Climacteric status at age 46 is associated with poorer work ability, lower 2-year participation in working life, and a higher 7-year disability retirement rate: a Northern Finland Birth Cohort 1966 study

OBJECTIVE

To study the association between an advanced climacteric status at 46 years of age and current perceived work ability, the consequent 2-year accumulation of disability and unemployment days, and the 7-year incidence of disability pensions.

METHODS

Study participants (n = 2,661) were recruited from the Northern Finland Birth Cohort 1966 study's 46-year follow-up in 2012. The participants' perceived work ability was investigated using the Work Ability Score (0-7 = poor vs 8-10 = good), along with potential covariates. Data concerning their consequent disability days, unemployment days, and disability pensions were collected from national registers. The association between their climacteric status at age 46 years, work ability, and working life participation was assessed using regression models.

RESULTS

The climacteric women were more often smokers and more often had a lower level of education. The odds ratio for poor perceived work ability was 1.41 (95% CI, 1.06-1.87), and the incidence rate ratios for disability and unemployment days during the 2-year follow-up were 1.09 (95% CI, 1.07-1.11) and 1.16 (95% CI, 1.14-1.18), respectively, for the climacteric women compared with the preclimacteric women in models adjusted for smoking and education. The 7-year hazard ratio for disability pensions was 1.72 (95% CI, 1.02-2.91) for the climacteric women.

CONCLUSIONS

An earlier menopausal transition is associated with poorer perceived work ability, and it predicts lower recorded work participation and a higher disability pension rate in subsequent years.

Associations of Chronotype, Work Schedule, and Sleep Problems with Work Engagement Experiences in Middle Age - The Northern Finland Birth Cohort 1966

OBJECTIVES

To investigate the role of chronotype for work engagement in middle age.

METHODS

We used data from the Northern Finland Birth Cohort 1966 study (n = 5,341) to analyze associations of self-reported chronotype (morning, intermediate, and evening type) with work engagement and its dimensions (vigor, dedication, absorption). We conducted multivariate analyses of variance to examine whether work schedule or sleep problems moderate these associations.

RESULTS

Evening types showed lower scores in work engagement and its dimensions than intermediate and morning types, even when work schedule and sleep problems were controlled. Sleep problems emphasized the chronotype-work engagement and chronotype-dedication linkages.

CONCLUSIONS

Chronotype may play a role in employees' work engagement. In addition, sleep problems seem relevant in terms of chronotype-work engagement linkage.

Effect of onset age on the long-term outcome of early-onset psychoses and other mental disorders: a register-based Northern Finland Birth Cohort 1986 study

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18-22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18-22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18-22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed.

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

BACKGROUND

The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals' implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care.

AIM

To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language.

DESIGN

A two-round Delphi study.

SETTING

National-level online survey.

POPULATION

Purposively recruited experts in multiprofessional rehabilitation (N.=25).

METHODS

Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals' implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts' suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave).

RESULTS

After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) "modifying"; 2) "supportive"; and 3) "critical". After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93.

CONCLUSIONS

A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context.

CLINICAL REHABILITATION IMPACT

A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.

The association between chronotype and wages at mid-age

Sleep has been shown to affect economic outcomes, including wages. The mechanisms by which sleep affects wages remain unclear. We examine the relationship between chronotype - morning larks, evening owls - and wages at mid-age. We propose a novel model relating chronotype to wages in consideration of human, social, and health capital constructs. Empirically, we explore the effects of chronotype mediated through life course choices, such as work experience, trust, and health behaviour. The data come from the 46-year-old follow-up study of the Northern Finland Birth Cohort (1966) and from registers of the Finnish Tax Administration. We find evening chronotype to have a significant indirect negative effect on wages, which occurs through accumulating less work experience and through poor health outcomes. The effect is largest for male workers, with a total indirect effect on average wages of - 4%. We also provide evidence that chronotype has a long-term association with wages between 29 and 50 years of age. We conclude that evening-type workers are less suited to typical working hours and accumulate less human, social and health capital which in turn negatively affects their wages. Our findings are of great socio-economic importance because evening chronotypes make up a significant part of the population.

The Örebro Musculoskeletal Pain Screening Questionnaire-Short Form and 2-year follow-up of registered work disability

BACKGROUND

The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) was developed to identify psychological and functioning-related risk factors among individuals with musculoskeletal pain at risk of work disability. This study aimed to examine whether the short version of the ÖMPSQ (ÖMPSQ-SF) can be used for this purpose, using registry-based outcomes.

METHODS

The ÖMPSQ-SF was completed by the members of the Northern Finland Birth Cohort 1966 at the age of 46 years (baseline). These data were enriched with national registers, including information on sick leaves and disability pensions (indicators of work disability). The associations between the ÖMPSQ-SF categories (low-, medium- and high risk) and work disability over a 2-year follow-up were analysed using negative binomial regression and binary logistic regression models. We made adjustments for sex, baseline education level, weight status and smoking.

RESULTS

Overall, 4063 participants provided full data. Of these, 90% belonged to the low-risk, 7% to the medium-risk and 3% to the high-risk group. Compared to the low-risk group, the high-risk group had a 7.5 [Wald 95% confidence interval (CI) 6.2-9.0] times higher number of sick leave days and 16.1 (95% CI 7.1-36.8) times higher odds of disability pension after adjustments in the 2-year follow-up.

CONCLUSIONS

: Our study suggests that the ÖMPSQ-SF could be used for predicting registry-based work disability at midlife. Those allocated to the high-risk group seemed to have a particularly great need of early interventions to support their work ability.

Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966)

BACKGROUND

The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966).

METHODS

The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS).

RESULTS

Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r₍₃₀₁₃₎ = 0.41, p < 0.01, 46 y: r₍₃₀₁₃₎ = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period.

LIMITATIONS

Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship.

CONCLUSIONS

Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.

Glucose Metabolism in Midlife Is Associated With Preceding 30-Year Employment Trajectories: A Northern Finland Birth Cohort 1966 Study

OBJECTIVE

The aim of the study is to evaluate how glucose metabolism in midlife is related to preceding 30-year-long employment trajectories.

METHODS

In the Northern Finland Birth Cohort 1966, we compared glucose metabolism at 46 to employment trajectories (previously defined for men and women and named as high-educated, traditional, self-employed, delayed, and floundering; n = 6399).

RESULTS

Compared with individuals in high-educated trajectories, odds ratios for type 2 diabetes (T2D, 95% confidence interval) in traditional and floundering trajectories in men were 1.65 (1.02-2.68) and 2.42 (1.38-4.23) and in women 1.89 (1.04-3.43) and 2.60 (1.46-4.62), respectively. In self-employed trajectory in women, odds ratios for prediabetes and T2D were 1.66 (1.09-2.51) and 2.47 (1.21-5.04).

CONCLUSIONS

The highest risks for T2D in midlife were associated after traditional and floundering trajectories in men and women and after self-employment trajectory in women.

Association between work characteristics and epigenetic age acceleration: cross-sectional results from UK - Understanding Society study

Occupation-related stress and work characteristics are possible determinants of social inequalities in epigenetic aging but have been little investigated. Here, we investigate the association of several work characteristics with epigenetic age acceleration (AA) biomarkers. The study population included employed and unemployed men and women (n = 631) from the UK Understanding Society study. We evaluated the association of employment and work characteristics related to job type, job stability; job schedule; autonomy and influence at work; occupational physical activity; and feelings regarding the job with four epigenetic age acceleration biomarkers (Hannum, Horvath, PhenoAge, GrimAge) and pace of aging (DunedinPoAm, DunedinPACE). We fitted linear regression models, unadjusted and adjusted for established risk factors, and found the following associations for unemployment (years of acceleration): HorvathAA (1.51, 95% CI 0.08, 2.95), GrimAgeAA (1.53, 95% CI 0.16, 2.90) and 3.21 years for PhenoAA (95% CI 0.89, 5.33). Job insecurity increased PhenoAA (1.83, 95% CI 0.003, 3.67), while working at night was associated with an increase of 2.12 years in GrimAgeAA (95% CI 0.69, 3.55). We found effects of unemployment to be stronger in men and effects of night shift work to be stronger in women. These results provide evidence of associations between unemployment with accelerated ageing and suggest that insecure employment and night work may also increase age acceleration. Our findings have implications for policies relating to current changes in working conditions and highlight the utility of biological age biomarkers in studies in younger populations without long-term health information.

Women with polycystic ovary syndrome have poorer work ability and higher disability retirement rate at midlife: a Northern Finland Birth Cohort 1966 study

OBJECTIVE

Polycystic ovary syndrome (PCOS) presents with multiple comorbidities potentially affecting function. This was the first general population-based study to evaluate work ability, participation in working life, and disability retirement in middle-aged women with and without PCOS.

DESIGN

This is a cohort study.

METHODS

Women with PCOS (n = 280) and women without PCOS symptoms or diagnosis (n = 1573) were identified in the Northern Finland Birth Cohort in 1966 and were evaluated for self-rated work ability and potential confounders at age 46. Next, incidence rate ratios (IRRs) for disability and unemployment days were extracted from national registers during a prospective 2-year follow-up. Lastly, we assessed hazard ratios (HRs) for disability retirement between 16 and 52 years of age from national registers.

RESULTS

The women with PCOS reported poorer ability to work at age 46, especially due to poorer health. During the 2-year follow-up period, the affected women gained on average an additional month of disability and unemployment days, corresponding to an approximately 25% higher risk for both disability (IRR (95% CI): 1.25 (1.22-1.27)) and unemployment days (IRR (95% CI): 1.26 (1.23-1.28)) in models adjusted for health and socioeconomic factors. Lastly, we found a two-fold higher cumulative risk for disability retirement by age 52 compared to non-PCOS women (HR (95% CI): 1.98 (1.40-2.80)), which remained after adjusting for confounding factors (aHR (95% CI): 1.55 (1.01-2.38)).

CONCLUSIONS

PCOS is associated with lower participation in working life already in midlife. Acknowledging PCOS-related multimorbidity, concerted efforts are needed to support sustainable careers for women with PCOS.

Lost individual income due to severe health events: life-course perspective in the Northern Finland Birth Cohort 1966

Background

Severe health events may lead to reduced income among survivors. Importantly, individuals’ risks for both severe health events and for lower income are shaped by early life course. Our aim was to consider early-life factors in determining lost individual income after stroke, heart attack and cancer between ages 18 and 50.

Methods

A population-based Northern Finland Birth Cohort 1966 (N = 12 058) was used. Early-life factors were collected since mid-pregnancy until age 16 years and used to match all persons with stroke, heart attack, or cancer (n = 995) with four controls. Registered annual individual income development 15 years before and after the event was compared between cases and propensity score matched controls using time-to-event mixed models, stratified for sex.

Results

Compared to controls, a new decreasing income trend emerged among women after stroke (logarithmic income per time −0.54; 95% CI −0.88 to −0.20), whereas men getting stroke showed declining earnings already by the time of the event, further declining after stroke (−1.00, −1.37 to −0.63). Getting heart attack was associated with a new declining trend both in women (−0.68; −1.28 to −0.09) and men (−0.69, −1.05 to −0.32). Income declined also among control men (−0.24, −0.34 to −0.14), who had higher income but were less educated than control women.

Conclusions

Stroke and heart attack but not cancer have exogenous deleterious effects on individual economy, independently of early-life factors. The effects accelerate by time. Negative income trend in control men shows that severe health events do not explain all decrease in income.

More Physical Activity, More Work Engagement? A Northern Finland Birth Cohort 1966 Study

OBJECTIVE

To examine the role of physical activity (PA) and sedentary behavior (SED) for work engagement.

METHODS

We used data from Northern Finland Birth Cohort 1966 Study ( n = 3046 to 4356) to analyze self-reported weekly leisure-time physical activity (LTPA), daily leisure-time sitting time (LTST) and work engagement. PA and SED 24-hour were also measured with accelerometer for 14 days. The data were analyzed using linear regression analyses.

RESULTS

High self-reported LTPA and sports participation were associated with higher work engagement and its subdimensions. High self-reported ST was associated with lower work engagement, vigor, and absorption. Accelerometer-measured light PA was associated with higher work engagement and vigor, and accelerometermeasured steps were linked to higher vigor. Accelerometer-measured SED was associated with lower work engagement, vigor, and dedication.

CONCLUSIONS

Self-reported and accelerometer-measured PA and SED may play a role in people's work engagement.

Work-related stress and well-being in association with epigenetic age acceleration: A Northern Finland Birth Cohort 1966 Study

Recent evidence indicates consistent association of low socioeconomic status with epigenetic age acceleration, measured from DNA methylation. As work characteristics and job stressors are crucial components of socioeconomic status, we investigated their association with various measures of epigenetic age acceleration. The study population included employed and unemployed men and women (n=604) from the Northern Finland Birth Cohort 1966. We investigated the association of job strain, effort-reward imbalance and work characteristics with five biomarkers of epigenetic aging (Hannum, Horvath, PhenoAge, GrimAge, and DunedinPoAm). Our results indicate few significant associations between work stress indicators and epigenetic age acceleration, limited to a range of ±2 years, and smoking recording the highest effect on GrimAge age acceleration biomarker between current and no smokers (median difference 4.73 years (IQR 1.18, 8.41). PhenoAgeAA was associated with job strain active work (β=-1.301 95%CI -2.391, -0.212), slowing aging of less than 1.5 years, and working as white-collar slowed aging six months (GrimAgeAA β=-0.683, 95%CI -1.264, -0.102) when compared to blue collars. Association was found for working for more than 40 hours per week that increased the aging over 1.5 years, (HorvathAA β =2.058 95%CI 0.517,3.599, HannumAA β=1.567, 95%CI 0.415,2.719). The pattern of associations was different between women and men and some of the estimated effects are inconsistent with current literature. Our results provide the first evidence of association of work conditions with epigenetic aging biomarkers. However, further epidemiological research is needed to fully understand how work-related stress affects epigenetic age acceleration in men and women in different societies.

Modeling the Multidimensional Predictors of Multisite Musculoskeletal Pain Across Adulthood-A Generalized Estimating Equations Approach

Background: Multisite pain is commonly chronic and often lacks its initial role as a potential tissue damage signal. Chronic pain among working-age individuals is a risk for disability and imposes a major burden on health care systems and society. As effective treatments for chronic pain are largely lacking, better identification of the factors associated with pain over working years is needed. Methods: Members of the Northern Finland Birth Cohort 1966 participated in data collection at the ages of 31 (n = 4,028) and 46 (n = 3,429). Using these two time points, we performed a multivariable analysis of the association of socioeconomic, occupational, psychological and lifestyle factors (i.e., low education, living alone, low household income, unemployment, occupational physical exposures [hard physical labor, leaning forward, back twisting, constant moving, lifting loads of ≥ 1 kg], physical inactivity, regular smoking, regular drinking, overweight, and psychiatric symptoms) with the number of musculoskeletal pain sites (i.e., upper extremity, lower extremity, lower back, and the neck-shoulder region; totalling 0-4 pain sites). The data were analyzed using generalized estimating equations. Results: At the age of 31, multisite pain was reported by 72.5% of men and 78.6% of women. At the age of 46, the prevalence of multisite pain was 75.7% among men and 82.7% among women. Among men, the number of pain sites was positively associated with age (rate ratio 1.05, 95% confidence interval 1.01-1.08), low household income (1.05, 1.01-1.08), unemployment (1.13, 1.06-1.19), any occupational exposure (1.17, 1.12-1.22), regular smoking (1.06, 1.02-1.11), and psychiatric symptoms (1.21, 1.17-1.26). Among women, the number of pain sites was positively associated with age (1.06, 1.04-1.10), unemployment (1.10, 1.05-1.15), any occupational exposure (1.10, 1.06-1.13), regular smoking (1.06, 1.02-1.10), overweight (1.08, 1.05-1.11), and psychiatric symptoms (1.19, 1.15-1.22); living alone was negatively associated with the number of pain sites (0.95, 0.91-0.99). Conclusion: Of the studied predictors, psychiatric symptoms, occupational physical exposures and unemployment were most strongly associated with multisite pain among both sexes. The results of this study deepen the understanding of the underlying factors of and comorbidities behind multisite pain, and help develop pain relief and rehabilitation strategies for working-age individuals with multisite pain.

The association of endometriosis with work ability and work life participation in late forties and lifelong disability retirement up till age 52: A Northern Finland Birth Cohort 1966 study

INTRODUCTION

Endometriosis may cause a deterioration of daily functioning due to related symptoms such as pain, fatigue and psychological distress. Accordingly, endometriosis may jeopardize work ability, as suggested in mainly survey-based case-control studies, including clinically established cases at fertile age. This is the first general population-level study to evaluate how endometriosis is associated with (1) self-rated work ability and sick leave dates at age 46 years, (2) registered disability and unemployment days between age 46 and 48 and (3) lifelong emergence of registered disability retirement up to age 52.

MATERIAL AND METHODS

Endometriosis case identification was based on the Care Register for Health Care and self-reported diagnosis from a population-based birth cohort, which covers 96% of children born in Northern Finland in 1966. A total of 348 women with endometriosis and 3487 women without endometriosis were identified. Questionnaire data on Work Ability Index Score was collected at age 46. Unemployment and disability days were determined from the Social Insurance Institution of Finland and the Finnish Center for Pensions registers. Finally, each individual's first-ever granted pension decision and diagnoses were collected until age 52 years. The associations between endometriosis and work ability were assessed using logistic regression models.

RESULTS

Endometriosis was associated with poor work ability at age 46 (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.06-2.47). Furthermore, the association between endometriosis and over 10 days of absenteeism was increased (OR 1.53; 95% CI 1.05-2.23). Between ages 46 and 48, women with endometriosis had 10 days more disability days (55.5 vs 45.5, p = 0.030) in comparison to women without endometriosis, but 20 days less unemployment days (40.6 vs 59.2 days, p = 0.013). There were no differences in early retirement between the study groups until age 52.

CONCLUSIONS

Our study showed that endometriosis associates with poor work ability at age 46. Women with endometriosis have more disability days. However, their employment rate and risk of early retirement are comparable to those of women without endometriosis at late fertile age.

Adjusted productivity costs of stroke by human capital and friction cost methods: a Northern Finland Birth Cohort 1966 study

BACKGROUND

Productivity costs result from loss of paid and unpaid work and replacements due to morbidity and mortality. They are usually assessed in health economic evaluations with human capital method (HCM) or friction cost method (FCM). The methodology for estimating lost productivity is an area of considerable debate.

OBJECTIVE

To compare traditional and adjusted HCM and FCM productivity cost estimates among young stroke patients.

METHODS

The Northern Finland Birth Cohort 1966 was followed until the age of 50 to identify all 339 stroke patients whose productivity costs were estimated with traditional, occupation-specific and adjusted HCM and FCM models by using detailed, national register-based data on care, disability, mortality, education, taxation and labour market.

RESULTS

Compared to traditional HCM, taking into account occupational class, national unemployment rate, disability-free life expectancy and decline in work ability, the productivity cost estimate decreased by a third, from €255,960 to €166,050. When traditional FCM was adjusted for occupational class and national unemployment rate, the estimate more than doubled from €3,040 to €7,020. HCM was more sensitive to adjustments for discount rate and wage growth rate than FCM.

CONCLUSIONS

This study highlights the importance of adjustments of HCM and FCM. Routine register-based data can be used for accurate productivity cost estimates of health shocks.

Leisure-time physical activity is associated with socio-economic status beyond income - Cross-sectional survey of the Northern Finland Birth Cohort 1966 study

We apply neoclassical economic modelling augmented with behavioral aspects to provide a detailed empirical investigation into indicators of socio-economic status (SES) as determinants of leisure-time physical activity. We utilize the data from the Northern Finland Birth Cohort 1966 obtained at the most recent time point during 2012-2014 (response rate 67 %), at which time the participants were approximately 46 years old. Our final study sample consists of 3,335 employed participants (1520 men, 1815 women; 32.3 % of the target population). We apply logistic regression methods for estimating how the probability of being physically active is related to various indicators of socio-economic status, taking into account physical activity at work and individual lifestyle, family- and health-related factors. Overall, our findings show that belonging to a higher socio-economic group, whether defined by income level, educational attainment, or occupational status, is associated with higher leisure-time physical activity. However, when we analyze different socio-economic groups, defined in terms of education, income and occupation, separately, we find that income is not a significant determinant of leisure-time physical activity within any of the particular SES groups. Further, we find that leisure-time physical activity is negatively associated with higher screen time (i.e., watching TV and sitting at a computer), and other aspects of unhealthy lifestyle, and positively associated with self-assessed health. In addition, we note that proxies for individual motivational factors and childhood physical activity, such as the grade point average and the grade achieved in physical education when leaving basic education, are strongly correlated with leisure-time physical activity in middle age among men, but not among women. Our results are in line with behavioral economics reasoning that social comparisons and environments affect behaviors. We emphasize the importance of considering behavioral economic factors when designing policies to promote physical activity.

Employment trajectories until midlife associate with early social role investments and current work-related well-being

Applying social investment theory (SIT), we examined whether employment trajectories until midlife, with differential investments in education and employment, are associated with social investments during early life and with work-related well-being in midlife, with a special reference to potential differences between self-employment and paid work. In the Northern Finland Birth Cohort 1966 (n = 6496; 2963 men, 3533 women), life-history calendars from age 16-45 were used to determine the respondents' yearly employment statuses (student, full-time employee, part-time employee, self-employed, unemployed, on parental leave, on sabbatical leave or otherwise not working). Latent class analysis was used to identify the employment trajectories. The associations of these trajectories with indicators of social investments in early life (mother's attitude to financial self-reliance, father's socioeconomic status, own success at school) and work-related well-being at age 46 (job satisfaction, life satisfaction, absence of retirement thoughts, work engagement, work favoring attitude and perceived job control) were studied using regression models and analyses of variance, adjusting for life situation at age 46. We identified five employment trajectories for both genders: 1) traditional full-time, 2) highly educated, 3) self-employed, 4) delayed full-time and 5) floundering employees. In early life, a mother emphasizing self-reliance in earning one's living was associated with both highly educated and self-employed trajectories. A white-collar father and own success at school preceded a highly educated trajectory. A farmer family background preceded self-employed trajectory. At age 46, highly educated and self-employed trajectories were associated with highest well-being at work, while those floundering perceived their work most negatively. Men in the delayed full-time employment trajectory reported better well-being at age 46 than those constantly floundering. Overall, the macroeconomic employment rates were unevenly reflected in the five trajectories. Our findings support SIT by showing that the employment trajectories most favorable for work-related well-being in midlife are long rooted in social investments during early life and characterized by further social investments in employment, such as higher education and self-employment.

Evening chronotype is associated with poor work ability and disability pensions at midlife: a Northern Finland Birth Cohort 1966 Study

OBJECTIVES

This is the first general population study to evaluate whether evening chronotypes (E) have poorer work ability (WA) and higher probability for early disability pensions (DPs) than morning types (M) in middle age.

METHODS

Among non-retired individuals (n=5831; 2672 men, 3159 women) of the Northern Finland Birth Cohort 1966, chronotype was determined at the age of 46 years with shortened Morningness-Eveningness Questionnaires in 2012. The outcomes were poor WA in 2012, indicated by scores 0-7/10 of Work Ability Score, and registered emergence of DPs in 2013-2016. Multivariate logistic and Cox regression analyses were separately adjusted for factors related to sleep, health and behaviours, sociodemographic and economic factors, or working times.

RESULTS

E-types represented 10% (n=264) of men and 12% (n=382) of women. Compared with M-types, the unadjusted ORs with 95% CIs of poor WA for E-type men and women were 2.24 (95% CI 1.62 to 3.08) and 2.33 (95% CI 1.74 to 3.10), respectively. The odds remained statistically significant and approximately twofold in all separate adjustment models tested. During 2013-2016, 8 (3.0%) E-type men and 10 (2.6%) E-type women were granted DP, which, compared with M-types, represented a higher HR that was statistically significant for men (HR 3.12, 95% CI 1.27 to 7.63) and remained significant except when multiple sleep variables or working times were adjusted for.

CONCLUSIONS

Eveningness appears a previously unrecognised risk factor for poor WA and early disability. We suggest that individual chronotype be considered in attempts to lengthen work careers.

Temperament and Early Intentions to Retire: A Northern Finland Birth Cohort 1966 Study

OBJECTIVE

To examine associations between temperament traits and early retirement intentions.

METHODS

In the Northern Finland Birth Cohort 1966, we analyzed early retirement intentions at the age 46 according to Cloninger temperament traits at the age 46 (n = 4409) and at the age 31 (n = 3226). Ordinal logistic regression analyses were used. Adjustments were made for marital status, education, work type, job satisfaction, perceived health, and mental health problems.

RESULTS

11% of men and 9% of women had strong retirement intentions. Especially higher harm avoidance was associated with higher early retirement intentions in both sexes at the age of 46. A similar pattern of results, although with weaker associations, was found for temperament assessed at the age of 31.

CONCLUSIONS

Temperament and especially harm avoidance is related to early retirement intentions.

Socioeconomic and health-related childhood and adolescence predictors of entry into paid employment

BACKGROUND

Most studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, and whether own education moderates these associations.

METHODS

The Northern Finland Birth Cohort 1986 was followed from birth until the end of 2015. We included 8542 participants (52% male) who had had a minimum of 6-month employment that was defined by registered earning periods. As socioeconomic predictors, we examined low parental education at age 7 and low household income at age 16. Behaviour- and health-related factors at age 16 included smoking, alcohol use, physical inactivity, overweight, length of sleep and not having breakfast, while mental health problems included symptoms of anxiety and depression, attention problems and social problems. The analyses for significant predictors were further stratified by register-based level of completed own education by age 28-29 (low/high).

RESULTS

After adjustments, low parental education, smoking and having been drunk were significant predictors of early entry into paid employment (≤18 vs. ≥24 years), especially among those who later obtained high education. Low parental education and smoking were predictors of low or non-specified (vs. high) occupational class in the first job. Mental health problems were not associated with either outcome.

CONCLUSIONS

Socioeconomic background and unhealthy lifestyle contribute to early entry into the labour market and low occupational status in the first job.

Understanding the cumulative risk of maternal prenatal biopsychosocial factors on birth weight: a DynaHEALTH study on two birth cohorts

Background

There are various maternal prenatal biopsychosocial (BPS) predictors of birth weight, making it difficult to quantify their cumulative relationship.

Methods

We studied two birth cohorts: Northern Finland Birth Cohort 1986 (NFBC1986) born in 1985–1986 and the Generation R Study (from the Netherlands) born in 2002–2006. In NFBC1986, we selected variables depicting BPS exposure in association with birth weight and performed factor analysis to derive latent constructs representing the relationship between these variables. In Generation R, the same factors were generated weighted by loadings of NFBC1986. Factor scores from each factor were then allocated into tertiles and added together to calculate a cumulative BPS score. In all cases, we used regression analyses to explore the relationship with birth weight corrected for sex and gestational age and additionally adjusted for other factors.

Results

Factor analysis supported a four-factor structure, labelled closely to represent their characteristics as ‘Factor1-BMI’ (body mass index), ‘Factor2-DBP’ (diastolic blood pressure), ‘Factor3-Socioeconomic-Obstetric-Profile’ and ‘Factor4-Parental-Lifestyle’. In both cohorts, ‘Factor1-BMI’ was positively associated with birth weight, whereas other factors showed negative association. ‘Factor3-Socioeconomic-Obstetric-Profile’ and ‘Factor4-Parental-Lifestyle’ had the greatest effect size, explaining 30% of the variation in birth weight. Associations of the factors with birth weight were largely driven by ‘Factor1-BMI’. Graded decrease in birth weight was observed with increasing cumulative BPS score, jointly evaluating four factors in both cohorts.

Conclusion

Our study is a proof of concept for maternal prenatal BPS hypothesis, highlighting the components snowball effect on birth weight in two different European birth cohorts.

Accumulated unhealthy behaviors and psychosocial problems in adolescence are associated with labor market exclusion in early adulthood - a northern Finland birth cohort 1986 study

Background

The relevance of health-related behaviors to exclusion from the labor market in early adulthood remains poorly studied in relation to the magnitude of the problem. We explored whether adolescents’ accumulated unhealthy behaviors and psychosocial problems are associated with later labor market exclusion, and whether multisite musculoskeletal pain (MMSP) impacts these relations.

Methods

We gathered questionnaire data on unhealthy behaviors and psychosocial problems and MMSP among adolescents aged 15 to 16 belonging to the Northern Finland Birth Cohort 1986. The findings were combined with registry data on unemployment, employment and permanent work disability during a five-year follow-up between the ages of 25 and 29 (n = 6692). In the statistical modeling we used education, family leave and socioeconomic status of childhood family as potential confounders, as well as latent class and logistic regression analyses.

Results

The Externalizing behavior cluster associated with over one year of unemployment (RR 1.64, CI 1.25–2.14) and permanent work disability (OR 2.49, CI 1.07–5.78) in the follow-up among the men. The Sedentary cluster also associated with over one year (RR 1.41, CI 1.13–1.75) and under one year of unemployment (RR 1.25, CI 1.02–1.52) and no employment days (RR 1.93, CI 1.26–2.95) among the men. Obese male participants were at risk of over one year of unemployment (RR 1.50, CI 1.08–2.09) and no employment days (RR 1.93, CI 1.07–3.50). Among the women, the Multiple risk behavior cluster related significantly to over one year of unemployment (RR 1.77, CI 1.37–2.28). MMSP had no influence on the associations.

Conclusions

Unhealthy behavior patterns and psychosocial problems in adolescence have long-term consequences for exclusion from the labor market in early adulthood, especially among men. Simultaneously supporting psychological well-being and healthy behaviors in adolescence may reduce labor market inclusion difficulties in the early phase of working life.

Early exposure to social disadvantages and later life body mass index beyond genetic predisposition in three generations of Finnish birth cohorts

Background

The study aimed to explore the association between early life and life-course exposure to social disadvantage and later life body mass index (BMI) accounting for genetic predisposition and maternal BMI.

Methods

We studied participants of Helsinki Birth Cohort Study born in 1934–1944 (HBCS1934–1944, n = 1277) and Northern Finland Birth Cohorts born in 1966 and 1986 (NFBC1966, n = 5807, NFBC1986, n = 6717). Factor analysis produced scores of social disadvantage based on social and economic elements in early life and adulthood/over the life course, and was categorized as high, intermediate and low. BMI was measured at 62 years in HBCS1934–1944, at 46 years in NFBC1966 and at 16 years in NFBC1986. Multivariable linear regression analysis was used to explore associations between social disadvantages and BMI after adjustments for polygenic risk score for BMI (PRS BMI), maternal BMI and sex.

Results

The association between exposure to high early social disadvantage and increased later life BMI persisted after adjustments (β = 0.79, 95% CI, 0.33, 1.25, p < 0.001) in NFBC1966. In NFBC1986 this association was attenuated by PRS BMI (p = 0.181), and in HBCS1934–1944 there was no association between high early social disadvantage and increased later life BMI (β 0.22, 95% CI –0.91,1.35, p = 0.700). In HBCS1934–1944 and NFBC1966, participants who had reduced their exposure to social disadvantage during the life-course had lower later life BMI than those who had increased their exposure (β − 1.34, [− 2.37,-0.31], p = 0.011; β − 0.46, [− 0.89,-0.03], p = 0.038, respectively).

Conclusions

High social disadvantage in early life appears to be associated with higher BMI in later life. Reducing exposure to social disadvantage during the life-course may be a potential pathway for obesity reduction.

Dimensions of social support in the experience of work engagement in middle age: A Northern Finland Birth Cohort 1966 Study

So far, the relationship between the various dimensions of social support and work engagement has not been widely examined in the literature. In this study, we examined the relationship of social support at work (from a colleague or supervisor) and social support in one's private life (from a spouse, relative or friend) with various dimensions of work engagement (vigor, dedication and absorption). The participants (N = 5,259-5,376, 46 years-old, 52.7% women) came from the Northern Finland Birth Cohort 1966 study. Social support was evaluated with the Social Support Questionnaire (SSQ), and work engagement was assessed with a short version of the Utrecht Work Engagement Scale (UWES-9). The data were analyzed using linear regression analyses. The results showed that high social support at work (p < 0.001) and in one's private life (p < 0.001) were associated with higher total work engagement, higher vigor, higher dedication, and higher absorption. These findings were adjusted for gender, marital status, education and occupational status. The results were essentially unchanged when they were additionally adjusted for job strain and effort-reward imbalance. To conclude, our findings indicate that the experience of overall social support may play a role in the experience of work engagement.

Glucose metabolism in midlife predicts participation in working life: a Northern Finland Birth Cohort 1966 study

Objective

To evaluate how clinically measured glucose metabolism categories predict registered participation in working life.

Methods

In the 46-year follow-up of Northern Finland Birth Cohort 1966 (n=5328, 2342 men and 2986 women), we used oral glucose tolerance tests, surveys and glycated haemoglobin to determine glucose metabolism categorised as normal, pre-diabetes, screen-detected and previous type 2 diabetes (T2D). Consequent participation in working life during the 2-year follow-up period was measured as registered disability, unemployment and employment days, for which incidence rate ratios (IRRs) with 95% CIs were calculated using Poisson regression, adjusted for baseline employment and socioeconomic, health-related and behavioural factors.

Results

In comparison to normal glucose, all categories of impaired glucose metabolism were associated with poorer participation in working life in the unadjusted models. After adjustments, the risks (IRR (95% CI)) of disability days remained heightened by both screen-detected and previous T2D among men (1.3 (1.3 to 1.4) and 1.5 (1.4 to 1.5), respectively), whereas among women the risks were lowered (0.9 (0.8 to 0.9) and 0.9 (0.9 to 1.0), respectively). The risks of unemployment were consistently higher in all categories of impaired glucose metabolism, and were the highest among women with previous T2D (1.6 (1.5 to 1.6)). Correspondingly, the rates of total employment days were lower in relation to screen-detected T2D among men and women (5% and 6%, respectively), and previous T2D (6% and 3%).

Conclusions

Overall, impaired glucose metabolism associated with deteriorated working life participation already in middle age. The high prevalence of impaired glucose metabolism emphasises the need for actions to support sustainable working careers.

Physical heaviness of work and sitting at work as predictors of mortality: a 26-year follow-up of the Helsinki Birth Cohort Study

OBJECTIVES

To examine the relationships of late-career physical heaviness of work and sitting at work with mortality. A national-level job exposure matrix was used to determine the occupation-specific level of physical heaviness and sitting.

DESIGN

Prospective cohort study between years 1990 and 2015.

SETTING

Community.

PARTICIPANTS

5210 men and 4725 women from the Helsinki Birth Cohort Study with an occupational code at baseline (ages 45-57 years).

PRIMARY AND SECONDARY OUTCOME MEASURES

Total, cardiovascular (International Classification of Diseases 10th Revision I00-I99), cancer (C00-C97) and external (S00-Y84) mortality.

RESULTS

The exposures, physical heaviness and sitting had a non-linear, inverse relationship. During the 26-year follow-up, 1536 men and 759 women died. Among men, physical heaviness of work was positively associated and sitting at work was negatively associated with all-cause, cardiovascular and external cause mortality but they were not associated with cancer mortality. The HRs for men in the highest quartile of physical heaviness of work compared with men in the lowest quartile were 1.54 (1.31-1.80) for all-cause mortality, 1.70 (1.30-2.23) for cardiovascular mortality and 3.18 (1.75-5.78) for external cause mortality (adjusted for age and years of education). Compared with the lowest quartile, the HRs for the highest quartile of sitting at work among men were 0.71 (0.61-0.82) for all-cause mortality, 0.59 (0.45-0.77) for cardiovascular mortality and 0.38 (0.22-0.66) for external cause mortality. In women, neither physical heaviness of work nor sitting at work was associated with mortality.

CONCLUSIONS

Men in physically heavy work at their late-work career are at higher risk of death than men in physically light work.

Personal meaning of work and perceived work ability among middle-aged workers with physically strenuous work: a Northern Finland Birth Cohort 1966 Study

PURPOSE

To investigate the association between personal meaning of work and perceived work ability among middle-aged workers with physically strenuous or light work. We evaluated the course of perceived work ability from 31 to 46 years and examined the possible differences in the association between personal meaning of work and perceived work ability at the age of 46 depending on physical workload.

METHODS

The study population consisted of participants of the Northern Finland Birth Cohort 1966 (n = 4420). Data were collected through questionnaires at 31 and 46 years. The main outcome was perceived work ability (0-7 = poor, 8-10 = good) and the main explanatory measures were physically strenuous work and personal meaning of work. Multivariate logistic regression analyses were adjusted for unhealthy habits, number of diseases, job strain, social support at work, employment history and gender. They were also stratified for the strenuousness of work.

RESULTS

Perceived work ability decreased during the 15-year follow-up in both the strenuous and light work groups, and was lowest among workers with strenuous work. Perceived work ability remained poor or decreased in 22% of men and 21% of women in the strenuous work group vs. 14% and 13% in the light work group, respectively. After adjusting for confounders, the participants in both groups who reported low personal meaning of work were at approximately a twofold risk of having poor perceived work ability at 46 years compared to the participants who reported high personal meaning of work.

CONCLUSIONS

Perceived work ability was significantly lower and deteriorated more during the follow-up among participants with strenuous work. High personal meaning of work was important for good work ability, irrespective of the strenuousness of work.

Relationship between BMI and emotion-handling capacity in an adult Finnish population: The Northern Finland Birth Cohort 1966

Background

Alexithymia, a difficulty in identifying and expressing emotions, has been associated with obesity and eating disorders in small-scale cross-sectional studies. Here, we assess the relationship between body mass index (BMI) and alexithymia in a large cohort of free-living Finnish adults over a 15-year period.

Methods

Participants were drawn from the Northern Finnish Birth Cohort 1966 (NFBC1966). The 20-Item Toronto Alexithymia Scale (TAS-20) was used as a measure of alexithymia and was completed at the age of 31 years (31y: n = 4841), and 46 years (46y: n = 5404). BMI was recorded at both time points. Where data at both time points were available (n = 3274), the relationship between changes in BMI and TAS-20 over this time period was also investigated.

Results

BMI was significantly and positively associated with TAS-20 score (p<0.0001, both at 31 years and at 46 years of ages). The association remained statistically significant after adjustment for potential confounders (sex, marital status and several socio-economic indicators). In individuals who experienced the greatest change in BMI (in either direction) over the 15-year period, there was a modest mean increase in TAS-20 score.

Conclusions

Our data revealed that TAS-20 score was correlated with and co-varied with body mass status. We suggest that future clinical research should consider the role of alexithymia in obesity. Further investigation of this relationship is warranted to ensure that the needs of obese subjects with undiagnosed alexithymia are considered in the design of weight management programmes.

Cloninger's Temperament Dimensions and Longitudinal Alcohol Use in Early Midlife: A Northern Finland Birth Cohort 1966 Study

BACKGROUND

Temperament is theorized to be an important factor contributing to the development of alcohol use disorder, but longitudinal studies on how temperament is related to alcohol use among general population in midlife are scarce. Our aims were to investigate potentially reciprocal associations between temperament and changes in alcohol use from age 31 to 46 using prospective birth cohort data.

METHOD

Within the Northern Finland Birth Cohort 1966, alcohol use and temperament were studied at ages 31 and 46. Participants (N = 5,274) were classified into moderate users, abstainers and heavy users based on their mean alcohol use (g/d). Additionally, participants were categorized as steady users, reducers, or increasers. Multinomial regression analyses were conducted with Cloninger's Temperament and Character Inventory (TCI) scores as factors influencing alcohol use using moderate and stable users as reference groups. Reciprocity of relations was assessed with cross-lagged structural equation modeling.

RESULTS

Temperament and alcohol use are rather stable in midlife. Novelty seeking (NS) predicted heavy use (OR = 1.4; CI: 1.3 to 1.6 for men, OR = 1.3; CI: 1.1 to 1.5 for women) and increasing use (OR = 1.2; CI: 1.1 to 1.4 for men, OR = 1.1; CI: 1.0 to 1.3 for women), whereas low NS predicted abstaining among women (OR = 0.7; CI: 0.6 to 0.8). High harm avoidance (HA) predicted abstaining (OR = 1.3; CI: 1.1 to 1.5) for men. Low persistence (P) among men predicted both abstaining (OR = 0.9; CI: 0.7 to 0.98) and heavy use (OR = 0.9; CI: 0.8 to 0.98). Among women, low reward dependence (RD) predicted heavy use (OR = 0.8; CI: 0.7 to 0.9). Among TCI scores, only NS predicted increasing use in the cross-lagged models.

CONCLUSIONS

Temperament has an impact on alcohol use in midlife. Of the TCI dimensions, only NS seems to predispose to increased alcohol use and problem use throughout life. Additionally, RD among women and P among men are significant factors from a life-course perspective. Our results did not support Cloninger's theory on type I alcoholism, as HA showed no relation to problematic alcohol use in midlife.

The association of unemployment with glucose metabolism: a systematic review and meta-analysis

OBJECTIVES

Unemployment has been linked with poor health. We hypothesized that being unemployed is associated with disorders of glucose metabolism and performed a systematic review and meta-analysis of the literature to ascertain the relationship.

METHODS

We searched the databases of Scopus, Medline Ovid and Web of Science for population-based original studies for past 20 years. Random effects meta-analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for prediabetes and type 2 diabetes among the unemployed as compared to those employed, separately for men and women when possible.

RESULTS

Out of 981 articles found, 12 articles were included in the systematic review and eight articles in the meta-analyses. Unemployment was associated with 1.6-fold odds for prediabetes (OR 1.58; 95% CI 1.07-2.35), and 1.7-fold odds for type 2 diabetes (OR 1.72; 95% CI 1.14-2.58) in the total sample. The corresponding associations for type 2 diabetes were also found stratified for men (OR 1.53; 95% CI 1.47-1.60) and women (OR 1.60; 95% CI 1.33-1.92).

CONCLUSIONS

Unemployment is associated with prediabetes and type 2 diabetes, global concerns of public health with potential for prevention.

Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: A follow-up of the Northern Finland Birth Cohort 1966

AIMS

We explored whether registered unemployment is associated with impaired glucose metabolism in general population.

METHODS

Based on Northern Finland Birth Cohort 1966 at 46 years, we analyzed the oral glucose tolerance tests of 1970 men and 2544 women in relation to their preceding three-year employment records in three categories of unemployment exposure: no (employed), low (≤1-year) and high exposure (>1-year).

RESULTS

Among men, pre-diabetes was found in 19.2% of those with no unemployment, 23.0% with low and 27.0% with high exposure, the corresponding figures for screen-detected type 2 diabetes were 3.8%, 3.8% and 9.2% (p<0.01). Among women, analogous figures for pre-diabetes were 10.0%, 12.6% and 16.2% and for screen-detected type 2 diabetes 1.7%, 3.4% and 3.6% (p<0.01). Men with high exposure to unemployment had a higher risk for pre-diabetes (OR 1.61, CI 95% 1.03-2.51) and screen-detected type 2 diabetes (OR 2.58 95% CI 1.23-5.44) than employed men, after adjustment for education, smoking, alcohol intake, physical activity and body mass index. Among women, associations were attenuated in the adjusted models.

CONCLUSIONS

High exposure to unemployment may predispose to type 2 diabetes in middle-aged men. For clinicians, awareness of the patient's unemployment status may be helpful in recognizing undiagnosed cases.

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

OBJECTIVE

Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers.

DESIGN

Community-level, cross-sectional analysis with multidimensional clinical work ability assessments.

SETTING

Paltamo, Finland.

PARTICIPANTS

Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%).

MAIN OUTCOME MEASURES

Based on data from theme interviews, patient records, supervisors' observations of work performance and clinical examinations, a physician concluded the individual's work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated.

RESULTS

Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability.

CONCLUSIONS

Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTS Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce. Work disabilities are common among the unemployed. Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work. Context sensitivity may add to the accuracy of the doctor's conclusions on work ability.

Perceived Work Ability in the Light of Long-Term and Stress-Related Unhealthy Behaviors-a Prospective Cohort Study

BACKGROUND

Most of the few studies that exist on the longitudinal associations between health behaviors and work ability target to single health behaviors.

PURPOSE

To investigate how lifetime clusters of unhealthy behaviors associate with perceived work ability in early midlife.

METHODS

The study population consisted of 46-year-old men and women (n = 3107) born in Northern Finland in 1966. Their current perceived work ability compared to lifetime best, and their unhealthy behaviors (physical inactivity, smoking, and alcohol consumption) were assessed by questionnaires. We determined clusters of unhealthy behaviors at the ages of 14, 31, and 46 and created lifetime development trajectories of health behaviors. We also assessed stress-related eating and drinking at the ages of 31 and 46. Cross-tabulations and multivariate logistic regression models were used to investigate the associations between clusters of health behaviors, stress-related eating and drinking, and work ability at 46 years. The analyses were controlled for basic education and physical strenuousness of work, psychosocial job characteristics, perceived work ability, and BMI (kg/m(2)) at 31 years.

RESULTS

Four health behavior trajectories emerged: always healthy, moderate (reference group), deteriorated. and always unhealthy. Among men, always unhealthy behaviors [OR (95 % confidence interval) 2.81 (1.35, 5.86)], and among women, deteriorated health behaviors [1.67 (1.07, 2.58)] associated with poor perceived work ability at 46 years. In addition, stress-related eating and drinking associated independently with poor perceived work ability at 46 years [men 2.58 (1.62, 4.12) and women 2.48 (1.70, 3.61)].

CONCLUSION

Long-lasting and stress-related unhealthy behaviors increase the risk of poor work ability in midlife.

Prognosis of schizophrenia spectrum disorder may not be predetermined during early development--the Northern Finland Birth Cohort 1966

BACKGROUND

Little is known about whether factors during the first years of life predict later outcomes in schizophrenia spectrum disorder (SSD). As part of the Northern Finland Birth Cohort 1966, we examined if prospectively collected early parenthood-related and developmental factors predict employment and hospitalization in individuals with and without SSD.

METHODS

Overall, 161 individuals with SSD and 10,116 without SSD were included in the study. Outcomes were analysed at age of 44-45years, defining "employment" as being employed for at least 25% of working days and "hospitalization" as having psychiatric hospitalization at least once during the last two years of follow-up. Maternal age, wantedness of pregnancy, grand multiparity, parental psychoses, birth weight, birth height, age of standing up and standing and walking without support were analysed as predictors.

RESULTS

Of the individuals with SSD, only 11.2% were employed, although 77.6% remained not hospitalized. In individuals with SSD, only young maternal age was associated with lower probability (OR 0.25, CI 0.08-0.77) of being non-hospitalized after controlling for sex and onset age of illness. Among persons without SSD, almost all parenthood-related and developmental factors were related to employment, while grand multiparity and parental psychosis were related to hospitalization after controlling for sex.

CONCLUSIONS

Only one of the early parenthood-related and developmental factors analysed in this study predicted outcome in individuals with SSD, while among those without SSD almost all factors were related to employment. Thus, prognosis of SSD does not seem to be predetermined much by early development.

Cloninger's temperament dimensions and longitudinal alcohol use in early mid-life: A Northern Finland birth cohort 1966 study

Background

Longitudinal studies on how temperament is related to alcohol use in general population are scarce.

Objectives

Finding relations with temperament and problematic alcohol use using prospective birth cohort data.

Aims

To investigate trends in self-reported alcohol consumption in adulthood.

Methods

In the Northern Finland Birth Cohort 1966 (n = 5247), alcohol use was studied with questionnaires at ages 31 and 46. Participants were classified into abstainers, bingers, heavy drinkers, steady drinkers, increasers or reducers based on the change in consumption (g/day). Cloninger's TCI-scores were calculated for each group. Multinomial regression analysis was conducted with TCI-scores as factors influencing the change in alcohol consumption.

Results

High novelty seeking was associated with increased consumption, binging and heavy drinking among both sexes at both time points (P < 0.01). Lower persistence was associated with increased consumption at both time points among men and among women at age 46. Baseline novelty seeking predicted both increasing (OR 1.1; 95% CI: 1.0–1.1) and reducing (1.1; 1.0–1.1) for men and for women also increasing (1.1; 1.0–1.1) and reducing (1.1; 1.0–1.1), but when adjusted with baseline alcohol use novelty seeking only predicted increasing for men (1.0; 1.0–1.1).

Conclusions

High novelty seeking and low persistence are associated with problematic alcohol use among middle-aged Northern Finns. Gender differences in predictors existed: novelty seeking predicted increase only for men in the adjusted model. Temperament scores do not seem to affect strongly changes in alcohol use.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Changes in alcohol use in relation to sociodemographic factors in early midlife

OBJECTIVE

To describe changes in alcohol use in relation to employment, education and relationship statuses in a general population sample in early midlife using prospective birth cohort data.

MATERIALS AND METHODS

In the Northern Finland Birth Cohort 1966 (N=5621) alcohol use was studied in participants at two time points: ages 31 and 46. The total mean consumption was calculated and participants were classified into steady drinkers, increasers and reducers based on the change in consumption between the ages of 31 and 46. Multinomial regression analysis was conducted with changes in employment and relationship statuses.

RESULTS

Daily alcohol consumption rose by 30% for men and 40% for women. Persons who were unemployed, single or had a low level of education consumed most. Of the alcohol users, 70% were classified as steady drinkers, 10% as reducers and 20% as increasers. For men, leaving a relationship (odds ratio, OR 1.5; 95% confidence interval, CI: 1.0-2.1) predicted increased alcohol use. The predictors of reducing consumption were entering a relationship for men (OR 1.9; 95% CI: 1.2-2.9) and women (OR 1.9; 95% CI: 1.1-3.1), and leaving a relationship (OR 2.6; 95% CI: 1.6-4.3) for women.

CONCLUSIONS

Alcohol consumption among Finns of northern origin does not seem to decline with age. Alcohol usage is fairly stable in the majority of middle-aged people. A substantial proportion of alcohol users engage in either binge or heavy drinking. Gender differences in predictors exist-- changes in relationship status predict a reduction in alcohol usage in women, whereas in men, divorce predicts an increase in usage.

Work time control and sleep disturbances: prospective cohort study of Finnish public sector employees

OBJECTIVES

Employee control over work times has been associated with favorable psychosocial and health-related outcomes, but the evidence regarding sleep quality remains inconclusive. We examined cross-sectional and prospective associations between work time control and sleep disturbances in a large working population, taking into account total hours worked.

METHODS

The data were from a full-panel longitudinal cohort study of Finnish public sector employees who responded to questions on work time control and sleep disturbances in years 2000-2001, 2004-2005, 2008-2009, and 2012. The analysis of cross-sectional associations was based on 129,286 person measurements from 68,089 participants (77% women) aged 17-73 years (mean 43.1). Data from 16,503 participants were used in the longitudinal analysis. Log-binomial regression analysis with the generalized estimating equations method was used.

RESULTS

Consistently in both cross-sectional and longitudinal models, less control over work time was associated with greater sleep disturbances in the total population and among those working normal 40-hour weeks. Among participants working more than 40 hours a week, work time that was both very high (cross-sectional prevalence ratio compared to intermediate work time control [PR] 1.32, 95% confidence interval [CI] 1.05-1.65) and very low (PR 1.23, 95% CI 1.08-1.39) was associated with sleep disturbances, after adjustment for potential confounding factors.

CONCLUSIONS

These data suggest that having few opportunities to influence the duration and positioning of work time may increase the risk of sleep disturbances among employees. For persons working long hours, very high levels of control over working times were also associated with increased risk of sleep disturbances.

CITATION

Salo P, Ala-Mursula L, Rod NH, Tucker P, Pentti J, Kivimäki M, Vahtera J. Work time control and sleep disturbances: prospective cohort study of Finnish public sector employees.

Extending employment beyond the pensionable age: a cohort study of the influence of chronic diseases, health risk factors, and working conditions

BACKGROUND

In response to the economic consequences of ageing of the population, governments are seeking ways with which people might work into older age. We examined the association of working conditions and health with extended employment (defined as >6 months beyond the pensionable age) in a cohort of older, non-disabled employees who have reached old-age retirement.

METHODS

A total of 4,677 Finnish employees who reached their old-age pensionable date between 2005 and 2011 (mean age 59.8 years in 2005, 73% women) had their survey responses before pensionable age linked to national health and pension registers, resulting in a prospective cohort study.

RESULTS

In all, 832 participants (17.8%) extended their employment by more than 6 months beyond the pensionable date. After multivariable adjustment, the following factors were associated with extended employment: absence of diagnosed mental disorder (OR 1.25, 95% confidence interval = 1.01-1.54) and psychological distress (OR 1.68; 1.35-2.08) and of the work characteristics, high work time control (OR 2.31; 1.88-2.84). The projected probability of extended employment was 21.3% (19.5-23.1) among those free of psychiatric morbidity and with high work time control, while the corresponding probability was only 9.2% (7.4-11.4) among those with both psychiatric morbidity and poor work time control. The contribution of chronic somatic diseases was modest.

CONCLUSIONS

In the present study, good mental health in combination with the opportunity to control work time seem to be key factors in extended employment into older age. In addition, high work time control might promote work life participation irrespective of employees' somatic disease status.

[From the disease-based assessment of work ability and functional capacity to a multidimensional assessment mode]

BACKGROUND. Doctors assess an individual's work ability by comparing the diagnoses and findings to the demands of work. The accuracy of this disease-based orientation has recently been challenged. METHODS. A case study was conducted to compare a disease-based and a multidimensional functioning -based work ability assessment, illustrated through an individual case. RESULTS. Relevant potential for promoting work ability was missed by the disease-based approach, evaluating the entitlement to social security benefits. In the assessment based on multidimensional functioning, dialogue-based plans were made to improve fitness for work. CONCLUSIONS. Multidimensional functioning is recommended as the basis of assessing work ability.

Job Strain and Adverse Health Behaviors: The Finnish Public Sector Study

OBJECTIVE

The objective of this study was to explore the association between job strain and the co-occurrence of adverse health behaviors; smoking, heavy drinking, obesity, and physical inactivity.

METHODS

The authors studied cross-sectional data of 34,058 female and 8154 male public sector employees.

RESULTS

Multinomial logistic regression models adjusted for sex, age, basic education, marital status, and type of job contract showed that high job strain and passive jobs were associated with 1.3 to 1.4 times higher odds of having > or =3 (vs 0) adverse health behaviors. Among men, low job control was associated with a 1.3-fold likelihood and among women active jobs were associated with a 1.2-fold likelihood of having > or =3 (vs 0) adverse behaviors. High demands were associated with a higher likelihood of co-occurrence of one to two (vs 0) adverse behaviors among women.

CONCLUSIONS

Job strain conditions may be associated with the co-occurrence of adverse health behaviors that contribute to preventable chronic diseases.

CLINICAL SIGNIFICANCE

Adverse job conditions may increase the likelihood of co-occurring health risk behaviors. Reducing work stress by increasing job control and decreasing psychologic demands might help efforts to promote healthy lifestyles.

Long hours in paid and domestic work and subsequent sickness absence: does control over daily working hours matter?

OBJECTIVES

To explore the associations of working hours (paid, domestic, commuting, and total) with sickness absence, and to examine whether these associations vary according to the level of employee control over daily working hours.

METHODS

Prospective cohort study among 25 703 full-time public sector employees in 10 towns in Finland. A survey of working hours and control over working hours was carried out in 2000-01. The survey responses were linked with register data on the number of self-certified (< or =3 days) and medically certified (>3 days) sickness absences until the end of 2003. Poisson regression analyses with generalised estimating equations were used to take into account the fact that the employees were nested within work units. Adjustments were made for work and family characteristics and health behaviour. The mean follow-up period was 28.1 (SD 8.1) months.

RESULTS

Long domestic and total working hours were associated with higher rates of medically certified sickness absences among both genders. In contrast, long paid working hours were associated with lower rates of subsequent self-certified sickness absences. Long commuting hours were related to increased rates of sickness absence of both types. Low control over daily working hours predicted medically certified sickness absences for both the women and men and self-certified absences for the men. In combinations, high control over working hours reduced the adverse associations of long domestic and total working hours with medically certified absences.

CONCLUSIONS

Employee control over daily working hours may protect health and help workers successfully combine a full-time job with the demands of domestic work.

Employee worktime control moderates the effects of job strain and effort-reward imbalance on sickness absence: the 10-town study

STUDY OBJECTIVE

To examine whether the effects of work stress on sickness absence vary by the level of control the employees have over their working times.

DESIGN

Prospective cohort study. A survey of job strain, effort-reward imbalance, and control over daily working hours and days off was carried out in 2000-01. The survey responses were linked with registered data on the number of medically certified (>3 days) sickness absences from one year before the survey until the end of 2003. The mean follow up period was 28.2 (SD 8.1) months. Adjustments were made for demographics and behavioural health risks. Aggregated measures of worktime control according to workplaces were used to control for differences in reactivity and response style.

SETTING

Ten towns in Finland.

PARTICIPANTS

16 139 public sector employees who had no medically certified sickness absences in the year preceding the survey.

MAIN RESULTS

Among the women, individually measured control over daily working hours and days off moderated the association between work stress and sickness absence. The combination of high stress and good worktime control was associated with lower absence rates than a combination of high stress and poor worktime control. This finding was replicated in the analyses using workplace aggregates of worktime control. Among the men, the findings were less consistent and not replicable using aggregated measures of worktime control.

CONCLUSIONS

Good control over working times reduces the adverse effect of work stress on sickness absence especially among female employees.

Combined effects of uncertainty and organizational justice on employee health: Testing the uncertainty management model of fairness judgments among Finnish public sector employees

We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires designed to assess organizational justice, workload and other factors. Hierarchical regression showed that after adjustment for age, income, and health behaviors low procedural and interactional justice were related to long sickness absence spells. In accordance with the uncertainty management model, these associations were dependent on experienced work-time control and perceived changes at work.