (1.48, 1.27-1.72; 6.6%), smoking (1.35, 1.20-1.53; 6.3%), and being overweight (1.20, 1.08-1.33; 6.2%) were associated with absences due to external causes; obesity (1.82, 1.40-2.36; 11.0%) and smoking (1.60, 1.30-1.98; 10.3%) were associated with absences due to circulatory diseases; low physical activity (1.37, 1.25-1.49; 12.0%) and smoking (1.27, 1.16-1.40; 4.9%) were associated with absences due to respiratory diseases; and obesity (1.67, 1.34-2.07; 9.7%) was associated with absences due to digestive diseases. Interpretation Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk. 

  • 29.
    Virtanen, Marianna
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Public Health and Caring Sciences, University of Uppsala, Sweden.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Magnusson Hanson, Linda L.
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Public Health, University of Helsinki, Finland.
    Nyberg, Solja T.
    Department of Public Health, University of Helsinki, Finland.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden.
    Batty, G David
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Department of Occupational Medicine, Koge Hospital, Koge, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    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.
    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.
    Heikkilä, Katriina
    Department of Health Services and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Finland.
    Lahelma, Eero
    Department of Public Health, University of Helsinki, Finland.
    Nielsen, Martin L.
    Unit of Social Medicine, Frederiksberg University Hospital, Copenhagen, Denmark.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish National Centre for Social Research, Copenhagen, Denmark.
    Pentti, Jaana
    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, Copenhagen, Denmark.
    Salo, Paula
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Psychology, University of Turku, Turku, Finland.
    Schupp, Jürgen
    German Institute for Economic Research, Berlin, Germany / Free University of Berlin, Berlin, Germany.
    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.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / 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.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Wagner, Gert G.
    German Institute for Economic Research, Berlin, Germany / Max Planck Institute for Human Development, Berlin, Germany / Berlin University of Technology, Berlin, Germany.
    Wang, Jian Li
    University of Ottawa Institute of Mental Health Research, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
    Yiengprugsawan, Vasoontara
    Centre for Research on Ageing, Health and Wellbeing and the ARC Centre of Excellence on Population Ageing Research, The Australian National University, Canberra, Australia.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Kivimäki, Mika
    Finnish Institute of Occupational Health, Helsinki, Finland / Department of Public Health, University of Helsinki, Finland / Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 3, p. 239-250, article id 3712Article, review/survey (Refereed)
    Abstract [en]

    Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I 2=45.1%, P=0.004). A moderate association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95, 95% CI 0.70-1.29). Differences by other characteristics were small. Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.

  • 30.
    Volanen, Salla-Maarit
    et al.
    Folkhälsan Research Center, Helsinki, Finland / Clinicum, Department of Public Health, University of Helsinki, Finland.
    Lassander, Maarit
    Institute of Behavioural Sciences, University of Helsinki, Finland.
    Hankonen, Nelli
    Social Psychology Unit, Faculty of Social Sciences, University of Helsinki, Finland.
    Santalahti, Päivi
    National Institute for Health and Welfare, Finland.
    Hintsanen, Mirka
    Unit of Psychology, University of Oulu, Finland.
    Simonsen, Nina
    Folkhälsan Research Center, Helsinki, Finland / Clinicum, Department of Public Health, University of Helsinki, Finland.
    Raevuori, Anu H.
    Clinicum, Department of Public Health, University of Helsinki, Finland / Department of Adolescent Psychiatry, Helsinki University Central Hospital, Finland / Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
    Mullola, Sari
    Institute of Behavioural Sciences, University of Helsinki, Finland / Department of Teacher Education, University of Helsinki, Finland.
    Vahlberg, Tero Juhani
    Department of Biostatistics, University of Turku, Finland.
    But, Anna
    Clinicum, 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.
    Healthy learning mind – Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 260, p. 660-669Article in journal (Refereed)
    Abstract [en]

    Background: Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial. Methods: Finnish school children and adolescents (N = 3519), aged 12–15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26). Results: Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=−0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (β=−1.37, SE 0.69, p = 0.049) and at T26 (β=−1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation. Limitations: The inactive control group was smaller than the intervention and active control groups, reducing statistical power. Conclusions: A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects. 

  • 31.
    Volanen, Salla-Maarit
    et al.
    Folkhälsan Research Center, Helsinki, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland.
    Lassander, Maarit
    Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
    Hankonen, Nelli
    School of Social Sciences and Humanities, University of Tampere, Tampere, Finland.
    Santalahti, Päivi
    National Institute for Health and Welfare, Helsinki, Finland.
    Hintsanen, Mirka
    Unit of Psychology, University of Oulu, Oulu, Finland.
    Simonsen, Nina
    Folkhälsan Research Center, Helsinki, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland.
    Raevuori, Anu
    Department of Public Health, University of Helsinki, Helsinki, Finland / Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland / Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
    Mullola, Sari
    Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland / Department of Teacher Education, University of Helsinki, Helsinki, Finland.
    Vahlberg, Tero
    Department of Biostatistics, University of Turku, Turku, Finland.
    But, Anna
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Folkhälsan Research Center, Helsinki, Finland / Department of Public Health, University of Turku, Turku, Finland.
    Healthy Learning Mind - a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial2016In: BMC Psychology, E-ISSN 2050-7283, Vol. 4, article id 35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mindfulness has shown positive effects on mental health, mental capacity and well-being among adult population. Among children and adolescents, previous research on the effectiveness of mindfulness interventions on health and well-being has shown promising results, but studies with methodologically sound designs have been called for. Few intervention studies in this population have compared the effectiveness of mindfulness programs to alternative intervention programs with adequate sample sizes.

    METHODS/DESIGN: Our primary aim is to explore the effectiveness of a school-based mindfulness intervention program compared to a standard relaxation program among a non-clinical children and adolescent sample, and a non-treatment control group in school context. In this study, we systematically examine the effects of mindfulness intervention on mental well-being (primary outcomes being resilience; existence/absence of depressive symptoms; experienced psychological strengths and difficulties), cognitive functions, psychophysiological responses, academic achievements, and motivational determinants of practicing mindfulness. The design is a cluster randomized controlled trial with three arms (mindfulness intervention group, active control group, non-treatment group) and the sample includes 59 Finnish schools and approx. 3 000 students aged 12-15 years. Intervention consists of nine mindfulness based lessons, 45 mins per week, for 9 weeks, the dose being identical in active control group receiving standard relaxation program called Relax. The programs are delivered by 14 educated facilitators. Students, their teachers and parents will fill-in the research questionnaires before and after the intervention, and they will all be followed up 6 months after baseline. Additionally, students will be followed 12 months after baseline. For longer follow-up, consent to linking the data to the main health registers has been asked from students and their parents.

    DISCUSSION: The present study examines systematically the effectiveness of a school-based mindfulness program compared to a standard relaxation program, and a non-treatment control group. A strength of the current study lies in its methodologically rigorous, randomized controlled study design, which allows novel evidence on the effectiveness of mindfulness over and above a standard relaxation program.

    TRIAL REGISTRATION: ISRCTN18642659 . Retrospectively registered 13 October 2015.

  • 32.
    Vuorio, Tina
    et al.
    Department of Family Medicine, Institute of Clinical Medicine, University of Turku and 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, Turku, Finland.
    Kautiainen, Hannu
    Folkhälsan Research Center, Helsinki, Finland / Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
    Korhonen, Päivi
    Department of Family Medicine, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku, Finland / Health Center of Harjavalta, Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.
    Determinants of sickness absence rate among Finnish municipal employees2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Objective: In addition to acute health problems, various aspects of health behavior, work-related and sociodemographic factors have been shown to influence the rate of sickness absence. The aim of this study was to concomitantly examine factors known to have an association with absenteeism. We hypothesized the prevalence of chronic diseases being the most important factor associated with sickness absence. Design: A cross-sectional study. Setting: Occupational health care in the region of Pori, Finland. Subjects: 671 municipal employees (89% females) with a mean age of 49 (SD 10) years. Information about the study subjects was gathered from medical records, by physical examination and questionnaires containing information about physical and mental health, health behavior, work-related and sociodemographic factors. The number of sickness absence days was obtained from the records of the city of Pori. Main outcome measures: The relationship of absenteeism rate with sociodemographic, health- and work-related risk factors. Results: In the multivariate analysis, the mean number of chronic diseases (IRR 1.24, 95% CI 1.13 to 1.36), work ability (IRR 0.83, 95% CI 0.76 to 0.91), and length of years in education (IRR 0.90, 95% CI 0.85 to 0.95) remained as independent factors associated with absenteeism. Conclusion: According to our results, chronic diseases, self-perceived work ability and length of years in education are the most important determinants of the rate of sickness absence. This implies that among working-aged people the treatment of chronic medical conditions is also worth prioritizing, not only to prevent complications, but also to avoid sickness absences. KEY POINTS Various sociodemographic, health- and work- related risk factors have been shown to influence sickness absence. The study aimed to find the most important determinants of absenteeism among several known risk factors in Finnish municipal employees. Chronic diseases, self-perceived work ability and education years remained as the most important determinants of sickness absence rates. Treatment of chronic medical conditions should be prioritized in order to reduce sickness absence rate. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

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