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El Ansari W, Sebena R, El-Ansari K, Suominen S. Clusters of lifestyle behavioral risk factors and their associations with depressive symptoms and stress: evidence from students at a university in Finland. BMC Public Health 2024; 24:1103. [PMID: 38649903 PMCID: PMC11034152 DOI: 10.1186/s12889-024-18421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND No previous research of university students in Finland assessed lifestyle behavioral risk factors (BRFs), grouped students into clusters, appraised the relationships of the clusters with their mental well-being, whilst controlling for confounders. The current study undertook this task. METHODS Students at the University of Turku (n = 1177, aged 22.96 ± 5.2 years) completed an online questionnaire that tapped information on sociodemographic variables (age, sex, income sufficiency, accommodation during the semester), four BRFs [problematic alcohol consumption, smoking, food consumption habits, moderate-to-vigorous physical activity (MVPA)], as well as depressive symptoms and stress. Two-step cluster analysis of the BRFs using log-likelihood distance measure categorized students into well-defined clusters. Two regression models appraised the associations between cluster membership and depressive symptoms and stress, controlling for sex, income sufficiency and accommodation during the semester. RESULTS Slightly more than half the study participants (56.8%) had always/mostly sufficient income and 33% lived with parents/partner. Cluster analysis of BRFs identified three distinct student clusters, namely Cluster 1 (Healthy Group), Cluster 2 (Smokers), and Cluster 3 (Nonsmokers but Problematic Drinkers). Age, sex and MVPA were not different across the clusters, but Clusters 1 and 3 comprised significantly more respondents with always/mostly sufficient income and lived with their parents/partner during the semester. All members in Clusters 1 and 3 were non-smokers, while all Cluster 2 members comprised occasional/daily smokers. Problematic drinking was significantly different between clusters (Cluster 1 = 0%, Cluster 2 = 54%, Cluster 3 = 100%). Cluster 3 exhibited significantly healthier nutrition habits than both other clusters. Regression analysis showed: (1) males and those with sufficient income were significantly less likely to report depressive symptoms or stress; (2) those living with parents/partner were significantly less likely to experience depressive symptoms; (3) compared to Cluster 1, students in the two other clusters were significantly more likely to report higher depressive symptoms; and (4) only students in Cluster 2 were more likely to report higher stress. CONCLUSIONS BRFs cluster together, however, such clustering is not a clear-cut, all-or-none phenomenon. Students with BRFs consistently exhibited higher levels of depressive symptoms and stress. Educational and motivational interventions should target at-risk individuals including those with insufficient income or living with roommates or alone.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, 3050, Doha, Qatar
- College of Medicine, Qatar University, 3050, Doha, Qatar
- Department of Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Rene Sebena
- Department of Psychology, Faculty of Arts, PJ Safarik University, Kosice, Slovak Republic
| | - Kareem El-Ansari
- Faculty of Medicine, St. George's University, Saint George's, Grenada
| | - Sakari Suominen
- School of Health Sciences, University of Skövde, 541 28, Skövde, Sweden.
- Department of Public Health, University of Turku, Turku, Finland.
- Research Services, The wellbeing services county of Southwest Finland, Turku, Finland.
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Stenlund S, Sillanmäki L, Koivumaa-Honkanen H, Rautava P, Lagström H, Suominen S. A healthy lifestyle can support future sexual satisfaction: results from a 9-year longitudinal survey. J Sex Med 2024; 21:304-310. [PMID: 38441479 DOI: 10.1093/jsxmed/qdae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Previous follow-up studies have demonstrated the association between good health behavior and good sexual functioning for men, but the longitudinal relationship between multiple health behaviors and satisfaction with sex life remains understudied. AIM The aim of the study was to explore whether good health behavior associates with improved satisfaction with sex life for men and women in a follow-up of 9 years. METHODS This cohort study utilized survey data from the population-based Health and Social Support study. It includes responses from 10 671 working-aged Finns. Using linear regression models, we examined a composite sum score representing 4 health behaviors (range, 0-4) in 2003 as a predictor of satisfaction with sex life in 2012. The analyses adjusted for various covariates in 2003, including satisfaction with sex life, living status, age, gender, education, number of diseases, and importance of sex life in 2012. OUTCOMES The outcome in the study was satisfaction with sex life in the year 2012. RESULTS Participants who exhibited better health behavior at baseline demonstrated improved satisfaction with sex life when compared with those with poorer health behavior (β = -0.046, P = .009), even when controlling for the aforementioned covariates. The positive effect of reporting all beneficial health behaviors vs none of them was greater than having none vs 3 chronic conditions. Furthermore, this was almost half the effect of how satisfaction with sex life in 2003 predicted its level in 2012. These findings were supported by an analysis of the congruence of health behavior in the observation period from 2003 to 2012 predicting changes in satisfaction with sex life. CLINICAL IMPLICATIONS The results could serve as a motivator for a healthy lifestyle. STRENGTHS AND LIMITATIONS The current study used a longitudinal large sample and a consistent survey procedure, and it explored the personal experience of satisfaction instead of sexual function. However, the study is limited in representing today's diversity of gender, since the options for gender at the time of survey were only male and female. CONCLUSION These findings indicate that engaging in healthy behaviors contributes to the maintenance and enhancement of satisfaction with sex life over time.
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Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada
- Department of Psychology, University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- Department of Public Health, University of Helsinki, Helsinki, 00014, Finland
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, University of Eastern Finland, Kuopio, 70029, Finland
- Kuopio University Hospital, Kuopio, 70029, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, 20014, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- School of Health Sciences, University of Skövde, Skövde, 54128, Sweden
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El Ansari W, Suominen S, El-Ansari K, Šebeňa R. Are behavioural risk factors clusters associated with self-reported health complaints? University students in Finland. Cent Eur J Public Health 2023; 31:248-255. [PMID: 38309702 DOI: 10.21101/cejph.a7916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/14/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES No previous research of university students in Finland assessed lifestyle behavioural risk factors (BRFs) and categorized students into clusters, explored the associations of the clusters with self-reported health complaints (HCs), whilst controlling for potential confounders. The current study undertook this task. METHODS Students at the University of Turku (1,177) completed an online well-being questionnaire that assessed socio-demographic variables, 5 BRFs - problematic alcohol consumption, smoking, illicit drug use, food consumption habits, moderate-to-vigorous physical activity (MVPA), and 22 HCs. A food frequency questionnaire assessed students' consumption of a range of foods, and a dietary guideline adherence score was computed based on WHO dietary recommendations for Europe. Three separate regression models appraised the associations between the cluster membership and HCs factors, adjusting for sex, income sufficiency and self-rated health. RESULTS Mean age was 23 ± 5.2 years, 77% had never smoked and 79% never used illicit drug/s. Factor analysis of HCs resulted in four-factors (psychological, circulatory/breathing, gastro-intestinal, pains/aches); cluster analysis of BRFs identified two distinctive student clusters. Cluster 1 represented more healthy students who never smoked/used illicit drugs, had no problematic drinking, and undertook MVPA on 4.42 ± 3.36 days/week. As for cluster 2 students, half the cluster smoked occasionally/daily, used illicit drug/s, and > 50% had problematic drinking and students undertook MVPA on 4.02 ± 3.12 days/week. More cluster 2 students adhered to healthy eating recommendations, but the difference was not significant between clusters. Regression analysis revealed that females, those with sufficient income, and with excellent/very good self-rated general health were significantly less likely to report all four HCs. Cluster 2 students were significantly more likely to report psychological complaints, circulatory/breathing and gastro-intestinal complaints. There was no significant association between BRFs clusters and pains/aches factor. CONCLUSIONS Risk taking students with less healthy lifestyles and behaviour were consistently associated with poorer psychological and somatic health.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Population Health, Weill Cornell Medicine Qatar, Doha, Qatar
| | - Sakari Suominen
- School of Health and Education, University of Skovde, Skovde, Sweden
- Department of Public Health, University of Turku, Turku, Finland
- Wellbeing Services, County of Southwest Finland, Finland
| | - Kareem El-Ansari
- School of Medicine, St. George's University, Grenada, West Indies
| | - René Šebeňa
- Department of Psychology, Faculty of Arts, Pavol Josef Safarik University, Kosice, Slovak Republic
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Carlén K, Suominen S, Augustine L. The association between adolescents' self-esteem and perceived mental well-being in Sweden in four years of follow-up. BMC Psychol 2023; 11:413. [PMID: 38007469 PMCID: PMC10676579 DOI: 10.1186/s40359-023-01450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The situation concerning adolescent mental health is a global public health concern, and the concept includes the ability to cope with problems of everyday life. A person's approach and attitude towards themselves, i.e., their self-esteem, affects mental health. The study aimed to appraise and deepen the scientific understanding of adolescents' self-reported self-esteem at age 12-13 from a resource perspective and test its ability to predict subsequent perceived mental well-being at age 17. METHODS Data from the Longitudinal Research on Development in Adolescence (LoRDIA) prospective follow-up study of adolescents aged 12-13, and 17 (n = 654) were analysed using ANCOVA. The outcome variable, perceived mental well-being (MWB), covers the aspects of mental well-being inspired by the "Mental Health Continuum," representing positive mental health. Covariates were self-esteem (SE) and reported initially perceived MWB at age 12-13. Other independent explanatory variables were gender, the family's economy, and the mother's educational level. RESULTS Self-esteem appeared relatively stable from 12-13 to 17 years (M = 20.7 SD = 5.8 vs. M = 20.5 SD = 1.7). There was a significant but inverted U - shaped association between SE at age 12-13 and perceived MWB at age 17 [F (1, 646) = 19.02, β-0.057; CI -0.08--0.03, Eta = 0.03, p = .000]. Intermediate but not strong SE predicted significantly good MWB. When conducting the ANCOVA for boys and girls separately, only the mother's educational level was significantly positively associated with perceived MWB of girls. CONCLUSIONS Good self-esteem in early adolescence increases the likelihood of an unchanged favourable development of self-esteem and the probability of good perceived mental well-being. SE explained 18 per cent of the variation of MWB, and even more among girls. However, normal SE rather than high SE at 12 and 13 years is predictive of later mental well-being. Girls reported low self-esteem more often. Therefore, supporting self-esteem early in life can promote mental well-being in adolescence.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Box 408, Skövde, 54128, Sweden.
| | - Sakari Suominen
- School of Health Sciences, University of Skövde, Box 408, Skövde, 54128, Sweden
- Department of Public Health, University of Turku, Turku, Finland
| | - Lilly Augustine
- School of Learning and Communication, Jönköping University, Jönköping, Sweden
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Lautamatti E, Mattila KJ, Suominen S, Sillanmäki L, Sumanen M. A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years. BMC Health Serv Res 2023; 23:1178. [PMID: 37898748 PMCID: PMC10613364 DOI: 10.1186/s12913-023-10184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. OBJECTIVES The aim of the study was to determine whether having a named GP is associated with hospital service use. METHODS The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). RESULTS A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. CONCLUSION A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.
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Affiliation(s)
- Emmi Lautamatti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- The Wellbeing Services County of Pirkanmaa, Tampere, Finland.
| | - Kari J Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland
- The Wellbeing Services County of Southwest Finland, Research Centre, Turku, Finland
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Lauri Sillanmäki
- The Wellbeing Services County of Southwest Finland, Research Centre, Turku, Finland
- University of Turku, Turku, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Stenlund S, Mâsse LC, Stenlund D, Sillanmäki L, Appelt KC, Koivumaa-Honkanen H, Rautava P, Suominen S, Patrick DM. Do Patients' Psychosocial Characteristics Impact Antibiotic Prescription Rates? Antibiotics (Basel) 2023; 12:1022. [PMID: 37370341 DOI: 10.3390/antibiotics12061022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients' psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between a patient's psychosocial characteristics (self-reported in postal surveys in 2003) and the number of antibiotics they were prescribed (recorded in Finnish national registry data between 2004-2006) were analyzed for 19,300 working-aged Finns. Psychosocial characteristics included life satisfaction, a sense of coherence, perceived stress, hostility, and optimism. In a structural equation model, patients' adverse psychosocial characteristics were not related to increased antibiotic prescriptions in the subsequent three years. However, these characteristics were strongly associated with poor general health status, which in turn was associated with an increased number of subsequent antibiotic prescriptions. Furthermore, mediation analysis showed that individuals who used healthcare services more frequently also received more antibiotic prescriptions. The current study does not support the view that patients' adverse psychosocial characteristics are related to an increased number of antibiotic prescriptions. This could encourage physicians to actively discuss treatment options with their patients.
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Affiliation(s)
- Säde Stenlund
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - David Stenlund
- Department of Mathematics, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
- Faculty of Science and Engineering, Åbo Akademi University, 20500 Turku, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
| | - Kirstin C Appelt
- Sauder School of Business, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, 70029 Kuopio, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
- School of Health Sciences, University of Skövde, 54128 Skövde, Sweden
| | - David M Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
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Sipilä PN, Lindbohm JV, Batty GD, Heikkilä N, Vahtera J, Suominen S, Väänänen A, Koskinen A, Nyberg ST, Meri S, Pentti J, Warren-Gash C, Hayward AC, Kivimäki M. Severe Infection and Risk of Cardiovascular Disease: A Multicohort Study. Circulation 2023; 147:1582-1593. [PMID: 36971007 DOI: 10.1161/circulationaha.122.061183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The excess risk of cardiovascular disease associated with a wide array of infectious diseases is unknown. We quantified the short- and long-term risk of major cardiovascular events in people with severe infection and estimated the population-attributable fraction. METHODS We analyzed data from 331 683 UK Biobank participants without cardiovascular disease at baseline (2006-2010) and replicated our main findings in an independent population from 3 prospective cohort studies comprising 271 329 community-dwelling participants from Finland (baseline 1986-2005). Cardiovascular risk factors were measured at baseline. We diagnosed infectious diseases (the exposure) and incident major cardiovascular events after infections, defined as myocardial infarction, cardiac death, or fatal or nonfatal stroke (the outcome) from linkage of participants to hospital and death registers. We computed adjusted hazard ratios (HRs) and 95% CIs for infectious diseases as short- and long-term risk factors for incident major cardiovascular events. We also calculated population-attributable fractions for long-term risk. RESULTS In the UK Biobank (mean follow-up, 11.6 years), 54 434 participants were hospitalized for an infection, and 11 649 had an incident major cardiovascular event at follow-up. Relative to participants with no record of infectious disease, those who were hospitalized experienced increased risk of major cardiovascular events, largely irrespective of the type of infection. This association was strongest during the first month after infection (HR, 7.87 [95% CI, 6.36-9.73]), but remained elevated during the entire follow-up (HR, 1.47 [95% CI, 1.40-1.54]). The findings were similar in the replication cohort (HR, 7.64 [95% CI, 5.82-10.03] during the first month; HR, 1.41 [95% CI, 1.34-1.48] during mean follow-up of 19.2 years). After controlling for traditional cardiovascular risk factors, the population-attributable fraction for severe infections and major cardiovascular events was 4.4% in the UK Biobank and 6.1% in the replication cohort. CONCLUSIONS Infections severe enough to require hospital treatment were associated with increased risks for major cardiovascular disease events immediately after hospitalization. A small excess risk was also observed in the long-term, but residual confounding cannot be excluded.
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Affiliation(s)
- Pyry N Sipilä
- Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.)
- Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)
| | - Joni V Lindbohm
- Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.)
- UCL Brain Sciences (J.V.L., G.D.B., M.K.), University College London, UK
| | - G David Batty
- UCL Brain Sciences (J.V.L., G.D.B., M.K.), University College London, UK
| | - Nelli Heikkilä
- Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Finland (N.H., S.M.)
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Finland (J.V., S.S., J.P.)
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (J.V.)
| | - Sakari Suominen
- Department of Public Health, University of Turku, Finland (J.V., S.S., J.P.)
- Turku University Hospital, Finland (S.S.)
- School of Health and Education, University of Skövde, Sweden (S.S.)
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)
| | - Solja T Nyberg
- Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.)
- Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)
| | - Seppo Meri
- Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Finland (N.H., S.M.)
- HUSLAB, Helsinki University Hospital, Finland (S.M.)
| | - Jaana Pentti
- Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.)
- Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)
- Department of Public Health, University of Turku, Finland (J.V., S.S., J.P.)
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom (C.W.-G.)
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care (A.C.H.), University College London, UK
| | - Mika Kivimäki
- Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.)
- Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)
- UCL Brain Sciences (J.V.L., G.D.B., M.K.), University College London, UK
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Hawajri O, Lindberg J, Suominen S. Virtual Reality Exposure Therapy as a Treatment Method Against Anxiety Disorders and Depression-A Structured Literature Review. Issues Ment Health Nurs 2023; 44:245-269. [PMID: 37075308 DOI: 10.1080/01612840.2023.2190051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Mental illness is a growing global health problem affecting individuals and society. In Sweden, the number of people suffering from mental health illnesses, such as anxiety and depression, is increasing and is expected to be one of the largest public health challenges in 2030. As mental illness increases, the area also needs effective forms of treatment. This study aims to investigate if Virtual Reality Exposure Therapy (VRET) works as a treatment method for adults suffering from anxiety disorders and depression. A structured literature review based on 24 articles found in the databases PubMed, MEDLINE, CINAHL and PsycInfo. Two reviewers independently reviewed and collectively extracted data from the included articles. The articles have been analyzed by using thematic analysis. The results suggest that Virtual reality exposure therapy can work as an effective treatment method for adults with anxiety disorders. It also indicates that VRET may act as a health-promoting intervention to reduce anxiety disorders, phobias, and depression symptoms. Virtual reality exposure therapy can be an effective treatment method and health-promoting effort against anxiety disorders in adults. An essential factor for the patients who accept VRET as a treatment is the initial information therapists give.
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Affiliation(s)
- Omar Hawajri
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | | | - Sakari Suominen
- School of Health Sciences, University of Skövde, Skövde, Sweden
- Department of Public Health, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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Halme M, Rautava P, Sillanmäki L, Sumanen M, Suominen S, Vahtera J, Virtanen P, Salo P. Educational level and the use of mental health services, psychotropic medication and psychotherapy among adults with a history of physician diagnosed mental disorders. Int J Soc Psychiatry 2023; 69:493-502. [PMID: 35819228 PMCID: PMC9983050 DOI: 10.1177/00207640221111091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of mental disorders is increased among people of low socioeconomic status or educational level, but it remains unclear whether their access to treatment matches their increased need. AIMS Our objective was to examine whether educational level as an indicator of socioeconomic status is associated with use of mental health services, psychotropic medication and psychotherapy in Finland. METHOD Cross-sectional data from a follow-up survey of a longitudinal, population-based cohort study were used to form a sample of 3,053 men and women aged 24 to 68 with a current or previous physician diagnosed mental disorder. The prevalence of mental disorders, mental health service use and educational level were assessed with self-report questionnaire. Educational level was determined by the highest educational attainment and grouped into three levels: high, intermediate and low. The associations between educational level and mental health service -related outcomes were assessed with binary logistic regression. Covariates in the fully adjusted model were age, gender and number of somatic diseases. RESULTS Compared to high educational level, low educational level was associated with higher odds of using antidepressants (OR 1.35, 95% CI [1.09, 1.66]), hypnotics (OR 1.33, 95% CI [1.07, 1.66]) and sedatives (OR 2.17, 95% CI [1.69, 2.78]), and lower odds of using mental health services (OR 0.80, 95% CI [0.65, 0.98]). No associations were found between educational level and use of psychotherapy. CONCLUSIONS The results do not suggest a general socioeconomic status related mismatch. A pharmacological emphasis was observed in the treatment of low educational background participants, whereas overall mental health service use was emphasized among high educational background participants.
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Affiliation(s)
- Marie Halme
- Department of Psychology, University of
Turku, Finland
- Marie Halme, Department of Psychology,
University of Turku, Turku 20014, Finland.
| | - Päivi Rautava
- Department of Public Health, University
of Turku, Finland
- Turku Clinical Research Centre, Turku
University Hospital, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University
of Turku, Finland
- Turku Clinical Research Centre, Turku
University Hospital, Finland
- Department of Public Health, University
of Helsinki, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health
Technology, Tampere University, Finland
| | - Sakari Suominen
- Department of Public Health, University
of Turku, Finland
- Turku Clinical Research Centre, Turku
University Hospital, Finland
- School of Health Sciences, University
of Skövde, Sweden
| | - Jussi Vahtera
- Department of Public Health and Centre
for Population Health Research, University of Turku, Finland
| | | | - Paula Salo
- Department of Psychology, University of
Turku, Finland
- Finnish Institute of Occupational
Health, Helsinki, Finland
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10
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Elovainio M, Komulainen K, Sipilä PN, Pulkki-Råback L, Cachón Alonso L, Pentti J, Nyberg ST, Suominen S, Vahtera J, Lipsanen J, Batty GD, Hakulinen C, Kivimäki M. Association of social isolation and loneliness with risk of incident hospital-treated infections: an analysis of data from the UK Biobank and Finnish Health and Social Support studies. Lancet Public Health 2023; 8:e109-e118. [PMID: 36669514 PMCID: PMC9879771 DOI: 10.1016/s2468-2667(22)00253-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although loneliness and social isolation have been linked to an increased risk of non-communicable diseases such as cardiovascular disease and dementia, their association with the risk of severe infection is uncertain. We aimed to examine the associations between loneliness and social isolation and the risk of hospital-treated infections using data from two independent cohort studies. METHODS We assessed the association between loneliness and social isolation and incident hospital-treated infections using data for participants from the UK Biobank study aged 38-73 years at baseline and participants from the nationwide population-based Finnish Health and Social Support (HeSSup) study aged 20-54 years at baseline. For inclusion in the study, participants had to be linked to national health registries, have no history of hospital-treated infections at or before baseline, and have complete data on loneliness or social isolation. Participants with missing data on hospital-treated infections, loneliness, and social isolation were excluded from both cohorts. The outcome was defined as a hospital admission with a primary diagnosis of infection, ascertained via linkage to electronic health records. FINDINGS After exclusion of 8·6 million participants for not responding or not providing appropriate consent, the UK Biobank cohort consisted of 456 905 participants (249 586 women and 207 319 men). 26 860 (6·2%) of 436 001 participants with available data were reported as being lonely and 40 428 (9·0%) of 448 114 participants with available data were socially isolated. During a median 8·9 years (IQR 8·0-9·6) of follow-up, 51 361 participants were admitted to hospital due to an infectious disease. After adjustment for age, sex, demographic and lifestyle factors, and morbidities, loneliness was associated with an increased risk of a hospital-treated infection (hazard ratio [HR] 1·12 [95% CI 1·07-1·16]), whereas social isolation was not (HR 1·01 [95% CI 0·97-1·04]). Of 64 797 individuals in the HeSSup cohort, 18 468 (11 367 women and 7101 men) were eligible for inclusion. 4466 (24·4%) of 18 296 were lonely and 1776 (9·7%) of 18 376 socially isolated. During a median follow-up of 10·0 years (IQR 10·0-10·1), 814 (4·4%) participants were admitted to hospital for an infectious disease. The HRs for the HeSSup study replicated those in the UK Biobank (multivariable-adjusted HR for loneliness 1·32 [95% CI 1·06-1·64]; 1·08 [0·87-1·35] for social isolation). INTERPRETATION Loneliness might increase susceptibility to severe infections, although the magnitude of this effect appears modest and residual confounding cannot be excluded. Interventional studies are required before policy recommendations can advance. FUNDING Academy of Finland, the UK Medical Research Council, and Wellcome Trust UK.
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Affiliation(s)
- Marko Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Kaisla Komulainen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pyry N Sipilä
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Cachón Alonso
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Solja T Nyberg
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland; Centre of Population Health Research, Turku University Hospital, Turku, Finland; School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland; Centre of Population Health Research, Turku University Hospital, Turku, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Kivimäki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Mental Health of Older People, Faculty of Brain Sciences, University College London, London, UK
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11
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Lautamatti E, Mattila K, Suominen S, Sillanmäki L, Sumanen M. A named GP increases self-reported access to health care services. BMC Health Serv Res 2022; 22:1262. [PMID: 36261827 PMCID: PMC9580200 DOI: 10.1186/s12913-022-08660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Continuity of care strengthens health promotion and decreases mortality, although the mechanisms of these effects are still unclear. In recent decades, continuity of care and accessibility of health care services have both decreased in Finland. Objectives The aim of the study was to investigate whether a named and assigned GP representing continuity of care is associated with the use of primary and hospital health care services and to create knowledge on the state of continuity of care in a changing health care system in Finland. Methods The data are part of the Health and Social Support (HeSSup) mail survey based on a random Finnish working age population sample of 64,797 individuals drawn in 1998 and follow-up surveys in 2003 and 2012. The response rate in 1998 was 40% (n = 25,898). Continuity of care was derived from the 2003 and 2012 data sets, other variables from the 2012 survey (n = 11,924). The principal outcome variables were primary health care and hospital service use reported by participants. The association of the explanatory variables (gender, age, education, reported chronic diseases, health status, smoking, obesity, NYHA class of any functional limitation, depressive mood and continuity of care) with the outcome variables was analysed by binomial logistic regression analysis. Results A named and assigned GP was independently and significantly associated with more frequent use of primary and hospital care in the adjusted logistic regression analysis (ORs 1.53 (95% CI 1.35–1.72) and 1.19 (95% CI 1.08–1.32), p < 0.001). Conclusion A named GPs is associated with an increased use of primary care and hospital services. A named GP assures access to health care services especially to the chronically ill population. The results depict the state of continuity of care in Finland. All benefits of continuity of care are not enabled although it still assures treatment of population in the most vulnerable position.
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Affiliation(s)
- Emmi Lautamatti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. .,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland.
| | - Kari Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sakari Suominen
- School of Health Sciences, University of Skövde, Skövde, Sweden.,Department of Public Health and Clinical Research Centre, University of Turku, Turku University Hospital, Turku, Finland
| | - Lauri Sillanmäki
- Turku University Hospital and University of Turku, Turku, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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12
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Piiroinen I, Tuomainen TP, Tolmunen T, Kauhanen J, Kurl S, Nilsen C, Suominen S, Välimäki T, Voutilainen A. Long-term changes in sense of coherence and mortality among middle-aged men: A population -based follow-up study. Adv Life Course Res 2022; 53:100494. [PMID: 36652218 DOI: 10.1016/j.alcr.2022.100494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 06/17/2023]
Abstract
Sense of coherence (SOC) scale measures one's orientation to life. SOC is the core construct in Antonovsky's salutogenic model of health. It has been shown that weak SOC correlates with poor perceived health, low quality of life, and increased mortality. Some studies have indicated that SOC is not stable across life, but there are no previous studies on how a change of SOC is reflected in mortality. However, there is some evidence that a change in perceived quality of life is associated with mortality. The study explores the association between the change in SOC and mortality using longitudinal data from a cohort of middle-aged Finnish men recruited between 1986 and 1989. Approximately 11 years after the baseline examinations, between 1998 and 2001, 854 men returned the SOC questionnaire a second time. The baseline SOC was adjusted for the regression to the mean phenomenon between the two measurements. The hazard ratios of the SOC difference scores were adjusted for initial SOC age and 12 somatic risk factors of mortality (alcohol consumption, blood pressure, body mass index, cholesterol concentration, physical activity, education, smoking, marital status, employment status, history of cancer, history of cardiovascular disease and diabetes). SOC was not stable among middle-aged Finnish men and a decline in SOC was associated with an increased hazard of all-cause mortality. In the fully adjusted model, a decrease of one standard deviation (SD) of the SOC mean difference increased the mortality hazard by about 35 %, two SDs decrease about 70 %, and 2.5 SDs about 100 %. Strengthening SOC showed a limited association with decreasing mortality hazards in the age-adjusted model. Policies, strategies, or plans, supporting SOC in the middle-age may help to decrease mortality and increase quality of life in later years.
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Affiliation(s)
- Ilkka Piiroinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Tommi Tolmunen
- Department of Adolescent Psychiatry, Kuopio University Hospital, Institute of Clinical Medicine / Psychiatry, University of Eastern Finland, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Charlotta Nilsen
- Stress Research Institute, Stockholm University, Sweden; Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Sweden; Institute of Gerontology, Jönköping University, Sweden
| | - Sakari Suominen
- University of Turku, Turku, Finland; University of Skövde, Skövde, Sweden
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
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13
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Nyberg ST, Batty GD, Pentti J, Madsen IEH, Alfredsson L, Bjorner JB, Borritz M, Burr H, Ervasti J, Goldberg M, Jokela M, Knutsson A, Koskinen A, Lallukka T, Lindbohm JV, Nielsen ML, Oksanen T, Pejtersen JH, Pietiläinen O, Rahkonen O, Rugulies R, Shipley MJ, Sipilä PN, Sørensen JK, Stenholm S, Suominen S, Väänänen A, Vahtera J, Virtanen M, Westerlund H, Zins M, Singh-Manoux A, Kivimäki M. Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank. Lancet Reg Health Eur 2022; 19:100417. [PMID: 35664051 PMCID: PMC9160494 DOI: 10.1016/j.lanepe.2022.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use. Methods In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines - non-drinking (never or former drinkers); moderate consumption (1-14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study. Findings During 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9-30·8) years, women 29·8 (29·2-30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4-29·0) years, women 29·6 (29·4-29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9-26·0) years, women 24·0 (21·4-26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3-26·8), women 27·5 (26·4-28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less. Interpretation Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller. Funding Medical Research Council, National Institute on Aging, NordForsk, Academy of Finland, Finnish Work Environment Fund.
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Affiliation(s)
- Solja T Nyberg
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jaana Pentti
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland.,Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden
| | - Jakob B Bjorner
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Hermann Burr
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marcel Goldberg
- Paris Descartes University, Paris, France.,Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tea Lallukka
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland
| | - Joni V Lindbohm
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland
| | | | - Tuula Oksanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jan H Pejtersen
- VIVE-The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Olli Pietiläinen
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland
| | - Ossi Rahkonen
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland
| | - Jeppe K Sørensen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,School of Health Science, University of Skövde, Skövde, Sweden
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Marie Zins
- Paris Descartes University, Paris, France.,Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK.,Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, France
| | - Mika Kivimäki
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8B, FI-00014 Helsingin yliopisto, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, London, UK
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14
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Kangasniemi M, Papinaho O, Moilanen T, Leino-Kilpi H, Siipi H, Suominen S, Suhonen R. Neglecting the care of older people in residential care settings: A national document analysis of complaints reported to the Finnish supervisory authority. Health Soc Care Community 2022; 30:e1313-e1324. [PMID: 34499408 DOI: 10.1111/hsc.13538] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
Neglecting to provide older people with the care they need in residential care settings leads to human suffering and increased service needs. Research is lacking on neglect in older people's residential care and one way to assess the key issues is to study complaints. The aim of this study was to analyse official complaints related to allegations of neglect in residential care settings caring for older people in Finland. The data covered 317 complaints that were recorded in the national database in 2018 and 2019. The analysis of the complaints yielded 2,922 observations of neglect in older people's care in residential care settings. Based on our results, most of the complaints were made by family members when the patients were alive and their motivation was to improve the care their relative received, as well as the care of others, in the residential care home. The complaints focused on neglecting clinical care, including restricting older people's movements, not providing daily activities and not paying sufficient attention to their hygiene and secretions. Other complaints included issues relating to nutrition, medication, communication and issues that compromised their privacy, respect and dignity. Nearly three of four complaints identified staffing issues in relation to neglect and most of the complaints concerned private, rather than public, residential care homes. Although the complaints only concerned a small proportion of the annual care provided, more attention should be paid to care practices that prevent neglect in residential care and to multi-level monitoring for dignified care.
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Affiliation(s)
- Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Oili Papinaho
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Oulu University Hospital, Oulu, Finland
| | - Tanja Moilanen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | | | - Sakari Suominen
- Public Health, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Welfare Division, Turku, Finland
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15
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Lassander M, Hintsanen M, Ravaja N, Määttänen I, Suominen S, Mullola S, Makkonen T, Vahlberg T, Volanen SM. Pilot study on students’ stress reactivity after mindfulness intervention compared to relaxation control group. International Journal of Stress Management 2022. [DOI: 10.1037/str0000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Carlén K, Suominen S, Augustine L, Saarinen MM, Aromaa M, Rautava P, Sourander A, Sillanpää M. Teenagers' mental health problems predict probable mental diagnosis 3 years later among girls, but what about the boys? Child Adolesc Psychiatry Ment Health 2022; 16:41. [PMID: 35681228 PMCID: PMC9185898 DOI: 10.1186/s13034-022-00473-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of mental disorders is increasing, and there seems to be a gender difference in prevalence, with girls reporting more mental health problems than boys, especially regarding internalizing problems. Most mental disorders debut early but often remain untreated into adulthood. Early detection of mental disorders is essential for successful treatment, which is not always happening. The study aimed to estimate to what extent teenagers' self-reports predict probable mental diagnosis as they enter adulthood, particularly regarding gender differences. METHODS Self-reported mental health problems, Youth Self-Report (YSR) at 15 years (range 3-110, n = 504) from the ongoing Finnish family competence study (FFC) using modified multivariable Poisson regression analysis for prediction of DAWBA (Development and Wellbeing Assessment) interview outcomes 3 years later. RESULTS One unit's increase in YSR was estimated to correspond to an increase in the relative risk of a probable DAWBA-based diagnosis by 3.3% [RR (95% CI) 1.03 (1.03-1.04), p < 0.001]. In gender-specific analysis, the findings applied, particularly to girls. CONCLUSIONS Youth Self-Report (YSR) scores at pubertal age predicted the risk of a probable mental diagnosis at the onset of adulthood, particularly in girls. Further research is needed to explain the lower sensitivity of YSR among boys.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Box 408, 54128, Skövde, Sweden. .,The Research School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sakari Suominen
- grid.412798.10000 0001 2254 0954School of Health Sciences, University of Skövde, Box 408, 54128 Skövde, Sweden ,grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Lilly Augustine
- grid.118888.00000 0004 0414 7587CHILD, School of Learning and Communication, Jönköping University, Jönköping, Sweden
| | - Maiju M. Saarinen
- grid.1374.10000 0001 2097 1371Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland ,City of Turku Welfare Division, Turku, Finland
| | - Päivi Rautava
- grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland ,grid.410552.70000 0004 0628 215XClinical Research Centre, Turku University Hospital, Turku, Finland
| | - André Sourander
- grid.1374.10000 0001 2097 1371Department of Child Psychiatry, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Matti Sillanpää
- grid.1374.10000 0001 2097 1371Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
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17
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Stenlund S, Koivumaa-Honkanen H, Sillanmäki L, Lagström H, Rautava P, Suominen S. Changed health behavior improves subjective well-being and vice versa in a follow-up of 9 years. Health Qual Life Outcomes 2022; 20:66. [PMID: 35449057 PMCID: PMC9027415 DOI: 10.1186/s12955-022-01972-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Previous research on health behavior and subjective well-being has mainly focused on interindividual differences or explored certain domains of health behavior. Good health behavior and subjective well-being at baseline can predict each other after a follow-up. In the present cohort study, we explored the outcomes of change for an individual i.e., how changed health behavior is reflected in subsequent subjective well-being and vice versa. Methods Data (n = 10,855) originates from a population-based Health and Social Support (HeSSup) study on working-age Finns in 2003 and 2012. A composite measure of health behavior included physical activity, dietary habits, alcohol consumption, and smoking status (range 0–4, worst–best) and a composite measure of subjective well-being (with reversed scoring) included three life assessments, i.e., interest, happiness, and ease in life, and perceived loneliness (range 4–20, best–worst). Different multiple linear regression models were used to study how changes in health behavior predict subjective well-being and the opposite, how changes in subjective well-being predict health behavior. Results A positive change in health behavior from 2003 to 2012 predicted better subjective well-being (i.e., on average 0.31 points lower subjective well-being sum score), whereas a negative change predicted poorer subjective well-being (i.e., 0.37 points higher subjective well-being sum score) (both: p < 0.001) compared to those study subjects who had no change in health behavior. Similarly, when a positive and negative change in subjective well-being was studied, these figures were 0.071 points better and 0.072 points worse (both: p < 0.001) health behavior sum score, respectively. When the magnitude of the effect of change was compared to the range of scale of the outcome the effect of health behavior change appeared stronger than that of subjective well-being. Conclusion Changes in health behavior and subjective well-being have long-term effects on the level of the other, the effect of the first being slightly stronger than vice versa. These mutual long-term benefits can be used as a motivator in health promotion on individual and societal levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01972-4.
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Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, 20014, Turku, Finland. .,Research Services, Turku University Hospital, 20014, Turku, Finland.
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, 70211, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, 70029, Kuopio, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Research Services, Turku University Hospital, 20014, Turku, Finland.,Department of Public Health, University of Helsinki, 00014, Helsinki, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, 20014, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Research Services, Turku University Hospital, 20014, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Research Services, Turku University Hospital, 20014, Turku, Finland.,School of Health Sciences, University of Skövde, 54128, Skövde, Sweden
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18
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Carlén K, Suominen S, Augustine L, Saarinen MM, Aromaa M, Rautava P, Sourander A, Sillanpää M. Parental distress rating at the child's age of 15 years predicts probable mental diagnosis: a three-year follow-up. BMC Pediatr 2022; 22:177. [PMID: 35379223 PMCID: PMC8978369 DOI: 10.1186/s12887-022-03248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Mental health in adolescence is an increasing global public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, underlining the significance of early detection. The study aimed to investigate whether parental distress rating at the child’s age of 15 predicts a probable mental diagnosis in a three-year follow-up. Methods All data was derived from the Finnish Family Competence (FFC) Study. The analysis focused on whether parental CBCL (Child Behavior Checklist) rating (n = 441) at the child’s age of 15 years predicted the outcome of the child’s standardised DAWBA (Development and Well-Being Assessment) interview at offspring’s 18 years. Results Multivariable analysis showed that a one-unit increase in the total CBCL scores increased the relative risk of a DAWBA-based diagnosis by 3% (RR [95% CI] 1.03 [1.02–1.04], p < 0.001). Conclusions Parental CBCL rating in a community sample at the adolescent’s age of 15 contributes to early identification of adolescents potentially at risk and thus benefitting from early interventions.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Skövde, Box 408, 54128, Skövde, Sweden. .,The Research School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sakari Suominen
- School of Health Sciences, University of Skövde, Skövde, Box 408, 54128, Skövde, Sweden.,Department of Public Health, University of Turku, Turku, Finland
| | - Lilly Augustine
- CHILD, School of Learning and Communication, Jönköping University, Jönköping, Sweden
| | - Maiju M Saarinen
- Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- Department of Public Health, University of Turku, Turku, Finland.,City of Turku Welfare Division, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku University Hospital, Clinical Research Centre, Turku, Finland
| | - André Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Matti Sillanpää
- Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
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19
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Gonzales-Inca C, Pentti J, Stenholm S, Suominen S, Vahtera J, Käyhkö N. Residential greenness and risks of depression: Longitudinal associations with different greenness indicators and spatial scales in a Finnish population cohort. Health Place 2022; 74:102760. [DOI: 10.1016/j.healthplace.2022.102760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/08/2022] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
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20
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Virtanen JK, Nurmi T, Aro A, Bertone-Johnson ER, Hyppönen E, Kröger H, Lamberg-Allardt C, Manson JE, Mursu J, Mäntyselkä P, Suominen S, Uusitupa M, Voutilainen A, Tuomainen TP, Hantunen S. Vitamin D supplementation and prevention of cardiovascular disease and cancer in the Finnish Vitamin D Trial: a randomized controlled trial. Am J Clin Nutr 2022; 115:1300-1310. [PMID: 34982819 PMCID: PMC9071497 DOI: 10.1093/ajcn/nqab419] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vitamin D insufficiency is associated with risks of cardiovascular diseases (CVD) and cancer in observational studies, but evidence for benefits with vitamin D supplementation is limited. OBJECTIVES To investigate the effects of vitamin D3 supplementation on CVD and cancer incidences. METHODS The study was a 5-year, randomized, placebo-controlled trial among 2495 male participants ≥60 years and post-menopausal female participants ≥65 years from a general Finnish population who were free of prior CVD or cancer. The study had 3 arms: placebo, 1600 IU/day, or 3200 IU/day vitamin D3. Follow-up was by annual study questionnaires and national registry data. A representative subcohort of 551 participants had more detailed in-person investigations. The primary endpoints were incident major CVD and invasive cancer. Secondary endpoints included the individual components of the primary CVD endpoint (myocardial infarction, stroke, and CVD mortality), site-specific cancers, and cancer death. RESULTS During the follow-up, there were 41 (4.9%), 42 (5.0%), and 36 (4.3%) major CVD events in the placebo, 1600 IU/d (compared with placebo: HR: 0.97; 95% CI: 0.63-1.49; P = 0.89), and 3200 IU/d (HR: 0.84; 95% CI: 0.54-1.31; P = 0.44) arms, respectively. Invasive cancer was diagnosed in 41 (4.9%), 48 (5.8%), and 40 (4.8%) participants in the placebo, 1600 IU/d (HR: 1.14; 95% CI: 0.75-1.72; P = 0.55), and 3200 IU/d (HR: 0.95; 95% CI: 0.61-1.47; P = 0.81) arms, respectively. There were no significant differences in the secondary endpoints or total mortality. In the subcohort, the mean baseline serum 25-hydroxyvitamin D concentration was 75 nmol/L (SD, 18 nmol/L). After 12 months, the concentrations were 73 nmol/L (SD, 18 nmol/L), 100 nmol/L (SD, 21 nmol/L), and 120 nmol/L (SD, 22 nmol/L) in the placebo, 1600 IU/d, and 3200 IU/d arms, respectively. CONCLUSIONS Vitamin D3 supplementation did not lower the incidences of major CVD events or invasive cancer among older adults, possibly due to sufficient vitamin D status in most participants at baseline.
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Affiliation(s)
| | - Tarja Nurmi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Antti Aro
- Independent scientist, Kangasala, Finland
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA,Department of Epidemiology and Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Elina Hyppönen
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, Australia,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Heikki Kröger
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaakko Mursu
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland,School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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21
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Ervasti J, Pentti J, Nyberg ST, Shipley MJ, Leineweber C, Sørensen JK, Alfredsson L, Bjorner JB, Borritz M, Burr H, Knutsson A, Madsen IE, Magnusson Hanson LL, Oksanen T, Pejtersen JH, Rugulies R, Suominen S, Theorell T, Westerlund H, Vahtera J, Virtanen M, Batty GD, Kivimäki M. Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries. Lancet Reg Health Eur 2021; 11:100212. [PMID: 34917998 PMCID: PMC8642716 DOI: 10.1016/j.lanepe.2021.100212] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints. METHODS The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers. FINDINGS 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality. INTERPRETATION Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality. FUNDING NordForsk, the Medical Research Council, the National Institute on Aging, the Wellcome Trust, Academy of Finland, and Finnish Work Environment Fund.
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Affiliation(s)
- Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Solja T. Nyberg
- Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Martin J. Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Constanze Leineweber
- Stress Research Institute at the Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jeppe K. Sørensen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jakob B. Bjorner
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Hermann Burr
- Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Ida E.H. Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Tuula Oksanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jan H. Pejtersen
- VIVE–The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Denmark
| | - Sakari Suominen
- Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Turku, Finland
- University of Skövde, School of Health and Education, Skövde, Sweden
| | - Töres Theorell
- Stress Research Institute at the Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Hugo Westerlund
- Stress Research Institute at the Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jussi Vahtera
- Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
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22
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Stenlund S, Koivumaa-Honkanen H, Sillanmäki L, Lagström H, Rautava P, Suominen S. Subjective well-being predicts health behavior in a population-based 9-years follow-up of working-aged Finns. Prev Med Rep 2021; 24:101635. [PMID: 34976687 PMCID: PMC8684019 DOI: 10.1016/j.pmedr.2021.101635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022] Open
Abstract
Subjective well-being predicts subsequent health behavior in a 9-years of follow-up. Neither direction of influence was stronger as compared to the other one. Enhancing subjective well-being could serve as an additional support for health behavior change.
The cross-sectional association between measures of subjective well-being (SWB) and various health behaviors is well-established. In this 9-year (2003–2012) follow-up study, we explored how a composite indicator of SWB (range 4–20) with four items (interest, happiness, and ease in life, as well as perceived loneliness) predicts a composite health behavior measure (range 0–4) including dietary habits, physical activity, alcohol consumption, and smoking status. Study subjects (n = 10,855) originated from a population-based random sample of working-age Finns in the Health and Social Support study (HeSSup). According to linear regression analysis, better SWB predicted better health behavior sum score with a β = 0.019 (p < 0.001) with a maximum effect of 0.3 points after adjusting for age (p = 0.038), gender (p < 0.001), education (p = 0.55), baseline self-reported diseases (p = 0.020), baseline health behavior (β = 0.49, p < 0.001), and the interaction between SWB and education (p < 0.001). The results suggest that SWB has long-term positive effect on health behavior. Thus, interventions aiming at health behavioral changes could benefit from taking into account SWB and its improvement in the intervention.
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23
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Sipilä PN, Heikkilä N, Lindbohm JV, Hakulinen C, Vahtera J, Elovainio M, Suominen S, Väänänen A, Koskinen A, Nyberg ST, Pentti J, Strandberg TE, Kivimäki M. Hospital-treated infectious diseases and the risk of dementia: a large, multicohort, observational study with a replication cohort. Lancet Infect Dis 2021; 21:1557-1567. [PMID: 34166620 PMCID: PMC8592915 DOI: 10.1016/s1473-3099(21)00144-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/31/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Infections have been hypothesised to increase the risk of dementia. Existing studies have included a narrow range of infectious diseases, relied on short follow-up periods, and provided little evidence for whether the increased risk is limited to specific dementia subtypes or attributable to specific microbes rather than infection burden. We aimed to compare the risk of Alzheimer's disease and other dementias across a wide range of hospital-treated bacterial and viral infections in two large cohorts with long follow-up periods. METHODS In this large, multicohort, observational study, the analysis was based on a primary cohort consisting of pooled individual-level data from three prospective cohort studies in Finland (the Finnish Public Sector study, the Health and Social Support study, and the Still Working study) and an independent replication cohort from the UK Biobank. Community-dwelling adults (≥18 years) with no dementia at study entry were included. Follow-up was until Dec 31, 2012, in the Health and Social Support study, Dec 31, 2016, in the public sector study and the Still Working study, and Feb 7, 2018, in the replication cohort. Through record linkage to national hospital inpatient registers, we ascertained exposure to 925 infectious diseases (using the International Classification of Diseases 10th Revision codes) before dementia onset, and identified incident dementia from hospital records, medication reimbursement entitlements, and death certificates. Hazard ratios (HRs) for the associations of each infectious disease or disease group (index infection) with incident dementia were assessed by use of Cox proportional hazards models. We then repeated the analysis after excluding incident dementia cases that occurred during the first 10 years after initial hospitalisation due to the index infection. FINDINGS From March 1, 1986, to Jan 1, 2005, 260 490 people were included in the primary cohort, and from Dec 19, 2006, to Oct 1, 2010, 485 708 people were included in the replication cohort. In the primary cohort analysis based on 3 947 046 person-years at risk (median follow-up 15·4 years [IQR 9·8-21·0]), 77 108 participants had at least one hospital-treated infection before dementia onset and 2768 developed dementia. Hospitalisation for any infectious disease was associated with increased dementia risk in the primary cohort (adjusted HR [aHR] 1·48 [95% CI 1·37-1·60]) and replication cohort (2·60 [2·38-2·83]). The association remained when analyses were restricted to new dementia cases that occurred more than 10 years after infection (aHR 1·22 [95% CI 1·09-1·36] in the primary cohort, the replication cohort had insufficient follow-up data for this analysis), and when comorbidities and other dementia risk factors were considered. There was evidence of a dose-response association between the number of episodes of hospital-treated infections and dementia risk in both cohorts (ptrend=0·0007). Although the greatest dementia risk was seen for central nervous system (CNS) infections versus no infection (aHR 3·01 [95% CI 2·07-4·37]), excess risk was also evident for extra-CNS infections (1·47 [1·36-1·59]). Although we found little difference in the infection-dementia association by type of infection, associations were stronger for vascular dementia than for Alzheimer's disease (aHR 2·09 [95% CI 1·59-2·75] versus aHR 1·20 [1·08-1·33] in the primary cohort and aHR 3·28 [2·65-4·04] versus aHR 1·80 [1·53-2·13] in the replication cohort). INTERPRETATION Severe infections requiring hospital treatment are associated with long-term increased risk of dementia, including vascular dementia and Alzheimer's disease. This association is not limited to CNS infections, suggesting that systemic effects are sufficient to affect the brain. The absence of infection specificity combined with evidence of dose-response relationships between infectious disease burden and dementia risk support the hypothesis that increased dementia risk is driven by general inflammation rather than specific microbes. FUNDING UK Medical Research Council, US National Institute on Aging, Wellcome Trust, NordForsk, Academy of Finland, and Helsinki Institute of Life Science.
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Affiliation(s)
- Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Nelli Heikkilä
- Medicum, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland; Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Joni V Lindbohm
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian Hakulinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Elovainio
- Research Programs Unit, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland; Research Services, Turku University Hospital, Turku, Finland; School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Solja T Nyberg
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana Pentti
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Turku, Turku, Finland
| | - Timo E Strandberg
- Department of Medicine, Helsinki University Hospital, Helsinki, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Mika Kivimäki
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK
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24
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Stenlund S, Junttila N, Koivumaa-Honkanen H, Sillanmäki L, Stenlund D, Suominen S, Lagström H, Rautava P. Longitudinal stability and interrelations between health behavior and subjective well-being in a follow-up of nine years. PLoS One 2021; 16:e0259280. [PMID: 34714864 PMCID: PMC8555827 DOI: 10.1371/journal.pone.0259280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The bidirectional relationship between health behavior and subjective well-being has previously been studied sparsely, and mainly for individual health behaviors and regression models. In the present study, we deepen this knowledge focusing on the four principal health behaviors and using structural equation modeling with selected covariates. METHODS The follow-up data (n = 11,804) was derived from a population-based random sample of working-age Finns from two waves (2003 and 2012) of the Health and Social Support (HeSSup) postal survey. Structural equation modeling was used to study the cross-sectional, cross-lagged, and longitudinal relationships between the four principal health behaviors and subjective well-being at baseline and after the nine-year follow-up adjusted for age, gender, education, and self-reported diseases. The included health behaviors were physical activity, dietary habits, alcohol consumption, and smoking status. Subjective well-being was measured through four items comprising happiness, interest, and ease in life, and perceived loneliness. RESULTS Bidirectionally, only health behavior in 2003 predicted subjective well-being in 2012, whereas subjective well-being in 2003 did not predict health behavior in 2012. In addition, the cross-sectional interactions in 2003 and in 2012 between health behavior and subjective well-being were statistically significant. The baseline levels predicted their respective follow-up levels, the effect being stronger in health behavior than in subjective well-being. CONCLUSION The four principal health behaviors together predict subsequent subjective well-being after an extensive follow-up. Although not particularly strong, the results could still be used for motivation for health behavior change, because of the beneficial effects of health behavior on subjective well-being.
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Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
| | - Niina Junttila
- Department of Teacher Education, University of Turku, Turku, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - David Stenlund
- Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
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Stenlund S, Koivumaa-Honkanen H, Sillanmäki L, Lagström H, Rautava P, Suominen S. Health behavior of working-aged Finns predicts self-reported life satisfaction in a population-based 9-years follow-up. BMC Public Health 2021; 21:1815. [PMID: 34625042 PMCID: PMC8501556 DOI: 10.1186/s12889-021-11796-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/15/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Previous studies have shown positive association between health behavior and life satisfaction, but the studies have mostly been cross-sectional, had follow-up times up to 5 years or focused on only one health behavior domain. The aim of the study was to explore how principal health behavior domains predict life satisfaction as a composite score in a previously unexplored longitudinal setting. METHODS The present study tested whether a health behavior sum score (range 0-4) comprising of dietary habits, smoking, alcohol consumption, and physical activity predicted subsequent composite score of life satisfaction (range 4-20). Data included responses from 11,000 working-age Finns who participated in the Health and Social Support (HeSSup) prospective population-based postal survey. RESULTS Protective health behavior in 2003 predicted (p < .001) better life satisfaction 9 years later when sex, age, education, major diseases, and baseline life satisfaction were controlled for. The β in the linear regression model was - 0.24 (p < .001) corresponding to a difference of 0.96 points in life satisfaction between individuals having the best and worst health behavior. CONCLUSION Good health behavior has a long-term beneficial impact on subsequent life satisfaction. This knowledge could strengthen the motivation for improvement of health behavior particularly on an individual level but also on a policy level.
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Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, 70211 Kuopio, Finland
- Mental health & Wellbeing Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20014 Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
- School of Health Sciences, University of Skövde, 54128 Skövde, Sweden
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Lassander M, Hintsanen M, Suominen S, Mullola S, Vahlberg T, Volanen SM. Effects of school-based mindfulness intervention on health-related quality of life: moderating effect of gender, grade, and independent practice in cluster randomized controlled trial. Qual Life Res 2021; 30:3407-3419. [PMID: 34169412 PMCID: PMC8602227 DOI: 10.1007/s11136-021-02868-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/11/2022]
Abstract
Object We investigated the impact of a school-based 9-week mindfulness program vs. active control program (relaxation) and inactive control group on children’s self-reported Health-Related Quality of Life (HRQoL) moderated by gender, grade, and independent practice. Method In total 3519 (50/50% boys/girls) Finnish students aged 12–15 years from 56 schools were randomized into mindfulness intervention, active, and inactive control groups. HRQoL was measured at baseline, at 9 weeks, and at 26 weeks and analyzed with multilevel linear modeling. Results Significant improvement on HRQoL was found (β = mean difference) (β = 1.587, 95% CI 0.672–2.502, p < 0.001) after 9 weeks and at 26 weeks of follow-up among students in the mindfulness group as compared to the active control group. Moderating effects on HRQoL were found for gender, grade, and independent practice: girls, 7th and 8th grade students, and students with regular independent mindfulness practice benefited most. Conclusions Gender and developmental stage may moderate the effects of mindfulness interventions on HRQoL and offer guidance in designing effective promotive interventions for children and adolescents. Trial Registration Information Healthy Learning Mind—a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial (RCT) ISRCTN18642659 retrospectively registered on 13 October 2015. The full trial protocol can be accessed at http://rdcu.be/t57S. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02868-4.
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Affiliation(s)
- Maarit Lassander
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Parrulaituri 16 D 62, 00540, Helsinki, Finland.
| | | | - Sakari Suominen
- Department of Public Health, University of Skövde, Skövde, Sweden.,Department of Public Health, University of Turku, Turku, Finland
| | - Sari Mullola
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland.,Teachers College, National Center for Children and Families (NCCF), Columbia University, New York, NY, USA
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Salla-Maarit Volanen
- Folkhälsan Research Center, Helsinki, Finland.,Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
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Hult M, Halminen O, Linna M, Suominen S, Kangasniemi M. Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review. Eur J Public Health 2021; 31:997-1003. [PMID: 33970246 PMCID: PMC8546878 DOI: 10.1093/eurpub/ckab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety. Methods Our systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis. Results The searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used. Conclusion This review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies.
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Affiliation(s)
- Marja Hult
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Olli Halminen
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management and Architecture (HEMA), Aalto University, Espoo, Finland
| | - Miika Linna
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management and Architecture (HEMA), Aalto University, Espoo, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland.,Department of Public Health, Turku University Hospital, Turku, Finland.,Department of Public Health, School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
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Simonsen N, Koponen AM, Suominen S. Empowerment among adult patients with type 2 diabetes: age differentials in relation to person-centred primary care, community resources, social support and other life-contextual circumstances. BMC Public Health 2021; 21:844. [PMID: 33933065 PMCID: PMC8088546 DOI: 10.1186/s12889-021-10855-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rising prevalence of type 2 diabetes (T2D), also among younger adults, constitutes a growing public health challenge. According to the person-centred Chronic Care Model, proactive care and self-management support in combination with community resources enhance quality of healthcare and health outcomes for patients with T2D. However, research is scarce concerning the importance of person-centred care and community resources for such outcomes as empowerment, and the relative impact of various patient support sources for empowerment is not known. Moreover, little is known about the association of age with these variables in this patient-group. This study, carried out among patients with T2D, examined in three age-groups (27-54, 55-64 and 65-75 years) whether person-centred care and diabetes-related social support, including community support and possibilities to influence community health issues, are associated with patient empowerment, when considering possible confounding factors, such as other quality of care indicators and psychosocial wellbeing. We also explored age differentials in empowerment and in the proposed correlates of empowerment. METHOD Individuals from a register-based sample with T2D participated in a cross-sectional survey (participation 56%, n = 2866). Data were analysed by descriptive statistics and multivariate logistic regression analyses. RESULTS Respondents in the youngest age-group were more likely to have low empowerment scores, less continuity of care, and lower wellbeing than the other age-groups, and to perceive less social support, but a higher level of person-centred care than the oldest group. Community support, including possibilities to influence community health issues, was independently and consistently associated with high empowerment in all three age-groups, as was person-centred care in the two older age-groups. Community support was the social support variable with the strongest association with empowerment across age-groups. Moreover, vitality was positively and diabetes-related distress negatively associated with high empowerment in all age-groups, whereas continuity of care, i.e. having a family/regular nurse, was independently associated in the youngest age-group only. CONCLUSION Person-centred care and community support, including possibilities to influence community health issues, supports empowerment among adults with T2D. Findings suggest that age is related to most correlates of empowerment, and that younger adults with T2D have specific healthcare needs.
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Affiliation(s)
- Nina Simonsen
- Folkhälsan Research Center, Public Health Research Program, P.O. Box 211, 00251 Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne M. Koponen
- Folkhälsan Research Center, Public Health Research Program, P.O. Box 211, 00251 Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku University Hospital, Lemminkäisenkatu 1, Turun yliopisto, 20014 Turku, Finland
- School of Health and Education, University of Skövde, Skövde, Sweden
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29
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Lietzén R, Suominen S, Sillanmäki L, Virtanen P, Virtanen M, Vahtera J. Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators. J Psychosom Res 2021; 143:110388. [PMID: 33639528 DOI: 10.1016/j.jpsychores.2021.110388] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood. METHODS Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators). RESULTS Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE-asthma association were 'severe financial difficulties' (24%), 'emotional, physical or sexual violence' (15%), 'major increase in marital problems' (8%), 'severe conflicts with supervisor' (7%), and 'divorce or separation' (5%). CONCLUSIONS Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset.
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Affiliation(s)
- Raija Lietzén
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; University of Skövde, School of Health Sciences, Department of Public Health, Sweden.
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Department of Public Health, University of Helsinki, Finland.
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
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30
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Simonsen N, Wackström N, Roos E, Suominen S, Välimaa R, Tynjälä J, Paakkari L. Does health literacy explain regional health disparities among adolescents in Finland? Health Promot Int 2021; 36:1727-1738. [PMID: 33611473 DOI: 10.1093/heapro/daaa122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Health literacy (HL)-as a broad range of health-related competencies-has been proposed to be a promising construct in understanding health disparities better, also among adolescents. Several factors have been found to explain differences in adolescents' HL levels; however, not much is known about how different regions of a country or majority/minority status is associated with HL, or whether HL is associated with regional health disparities. The aim of this study was to examine and compare HL and health levels among majority- and minority-language-speaking adolescents living in different regions of Finland, and to explore if HL explains regional health disparities, taking into account other important structural stratifying factors. The study uses Health Behaviour in School-aged Children survey data, collected among 13- and 15-year-old pupils in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). Findings suggest that regional differences in HL levels and regional health disparities exist in both language groups. Health disparities were present in the Finnish-speaking sample among boys, the proportion rating their health as excellent ranging from 23 to 31% across regions, and in the Swedish-speaking sample among girls, the corresponding numbers ranging from 13 to 20%. In addition to other important structural stratifying factors, comprehensive HL explains these regional health disparities. This study adds to prior studies on the role of HL as a modifiable health resource by showing that regional health disparities among adolescents can partially be attributed to corresponding HL differences.
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Affiliation(s)
- Nina Simonsen
- Public Health Research Program, Folkhälsan Research Center, PO Box 211, FI-00251 Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nanna Wackström
- Public Health Research Program, Folkhälsan Research Center, PO Box 211, FI-00251 Helsinki, Finland
| | - Eva Roos
- Public Health Research Program, Folkhälsan Research Center, PO Box 211, FI-00251 Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Lemminkäisenkatu 1, 20014 Turku, Finland.,University of Skövde, Skövde, Sweden
| | - Raili Välimaa
- Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, FI-40014 Jyväskylä, Finland
| | - Jorma Tynjälä
- Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, FI-40014 Jyväskylä, Finland
| | - Leena Paakkari
- Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, FI-40014 Jyväskylä, Finland
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Thapa DR, Oli N, Vaidya A, Suominen S, Ekström-Bergström A, Areskoug Josefsson K, Krettek A. Determination and Evaluation of Sense of Coherence in Women in Semi-urban Nepal: A part of the Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) Trial. Kathmandu Univ Med J (KUMJ) 2021; 19:69-75. [PMID: 34812161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals' overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal. Objective To determine and evaluate women's SOC before and after a health education intervention. Method This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban JhaukhelDuwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA. Result Women's total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p < 0.001). At followup three months later, SOC was significantly stronger in the intervention area than in the control area (p < 0.001). Conclusion Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated.
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Affiliation(s)
- D R Thapa
- Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden. School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - N Oli
- Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - A Vaidya
- Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - S Suominen
- Department of Public Health, School of Health Sciences, University of Skövde, Skövde, Sweden. Department of Public Health, University of Turku, Turku, Finland
| | - A Ekström-Bergström
- Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden. Department of Health Science, University West, Trollhättan, Sweden
| | - K Areskoug Josefsson
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping Sweden. Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway. Faculty of Health Sciences, VID Specialized University, Sandnes, Norway
| | - A Krettek
- Department of Public Health, School of Health Sciences, University of Skövde, Skövde, Sweden. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Pachito DV, Pega F, Bakusic J, Boonen E, Clays E, Descatha A, Delvaux E, De Bacquer D, Koskenvuo K, Kröger H, Lambrechts MC, Latorraca COC, Li J, Cabrera Martimbianco AL, Riera R, Rugulies R, Sembajwe G, Siegrist J, Sillanmäki L, Sumanen M, Suominen S, Ujita Y, Vandersmissen G, Godderis L. The effect of exposure to long working hours on alcohol consumption, risky drinking and alcohol use disorder: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ Int 2021; 146:106205. [PMID: 33189992 PMCID: PMC7786792 DOI: 10.1016/j.envint.2020.106205] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND The World Health Organization (WHO) and the International Labour Organization (ILO) are developing Joint Estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that exposure to long working hours may increase alcohol consumption and cause alcohol use disorder. In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from alcohol consumption and alcohol use disorder that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. OBJECTIVES We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption, risky drinking (three outcomes: prevalence, incidence and mortality) and alcohol use disorder (three outcomes: prevalence, incidence and mortality). DATA SOURCES We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trials Register, Ovid MEDLINE, PubMed, Embase, and CISDOC on 30 June 2018. Searches on PubMed were updated on 18 April 2020. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We considered for inclusion randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption (in g/week), risky drinking, and alcohol use disorder (prevalence, incidence or mortality). STUDY APPRAISAL AND SYNTHESIS METHODS At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from publications related to qualifying studies. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project. RESULTS Fourteen cohort studies met the inclusion criteria, comprising a total of 104,599 participants (52,107 females) in six countries of three WHO regions (Americas, South-East Asia, and Europe). The exposure and outcome were assessed with self-reported measures in most studies. Across included studies, risk of bias was generally probably high, with risk judged high or probably high for detection bias and missing data for alcohol consumption and risky drinking. Compared to working 35-40 h/week, exposure to working 41-48 h/week increased alcohol consumption by 10.4 g/week (95% confidence interval (CI) 5.59-15.20; seven studies; 25,904 participants, I2 71%, low quality evidence). Exposure to working 49-54 h/week increased alcohol consumption by 17.69 g/week (95% confidence interval (CI) 9.16-26.22; seven studies, 19,158 participants, I2 82%, low quality evidence). Exposure to working ≥55 h/week increased alcohol consumption by 16.29 g/week (95% confidence interval (CI) 7.93-24.65; seven studies; 19,692 participants; I2 82%, low quality evidence). We are uncertain about the effect of exposure to working 41-48 h/week, compared with working 35-40 h/week on developing risky drinking (relative risk 1.08; 95% CI 0.86-1.36; 12 studies; I2 52%, low certainty evidence). Working 49-54 h/week did not increase the risk of developing risky drinking (relative risk 1.12; 95% CI 0.90-1.39; 12 studies; 3832 participants; I2 24%, moderate certainty evidence), nor working ≥55 h/week (relative risk 1.11; 95% CI 0.95-1.30; 12 studies; 4525 participants; I2 0%, moderate certainty evidence). Subgroup analyses indicated that age may influence the association between long working hours and both alcohol consumption and risky drinking. We did not identify studies for which we had access to results on alcohol use disorder. CONCLUSIONS Overall, for alcohol consumption in g/week and for risky drinking, we judged this body of evidence to be of low certainty. Exposure to long working hours may have increased alcohol consumption, but we are uncertain about the effect on risky drinking. We found no eligible studies on the effect on alcohol use disorder. Producing estimates for the burden of alcohol use disorder attributable to exposure to long working hours appears to not be evidence-based at this time. PROTOCOL IDENTIFIER: https://doi.org/10.1016/j.envint.2018.07.025. PROSPERO REGISTRATION NUMBER CRD42018084077.
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Affiliation(s)
- Daniela V Pachito
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês, Rua Barata Ribeiro 142, Bela Vista, São Paulo, Brazil; Fundação Getúlio Vargas, Av. Paulista, 548, Bela Vista, São Paulo, Brazil
| | - Frank Pega
- Environment, Climate Change and Health Department, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
| | - Jelena Bakusic
- Centre for Environment and Health of KU Leuven, Kapucijnenvoer 35/5, box 7001, 3000 Leuven, Belgium.
| | - Emma Boonen
- KIR Department (Knowledge, Information & Research), IDEWE, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001 Leuven, Belgium.
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, Cornel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Alexis Descatha
- AP-HP (Paris Hospital), Occupational Health Unit, Poincaré University Hospital, Garches, France; Inserm Versailles St-Quentin Univ - Paris Saclay Univ (UVSQ), UMS 011, UMR-S 1168, Villejuif, France; Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France.
| | - Ellen Delvaux
- KIR Department (Knowledge, Information & Research), IDEWE, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001 Leuven, Belgium; Centre for Social and Cultural Psychology of KU Leuven, Dekenstraat 2, box 3701, 3000 Leuven, Belgium.
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, Cornel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Karoliina Koskenvuo
- The Social Insurance Institution of Finland, PO Box 450, FIN-00056 Kela, Finland; Department of Public Health, PO BOX 20, 00014 University of Helsinki, Finland.
| | - Hannes Kröger
- Socio-Economic Panel (SOEP), German Institute for Economic Research (DIW), Berlin, Germany.
| | - Marie-Claire Lambrechts
- Centre for Environment and Health of KU Leuven, Kapucijnenvoer 35/5, box 7001, 3000 Leuven, Belgium; VAD, Flemish Expertise Centre for Alcohol and Other Drugs, Vanderlindenstraat 15, Brussels, Belgium.
| | - Carolina O C Latorraca
- Discipline of Evidence-based Medicine, Universidade Federal de São Paulo, Rua Botucatu 740, Sao Paulo, Brazil
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California, Los Angeles, United States.
| | - Ana L Cabrera Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), 536 Conselheiro Nébias, Santos, Brazil; Cochrane Brazil, Affiliate Center Rio de Janeiro, 136 Barão do Rio Branco, Petrópolis, Brazil; Centro Universitário São Camilo, 1501 Nazaré, Sao Paulo, Brazil
| | - Rachel Riera
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês, Rua Barata Ribeiro 142, Bela Vista, São Paulo, Brazil; Discipline of Evidence-based Medicine, Universidade Federal de São Paulo, Rua Botucatu 740, Sao Paulo, Brazil; Oxford-Brazil EBM-Alliance, Brazil
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353 Copenhagen, Denmark.
| | - Grace Sembajwe
- Department of Occupational Medicine, Epidemiology and Prevention (OMEP), Donald and Barbara Zucker School of Medicine at Hofstra University, 175 Community Drive, NY 11021, United States; CUNY Institute for Implementation Science, CUNY Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY 10027, United States.
| | - Johannes Siegrist
- Life Science Centre, University of Düsseldorf, Merowingerplatz 1a, D-40225 Duesseldorf, Germany.
| | - Lauri Sillanmäki
- Department of Public Health, University of Helsinki, Mannerheimintie 172, 00300 Helsinki, Finland; Department of Public Health, University of Turku, Joukahaisenkatu 3-5, 20520 Turku, Finland; Turku Clinical Research Centre, Turku University Hospital, Finland.
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Sakari Suominen
- Turku Clinical Research Centre, Turku University Hospital, Finland; University of Skövde, School of Health Sciences, Sweden.
| | - Yuka Ujita
- Labour Administration, Labour Inspection and Occupational Safety and Health Branch, International Labour Organization, Route des Morillons 4, 1211 Geneva, Switzerland.
| | - Godelieve Vandersmissen
- KIR Department (Knowledge, Information & Research), IDEWE, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001 Leuven, Belgium.
| | - Lode Godderis
- Centre for Environment and Health of KU Leuven, Kapucijnenvoer 35/5, box 7001, 3000 Leuven, Belgium; KIR Department (Knowledge, Information & Research), IDEWE, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001 Leuven, Belgium.
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Lassander M, Hintsanen M, Suominen S, Mullola S, Fagerlund Å, Vahlberg T, Volanen SM. The Effects of School-based Mindfulness Intervention on Executive Functioning in a Cluster Randomized Controlled Trial. Dev Neuropsychol 2020; 45:469-484. [PMID: 33305618 DOI: 10.1080/87565641.2020.1856109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Executive functions (EFs) are essential for student's learning and classroom functioning. The current cluster randomized controlled trial examines the effects of mindfulness intervention vs. active control program (i.e., relaxation) focusing on the main EFs (i.e., working memory, response inhibition, cognitive processing, cognitive flexibility and verbal fluency). A total of 131 students from 6th grade and 8th grade (median age 12 and 15) from four comprehensive schools participated. The schools were to equal shares randomized to intervention and active control groups, i.e., groups who underwent a 9-week mindfulness practice or relaxation program, respectively. Participants completed a cognitive test-package at baseline/pre-intervention, post-intervention at 9 weeks and follow-up at 6 months. Both intervention and active relaxation-based control groups improved on a majority of EF measures at both 9 weeks and 6 months. There was no significant difference between the mindfulness intervention group and the active control program in EFs. The current study suggests that mindfulness intervention and active control program do not differ in their effects to EFs, although both may have positive outcomes. Further research with both active and inactive control groups is needed to map the potential benefits of similar programs for cognitive functioning.
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Affiliation(s)
- Maarit Lassander
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki , Helsinki, Finland
| | | | - Sakari Suominen
- Department of Public Health, University of Skövde , Skövde, Sweden.,Department of Public Health, University of Turku , Turku, Finland
| | - Sari Mullola
- Faculty of Educational Sciences, University of Helsinki , Helsinki, Finland.,Teachers College, National Center for Children and Families (NCCF), Columbia University , NY, USA
| | - Åse Fagerlund
- Public Health Research Programme, Folkhälsan Research Center , Helsinki, Finland
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku , Turku, Finland
| | - Salla-Maarit Volanen
- Public Health Research Programme, Folkhälsan Research Center , Helsinki, Finland.,Faculty of Medicine, Department of Public Health, University of Helsinki , Helsinki, Finland
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34
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Lagström H, Halonen JI, Suominen S, Pentti J, Stenholm S, Kivimäki M, Vahtera J. Neighbourhood characteristics as a predictor of adherence to dietary recommendations: A population-based cohort study of Finnish adults. Scand J Public Health 2020; 50:245-249. [PMID: 33238819 PMCID: PMC8873300 DOI: 10.1177/1403494820971497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: To investigate the association of six-year cumulative
level of socioeconomic neighbourhood disadvantage and population density with
subsequent adherence to dietary recommendations, controlling for preceding
dietary adherence, in adults in Finland. Methods:
Population-based Health and Social Support (HeSSup) study participants from four
age groups (20–24, 30–34, 40–44 and 50–54 years at baseline in 1998). Data on
diet and alcohol consumption were obtained from the 2003 and 2012 surveys and
information on neighbourhoods from Statistics Finland Grid database
(n = 10,414 men and women). Participants diet was measured
as adherence to Nordic Nutrition recommendation (score range 0–100).
Neighbourhood disadvantage was measured by median household
income, proportion of those with primary education only and unemployment rate,
and population density by the number of adult population
between years 2007 and 2012. Linear models were used to assess the associations
of neighbourhood characteristics with the score for adherence to dietary
recommendations in 2012. Results: Cumulative neighbourhood
socioeconomic disadvantage was associated with slightly weaker (1.49 (95%
confidence interval (CI) −1.89 to −1.09) point decrease in dietary score)
adherence while higher population density was associated with better (0.70 (95%
CI 0.38−1.01) point increase in dietary score) adherence to dietary
recommendations. These associations remained after controlling for prior dietary
habits, sociodemographic, chronic cardio-metabolic diseases, and severe life
events. Conclusions: These longitudinal findings support
the hypothesis that neighbourhood characteristics affect dietary
habits.
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Affiliation(s)
- Hanna Lagström
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Jaana I Halonen
- Health Security, Finnish Institute for Health and Welfare, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,School of Health Sciences, University of Skövde, Sweden
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
| | - Mika Kivimäki
- Clinicum, University of Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, UK
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Finland
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35
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Simonsen N, Lahti A, Suominen S, Välimaa R, Tynjälä J, Roos E, Kannas L. Empowerment-enabling home and school environments and self-rated health among Finnish adolescents. Health Promot Int 2020; 35:82-92. [PMID: 30590462 DOI: 10.1093/heapro/day104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Perceived health during adolescence has not only immediate consequences for individuals and for society, but also long-term. We need to understand better the health development in this period of the lifespan. Empowerment may be one pathway through which social factors and conditions translate into health effects. This study aimed to examine whether empowerment-enabling home and school environments are associated with self-rated health among adolescents, and whether the associations differ between genders, age or majority/minority language groups. Anonymous questionnaire data from respondents aged 11, 13 and 15 years were obtained from the Health Behaviour in School-aged Children study, conducted in Finland in 2014 in Finnish- and Swedish-speaking schools (n = 5925/1877). The proportion rating their health as excellent varied between 33.6 (11-year-olds) and 23.1% (15-year-olds), boys rating their health as excellent more often than girls in all age groups. Findings showed that indicators of both empowerment-enabling home and school environments were independently and positively related to adolescents' self-rated health. Whereas a respectful, accepting, kind and helpful attitude among classmates and a good home atmosphere were quite consistently associated with excellent health, there were gender and age differences with concern to the other empowerment-enabling indicators. Moreover, there were gender-, age- and language-related differences regarding adolescents' perceptions of how empowerment enabling their environments were. Home and school environments that create opportunities through encouragement and care, and through strengthening feelings of being secure, accepted and respected are potentially empowerment enabling. This study suggests that such environmental qualities are important for the perceived health of young people.
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Affiliation(s)
- Nina Simonsen
- Public Health Research Program, Folkhälsan Research Center, FI Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anna Lahti
- Public Health Research Program, Folkhälsan Research Center, FI Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Lemminkäisenkatu 1, Turku, Finland.,University of Skövde, Skövde, Sweden
| | - Raili Välimaa
- Faculty of Sport and Health Sciences, Research Center for Health Promotion, University of Jyväskylä, FI Jyväskylä, Finland
| | - Jorma Tynjälä
- Faculty of Sport and Health Sciences, Research Center for Health Promotion, University of Jyväskylä, FI Jyväskylä, Finland
| | - Eva Roos
- Public Health Research Program, Folkhälsan Research Center, FI Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Lasse Kannas
- Faculty of Sport and Health Sciences, Research Center for Health Promotion, University of Jyväskylä, FI Jyväskylä, Finland
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36
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Moilanen T, Kangasniemi M, Papinaho O, Mynttinen M, Siipi H, Suominen S, Suhonen R. Older people's perceived autonomy in residential care: An integrative review. Nurs Ethics 2020; 28:414-434. [PMID: 33000683 PMCID: PMC8151558 DOI: 10.1177/0969733020948115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.
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Affiliation(s)
| | | | - Oili Papinaho
- 8058University of Turku, Finland; Oulu University Hospital, Finland
| | | | | | | | - Riitta Suhonen
- 8058University of Turku, Finland; Turku University Hospital, Finland; City of Turku Welfare Division, Finland
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37
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Carlén K, Suominen S, Lindmark U, Saarinen MM, Aromaa M, Rautava P, Sillanpää M. Sense of coherence predicts adolescent mental health. J Affect Disord 2020; 274:1206-1210. [PMID: 32663952 DOI: 10.1016/j.jad.2020.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/12/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Strong sense of coherence (SOC) has been shown to predict good mental health among adults whereas its predictive value in adolescence is unclear. This life-course oriented prospective study explores whether SOC predicts mental health in a three-year follow-up. METHODS The data is part of the ongoing 'Finnish Family Competence Study' launched in 1986 in southwestern Finland (baseline n = 1287). The outcome variable was adolescent's mental health at 18 years of age, measured on the Development and Well-Being Assessment (DAWBA) scale. The main predictor was Antonovsky's SOC score (1987) measured at the age of 15. A total of 498 adolescents were included in the present analyses. Poisson regression was used by univariate and multivariable models using the parents' age and socioeconomic status and adolescents' gender as covariates. RESULTS Multivariable analysis showed that a one-unit increase in SOC decreased the relative risk of a DAWBA-based diagnosis by 4 % (RR [95% CI] 0.96 [0.94-0.98], p < 0.001). LIMITATIONS Typical of very long follow-up, as in our study of nearly two decades, a substantial proportion of the original population-based cohort was lost to follow-up weakening the representability of our cohort. CONCLUSIONS Sense of coherence is a useful and clinically sensitive tool to predict mental health in adolescence. The easily administered, coping-oriented SOC questionnaire is an appropriate instrument in screening for adolescents who would benefit from supportive measures to strengthen their mental well-being.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Skövde, Sweden; The Research School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sakari Suominen
- School of Health Sciences, University of Skövde, Skövde, Sweden; University of Turku, Department of Public Health, Turku, Finland
| | - Ulrika Lindmark
- School of Health and Welfare, Department of Natural Sciences and Biomedicine, Centre for Oral Health, Jönköping University, Jönköping, Sweden; Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Maiju M Saarinen
- Department of General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- University of Turku, Department of Public Health, Turku, Finland; City of Turku Welfare Division, Turku, Finland
| | - Päivi Rautava
- University of Turku, Department of Public Health, Turku, Finland; Turku University Hospital, Turku, Finland
| | - Matti Sillanpää
- Department of General Practice, University of Turku and Turku University Hospital, Turku, Finland
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38
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Wackström N, Koponen AM, Suominen S, Tarkka IM, Simonsen N. Does chronic pain hinder physical activity among older adults with type 2 diabetes? Health Psychol Behav Med 2020; 8:362-382. [PMID: 34040877 PMCID: PMC8114375 DOI: 10.1080/21642850.2020.1807350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 08/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Physical activity (PA) is a key component in management of type 2 diabetes (T2D). Pain might be a barrier to PA especially among older adults with T2D, but surprisingly few studies have investigated the association between chronic pain and PA. Our aim was to evaluate the prevalence of chronic pain among older adults with T2D and to examine the association between chronic pain and PA while taking important life-contextual factors into account. Methods: Data of this register-based, cross-sectional study were collected in a survey among adults with T2D (n=2866). In the current study, only respondents aged 65-75 years were included (response rate 63%, n=1386). Data were analysed by means of descriptive statistics and multivariate logistic regression analysis. Results: In total, 64% reported chronic pain. In specific groups, e.g. women and those who were obese, the prevalence was even higher. Among respondents experiencing chronic pain, frequent pain among women and severe pain among both genders were independently associated with decreased likelihood of being physically active. Moreover, the likelihood of being physically active decreased with higher age and BMI, whereas it increased with higher autonomous motivation and feelings of energy. Among physically active respondents suffering from chronic pain, neither intensity nor frequency of pain explained engagement in exercise (as compared with incidental PA). Instead, men were more likely to exercise regularly as were those with good perceived health and higher autonomous motivation. Conclusions: The prevalence of chronic pain is high among older adults with T2D. This study shows that among those suffering from chronic pain, severe pain is independently and inversely associated with being physically active, as is frequent pain, but only among women. Moreover, the findings show the importance of autonomous motivation and health variables for both incidental PA and exercise among older adults with T2D experiencing chronic pain.
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Affiliation(s)
- Nanna Wackström
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anne M. Koponen
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Ina M. Tarkka
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Nina Simonsen
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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39
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Salakari M, Nurminen R, Sillanmäki L, Pylkkänen L, Suominen S. The importance of and satisfaction with sex life among breast cancer survivors in comparison with healthy female controls and women with mental depression or arterial hypertension: results from the Finnish nationwide HeSSup cohort study. Support Care Cancer 2020; 28:3847-3854. [PMID: 31836939 PMCID: PMC7316835 DOI: 10.1007/s00520-019-05228-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Breast cancer (BC) and its treatment is associated with several physical and psychosocial changes that may influence sexuality for years after treatment. Women with BC show significantly greater rates of sexual dysfunction than do healthy women. The purpose of the study was to evaluate how a BC diagnosis associates with women's perceived sexuality and sexual satisfaction. MATERIAL AND METHODS The data of the ongoing prospective Health and Social Support (HeSSup) survey was linked with national health registries. Respondents with registry data confirmed BC (n = 66), mental depression (n = 612), arterial hypertension (n = 873), and healthy women (n = 9731) formed the study population. The importance of and satisfaction with sex life were measured by a self-report questionnaire modified from the Schover's and colleagues' Sexual History Form. RESULTS Women with BC considered sex life less important than did healthy women (p < 0.001). They were significantly less satisfied with their sex life than healthy women (p = 0.01) and women with arterial hypertension (p = 0.04). Living single or educational level did not explain the differences between the groups. CONCLUSIONS BC survivors depreciate their sex life and experience dissatisfaction with it. Sexuality can be a critical issue for the quality of life of women surviving from BC, and hence, the area deserves major attention in BC survivorship care. Health care professionals should regularly include sexual functions in the assessment of BC survivors' wellbeing.
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Affiliation(s)
- Minna Salakari
- Department of Public Health, University of Turku, Joukahaisenkatu 3-5, 20520 Turku, Finland
| | - Raija Nurminen
- University of Applied Science Turku, Joukahaisenkatu 3-5, 20520 Turku, Finland
| | - Lauri Sillanmäki
- Department of Occupational Health, University of Helsinki, Mannerheimintie 172, 00300 Helsinki, Finland
| | - Liisa Pylkkänen
- Department of Oncology, University of Turku, Kiinamyllynkatu 4, 20520 Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Joukahaisenkatu 3-5, 20520 Turku, Finland
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40
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Heikkilä K, Pentti J, Madsen IEH, Lallukka T, Virtanen M, Alfredsson L, Bjorner J, Borritz M, Brunner E, Burr H, Ferrie JE, Knutsson A, Koskinen A, Leineweber C, Magnusson Hanson LL, Nielsen ML, Nyberg ST, Oksanen T, Pejtersen JH, Pietiläinen O, Rahkonen O, Rugulies R, Singh‐Manoux A, Steptoe A, Suominen S, Theorell T, Vahtera J, Väänänen A, Westerlund H, Kivimäki M. Job Strain as a Risk Factor for Peripheral Artery Disease: A Multi-Cohort Study. J Am Heart Assoc 2020; 9:e013538. [PMID: 32342765 PMCID: PMC7428570 DOI: 10.1161/jaha.119.013538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/07/2020] [Indexed: 01/21/2023]
Abstract
Background Job strain is implicated in many atherosclerotic diseases, but its role in peripheral artery disease (PAD) is unclear. We investigated the association of job strain with hospital records of PAD, using individual-level data from 11 prospective cohort studies from Finland, Sweden, Denmark, and the United Kingdom. Methods and Results Job strain (high demands and low control at work) was self-reported at baseline (1985-2008). PAD records were ascertained from national hospitalization data. We used Cox regression to examine the associations of job strain with PAD in each study, and combined the study-specific estimates in random effects meta-analyses. We used τ2, I2, and subgroup analyses to examine heterogeneity. Of the 139 132 participants with no previous hospitalization with PAD, 32 489 (23.4%) reported job strain at baseline. During 1 718 132 person-years at risk (mean follow-up 12.8 years), 667 individuals had a hospital record of PAD (3.88 per 10 000 person-years). Job strain was associated with a 1.41-fold (95% CI, 1.11-1.80) increased average risk of hospitalization with PAD. The study-specific estimates were moderately heterogeneous (τ2=0.0427, I2: 26.9%). Despite variation in their magnitude, the estimates were consistent in both sexes, across the socioeconomic hierarchy and by baseline smoking status. Additional adjustment for baseline diabetes mellitus did not change the direction or magnitude of the observed associations. Conclusions Job strain was associated with small but consistent increase in the risk of hospitalization with PAD, with the relative risks on par with those for coronary heart disease and ischemic stroke.
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Affiliation(s)
- Katriina Heikkilä
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
- Finnish Institute of Occupational HealthTampere, Helsinki and TurkuFinland
| | - Jaana Pentti
- Department of Public HealthUniversity of Turku and Turku University HospitalTurkuFinland
- Department of Public HealthUniversity of HelsinkiFinland
| | - Ida E. H. Madsen
- National Research Centre for the Working EnvironmentCopenhagenDenmark
| | - Tea Lallukka
- Finnish Institute of Occupational HealthTampere, Helsinki and TurkuFinland
- Department of Public HealthUniversity of HelsinkiFinland
| | - Marianna Virtanen
- Finnish Institute of Occupational HealthTampere, Helsinki and TurkuFinland
- Department of Public Health and Caring SciencesUniversity of UppsalaSweden
- Stress Research InstituteUniversity of StockholmSweden
| | - Lars Alfredsson
- Centre for Occupational and Environmental MedicineStockholm County CouncilStockholmSweden
- Institute of Environmental MedicineKarolinska InstituteStockholmSweden
| | - Jakob Bjorner
- National Research Centre for the Working EnvironmentCopenhagenDenmark
| | - Marianne Borritz
- Department of Occupational and Environmental MedicineBispebjerg HospitalCopenhagen UniversityCopenhagenDenmark
| | - Eric Brunner
- Department of Epidemiology and Public HealthUniversity College LondonLondonUnited Kingdom
| | - Hermann Burr
- Federal Institute for Occupational Safety and HealthBerlinGermany
| | - Jane E. Ferrie
- Department of Epidemiology and Public HealthUniversity College LondonLondonUnited Kingdom
- Bristol Medical School: Population Health SciencesUniversity of BristolUnited Kingdom
| | - Anders Knutsson
- Department of Health SciencesMid Sweden UniversitySundsvallSweden
| | - Aki Koskinen
- Finnish Institute of Occupational HealthTampere, Helsinki and TurkuFinland
| | | | | | | | | | - Tuula Oksanen
- Finnish Institute of Occupational HealthTampere, Helsinki and TurkuFinland
| | - Jan H. Pejtersen
- VIVEThe Danish Center for Social Science ResearchCopenhagenDenmark
| | | | - Ossi Rahkonen
- Department of Public HealthUniversity of HelsinkiFinland
| | - Reiner Rugulies
- National Research Centre for the Working EnvironmentCopenhagenDenmark
- Department of Public Health and Department of PsychologyUniversity of CopenhagenDenmark
| | - Archana Singh‐Manoux
- Department of Epidemiology and Public HealthUniversity College LondonLondonUnited Kingdom
| | - Andrew Steptoe
- Department of Epidemiology and Public HealthUniversity College LondonLondonUnited Kingdom
| | - Sakari Suominen
- Department of Public HealthUniversity of Turku and Turku University HospitalTurkuFinland
- University of SkövdeSweden
| | | | - Jussi Vahtera
- Department of Public HealthUniversity of Turku and Turku University HospitalTurkuFinland
| | - Ari Väänänen
- Finnish Institute of Occupational HealthTampere, Helsinki and TurkuFinland
| | | | - Mika Kivimäki
- Department of Public HealthUniversity of HelsinkiFinland
- Department of Epidemiology and Public HealthUniversity College LondonLondonUnited Kingdom
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41
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Nyberg ST, Singh-Manoux A, Pentti J, Madsen IEH, Sabia S, Alfredsson L, Bjorner JB, Borritz M, Burr H, Goldberg M, Heikkilä K, Jokela M, Knutsson A, Lallukka T, Lindbohm JV, Nielsen ML, Nordin M, Oksanen T, Pejtersen JH, Rahkonen O, Rugulies R, Shipley MJ, Sipilä PN, Stenholm S, Suominen S, Vahtera J, Virtanen M, Westerlund H, Zins M, Hamer M, Batty GD, Kivimäki M. Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases. JAMA Intern Med 2020; 180:760-768. [PMID: 32250383 PMCID: PMC7136858 DOI: 10.1001/jamainternmed.2020.0618] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE It is well established that selected lifestyle factors are individually associated with lower risk of chronic diseases, but how combinations of these factors are associated with disease-free life-years is unknown. OBJECTIVE To estimate the association between healthy lifestyle and the number of disease-free life-years. DESIGN, SETTING, AND PARTICIPANTS A prospective multicohort study, including 12 European studies as part of the Individual-Participant-Data Meta-analysis in Working Populations Consortium, was performed. Participants included 116 043 people free of major noncommunicable disease at baseline from August 7, 1991, to May 31, 2006. Data analysis was conducted from May 22, 2018, to January 21, 2020. EXPOSURES Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status: optimal (2 points), intermediate (1 point), or poor (0 points) resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best). Sixteen lifestyle profiles were constructed from combinations of these risk factors. MAIN OUTCOMES AND MEASURES The number of years between ages 40 and 75 years without chronic disease, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease. RESULTS Of the 116 043 people included in the analysis, the mean (SD) age was 43.7 (10.1) years and 70 911 were women (61.1%). During 1.45 million person-years at risk (mean follow-up, 12.5 years; range, 4.9-18.6 years), 17 383 participants developed at least 1 chronic disease. There was a linear association between overall healthy lifestyle score and the number of disease-free years, such that a 1-point improvement in the score was associated with an increase of 0.96 (95% CI, 0.83-1.08) disease-free years in men and 0.89 (95% CI, 0.75-1.02) years in women. Comparing the best lifestyle score with the worst lifestyle score was associated with 9.9 (95% CI 6.7-13.1) additional years without chronic diseases in men and 9.4 (95% CI 5.4-13.3) additional years in women (P < .001 for dose-response). All of the 4 lifestyle profiles that were associated with the highest number of disease-free years included a body-mass index less than 25 (calculated as weight in kilograms divided by height in meters squared) and at least 2 of the following factors: never smoking, physical activity, and moderate alcohol consumption. Participants with 1 of these lifestyle profiles reached age 70.3 (95% CI, 69.9-70.8) to 71.4 (95% CI, 70.9-72.0) years disease free depending on the profile and sex. CONCLUSIONS AND RELEVANCE In this multicohort analysis, various healthy lifestyle profiles appeared to be associated with gains in life-years without major chronic diseases.
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Affiliation(s)
- Solja T Nyberg
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.,Inserm U1153, Epidemiology of Ageing and Neurodegenrative Diseases, Paris, France
| | - Jaana Pentti
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Severine Sabia
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.,Inserm U1153, Epidemiology of Ageing and Neurodegenrative Diseases, Paris, France
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jakob B Bjorner
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Hermann Burr
- Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Marcel Goldberg
- Faculty of Medicine, Paris Descartes University, Paris, France.,Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Katriina Heikkilä
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Tea Lallukka
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Joni V Lindbohm
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Maria Nordin
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Psychology, Umeå University, Umeå, Sweden
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jan H Pejtersen
- VIVE-The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Ossi Rahkonen
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.,University of Skövde, School of Health and Education, Skövde, Sweden
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Marie Zins
- Faculty of Medicine, Paris Descartes University, Paris, France.,Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Mark Hamer
- Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.,School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
| | - Mika Kivimäki
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
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El Ansari W, Salam A, Suominen S. Is Alcohol Consumption Associated with Poor Perceived Academic Performance? Survey of Undergraduates in Finland. Int J Environ Res Public Health 2020; 17:ijerph17041369. [PMID: 32093287 PMCID: PMC7068310 DOI: 10.3390/ijerph17041369] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
Abstract
The relationship between academic performance and alcohol consumption among students remains inconsistent. We assessed this relationship, controlling for sociodemographic characteristics across seven faculties at the University of Turku (1177 undergraduates). An online questionnaire assessed: seven sociodemographic characteristics (age, gender, year/discipline of study, accommodation type, being in intimate relationship, parental education, and income sufficiency); two perceived academic performance (students’ subjective importance of achieving good grades and students’ appraisal of their academic performance compared to peers); and six alcohol consumption behaviors (length of time, amount consumed, frequency, heavy episodic drinking, problem drinking, and possible alcohol dependence). Simple logistic regression assessed relationships between sociodemographic and academic variables with alcohol consumption behaviors; multiple logistic regression assessed the same relationships after controlling for all other variables. Students reported long duration and large amount of drinking (46% and 50%), high frequency of drinking (41%), heavy episodic drinking (66%), problem drinking (29%), and possible alcohol dependence (9%). After controlling, gender was associated with all alcohol consumption behaviors, followed by religiosity (associated with four alcohol behaviors), living situation, marital status, age (each associated with two alcohol behaviors), and parental education and year of study (each associated with one alcohol behavior). Study discipline, income sufficiency, importance of achieving good grades, and academic performance compared to peers were not associated with any alcohol behaviors. Universities need to assess problem drinking and alcohol use disorders among students. Prevention strategies are required to reduce risk. Health promotion efforts could focus on beliefs and expectations about alcohol and target student groups at risk for more efficient and successful efforts.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, Doha 3050, Qatar
- College of Medicine, Qatar University, Doha 3050, Qatar
- School of Health and Education, University of Skovde, 541 28 Skövde, Sweden;
- Correspondence:
| | - Abdul Salam
- Neuroscience Institute, Hamad General Hospital, Doha 3050, Qatar;
| | - Sakari Suominen
- School of Health and Education, University of Skovde, 541 28 Skövde, Sweden;
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43
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Volanen SM, Lassander M, Hankonen N, Santalahti P, Hintsanen M, Simonsen N, Raevuori A, Mullola S, Vahlberg T, But A, Suominen S. 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 trial. J Affect Disord 2020; 260:660-669. [PMID: 31546105 DOI: 10.1016/j.jad.2019.08.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- S-M Volanen
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; Clinicum, Department of Public Health, University of Helsinki, Finland.
| | - M Lassander
- Institute of Behavioural Sciences, University of Helsinki Finland
| | - N Hankonen
- Social Psychology Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - P Santalahti
- National Institute for Health and Welfare, Finland
| | - M Hintsanen
- Unit of Psychology, University of Oulu, Oulu, Finland
| | - N Simonsen
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; Clinicum, Department of Public Health, University of Helsinki, Finland
| | - A Raevuori
- Clinicum, Department of Public Health, University of 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
| | - S Mullola
- Institute of Behavioural Sciences, University of Helsinki Finland; Department of Teacher Education, University of Helsinki, Finland
| | - T Vahlberg
- Department of Biostatistics, University of Turku, Finland
| | - A But
- Clinicum, Department of Public Health, University of Helsinki, Finland
| | - S Suominen
- Department of Public Health, University of Skövde, Sweden; Department of Public Health, University of Turku, Finland
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44
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Magnusson Hanson LL, Rod NH, Vahtera J, Peristera P, Pentti J, Rugulies R, Madsen IEH, LaMontagne AD, Milner A, Lange T, Suominen S, Stenholm S, Xu T, Kivimäki M, Westerlund H. Multicohort study of change in job strain, poor mental health and incident cardiometabolic disease. Occup Environ Med 2019; 76:785-792. [PMID: 31488605 PMCID: PMC6839729 DOI: 10.1136/oemed-2018-105595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/02/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Social Medicine Section, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | | | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
| | - Reiner Rugulies
- 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, Copenhagen, Denmark
| | | | - Anthony D LaMontagne
- 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
| | - Allison Milner
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Sari Stenholm
- Department of Public Health, University of Turku, Turku, Finland
| | - Tianwei Xu
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Social Medicine Section, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Mika Kivimäki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
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45
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Simonsen N, Wackström N, Roos E, Suominen S, Välimaa R, Tynjälä J, Paakkari L. The role of health literacy in explaining regional health differences among adolescents. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Health disparities in adolescence track forward to adulthood. In understanding disparities better, health literacy (HL) - as a broad range of health-related competencies - has been identified as a valuable construct. Higher HL has been associated with better health outcomes, also among adolescents. Not much is known about how language or region in a bilingual country is associated with HL, or how HL is associated with regional health disparities. The aim of this study, in a bilingual country, was a) to examine and compare HL and health levels among majority and minority language speaking adolescents in different regions of Finland, and b) to explore if HL explains possible regional health differences in these two language groups, taking into account other important structural stratifying factors.
Methods
The data of 13- and 15-year-olds were obtained from the Health Behaviour in School-aged Children study, conducted in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). HL was measured with the HLSAC-instrument. The data were analysed by logistic regression and interaction analyses.
Results
In the total sample, 23% rated their health as excellent; 33% had a high and 10% a low HL. The preliminary findings showed no differences in health or HL between the language groups. However, regional health differences were found in both language groups: in the Finnish-speaking sample among boys, and in the Swedish-speaking sample among girls. Findings also showed regional differences in HL levels in both language groups, especially among the Swedish-speaking minority group. Comprehensive HL was an independent factor in explaining these regional health differences.
Conclusions
This study adds to prior studies on the role of HL as a modifiable health resource by showing that in addition to other structural stratifying factors comprehensive HL explains regional health disparities among adolescents in a bilingual country.
Key messages
This study in a bilingual country found regional health disparities and regional differences in HL levels among both majority and minority language speaking adolescents. In both language groups, taking into account other important structural stratifying factors, comprehensive HL was an independent factor in explaining the regional health differences.
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Affiliation(s)
- N Simonsen
- Public Health Research Program, Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - N Wackström
- Public Health Research Program, Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
| | - E Roos
- Public Health Research Program, Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - S Suominen
- Department of Public Health, University of Turku, Turku, Finland
- Department of Public Health, University of Skövde, Skövde, Sweden
| | - R Välimaa
- The Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - J Tynjälä
- The Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - L Paakkari
- The Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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46
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Virtanen M, Ervasti J, Head J, Oksanen T, Salo P, Pentti J, Kouvonen A, Väänänen A, Suominen S, Koskenvuo M, Vahtera J, Elovainio M, Zins M, Goldberg M, Kivimäki M. Lifestyle factors and risk of sickness absence from work: a multicohort study. Lancet Public Health 2019; 3:e545-e554. [PMID: 30409406 PMCID: PMC6220357 DOI: 10.1016/s2468-2667(18)30201-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/23/2023]
Abstract
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 (PAFexternal). 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; PAFexternal 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. Funding NordForsk, British Medical Research Council, Academy of Finland, Helsinki Institute of Life Sciences, and Economic and Social Research Council.
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Affiliation(s)
- Marianna Virtanen
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden; Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland
| | - Paula Salo
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland; Department of Psychology, University of Turku, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland; School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; University of Skövde, Skövde, Sweden; Folkhälsan Research Center, Helsinki, Finland
| | | | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Marie Zins
- Inserm, Population-based Epidemiologic Cohorts Unit UMS 011, Villejuif, France; Paris Descartes University, Paris, France
| | - Marcel Goldberg
- Inserm, Population-based Epidemiologic Cohorts Unit UMS 011, Villejuif, France; Paris Descartes University, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK; Clinicum, Faculty of Medicine, University of Helsinki, Finland
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Airaksinen J, Ervasti J, Pentti J, Oksanen T, Suominen S, Vahtera J, Virtanen M, Kivimäki M. The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials. Int J Epidemiol 2019; 48:415-422. [PMID: 30815682 PMCID: PMC6469311 DOI: 10.1093/ije/dyz020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability. METHODS We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies-the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)-as 'nested pseudo-trials'. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times. RESULTS Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81-0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81-1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point. CONCLUSIONS Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.
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Affiliation(s)
- Jaakko Airaksinen
- Department of Psychology and Logopedics, Medicum, University of Helsinki, Helsinki, Finland
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jenni Ervasti
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana Pentti
- Clinicum, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Tuula Oksanen
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Marianna Virtanen
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Mika Kivimäki
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
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48
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Abstract
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.
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Affiliation(s)
- Tiina Vuorio
- Department of Family Medicine, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku, Finland;
- CONTACT Tiina Vuorio Department of Family Medicine, Institute of Clinical Medicine, University of Turku, Yleislääketiede, 20014 Turun yliopisto, Finland and Turku University Hospital, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland;
- School of Health and Education, University of Skövde, Skövde, Sweden;
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland;
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland;
| | - Päivi Korhonen
- 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
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49
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Varinen A, Kosunen E, Mattila K, Suominen S, Sillanmäki L, Sumanen M. 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 individuals. J Psychosom Res 2019; 117:48-53. [PMID: 30665596 DOI: 10.1016/j.jpsychores.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Aleksi Varinen
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland; Nokia Health Centre, Nokia, Finland.
| | - Elise Kosunen
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland; Pirkanmaa Hospital District, Centre for General Practice, Finland
| | - Kari Mattila
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku University Hospital, Finland; Department of Public Health, School of Health and Education, University of Skövde, Sweden
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, Turku University Hospital, Finland; Health care services, Welfare Division, Turku, Finland
| | - Markku Sumanen
- Department of General Practice, Faculty of Medicine and Life Sciences, Tampere University, Finland
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50
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Ervasti J, Airaksinen J, Pentti J, Vahtera J, Suominen S, Virtanen M, Kivimäki M. Does increasing physical activity reduce the excess risk of work disability among overweight individuals? Scand J Work Environ Health 2019; 45:376-385. [PMID: 30640978 DOI: 10.5271/sjweh.3799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index ≥ 25kg/m 2). Methods We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (≥90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption. Results The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35-1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31-1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70-0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar. Conclusions These findings suggest that the excess risk of work disability among overweight individuals would drop by 3-4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.
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Affiliation(s)
- Jenni Ervasti
- Finnish Institute of Occupational Health, PO Box 18, FI-00032 TYÖTERVEYSLAITOS, Finland.
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