Are changes in sleep problems associated with changes in life satisfaction during the retirement transition?

Retirement reduces sleep problems, but changes in life satisfaction during the retirement transition are multifactorial and partly unknown. The aim of this prospective cohort study was to examine whether changes in sleep problems are associated with changes in total and domain-specific life satisfaction during the retirement transition (on average 0.5 years before and 0.5 years after retirement). The study population consisted of Finnish public sector employees (n = 3518) from the Finnish Retirement and Aging (FIREA) study who responded to annual surveys before and after transition to statutory retirement. Sleep problems were measured with Jenkins Sleep Problem Scale questionnaire and participants were grouped into four sleep problem groups depending on the state of their sleep problems during the retirement transition: 'Never,' 'Decreasing,' 'Increasing,' and 'Constant' sleep problems. Life satisfaction was measured with the Life Satisfaction Scale questionnaire including four domains (interestingness, happiness, easiness, togetherness). We found that the improvement in total life satisfaction was greatest for participants in the 'Decreasing' (0.17, 95% CI 0.11-0.23, SMD 0.27) and 'Constant' (0.12, 95% CI 0.07-0.18, SMD 0.19) sleep problem groups. Of the specific life satisfaction domains, similar findings were observed only for the easiness domain. It seems that decreasing or constant sleep problems are associated with improved life satisfaction during the retirement transition, especially in the feeling of easiness of life. This may be due to the fact that as the demands of working life are removed, sleep problems are alleviated or it becomes easier to live with them, which improves life satisfaction.

Correlation of Acoustic Radiation Force Impulse Imaging with Chronicity Markers in Native Renal Biopsy.

Introduction. Acoustic Radiation Force Impulse (ARFI) is an ultrasound parameter which has shown promise in assessing liver stiffness, but there are limited data on the correlation of ARFI with chronicity markers in renal biopsies. Objectives. Determine ARFI values in ultrasound and correlate with chronicity markers in renal biopsy. Determine whether ARFI can be used as a non-invasive chronicity predictor compared to renal length, Resistive Index (RI), and cortical thickness. Patients and Methods. Two hundred and fifty patients were enrolled in the study. The ultrasound variables ARFI, renal length, RI, and cortical thickness values were assessed by the radiologist prior to renal biopsy. The biopsy slides were graded as per the Mayo Clinic consensus report scoring system by an experienced pathologist. Results. Among 250 study participants, 167 were males and 83 were females. IgA nephropathy was the most common pathology (n=47;19%), followed by diabetic nephropathy (n=42;17%), membranous nephropathy (n=35;14%), FSGS (n=27;11%), and MCD (n=19; 8%). The mean eGFR was 55.9 ± 42.12 ml/min/1.73 m2. The average renal length was 10.086 ± 1.01 cm. The average cortical thickness was 0.707 ± 0.134 cm. Resistive index was 0.68 ± 0.09. Acoustic radiation force impulse had weak negative correlation (r=-0.286; p=0.0001) with total pathological score and weak positive correlation with eGFR (r=0.279; p=0.0001). RI was a better indicator for histologically evaluated chronicity with positive correlation coefficient (r=0.416; p=0.0005) compared to renal length, cortical thickness, and ARFI. Conclusion. ARFI didn't corelate with the pathological score in renal biopsies. RI had better predictive value for chronicity in native renal biopsies.

Longitudinal profiles of occupational physical activity during late midlife and their association with functional limitations at old age: a multi-cohort study.

OBJECTIVE: The aim was to examine longitudinal profiles of occupational physical activity (OPA) from midlife to retirement and to investigate how the different OPA-profiles are associated with mobility limitations (ML) and activities of daily living (ADL-disability) at old age. METHODS: Harmonized data from two cohort studies from Finland and the United States, that have followed people from midlife until old age were used. Repeated measurements of self-reported OPA were collected during approximately 11- to 12-year period. Persons who had data on OPA from ≥ 2 time points during the period from mid-working life to retirement were included. Latent class growth analysis was used to identify OPA-profiles. Risk ratios (RRs) with 95% confidence intervals for the associations of the OPA-profiles and later life MLs and ADL-disability were estimated. RESULTS: Three OPA-profiles were identified in both cohorts: high-persistent, moderate-fluctuating, and low-persistent. For majority OPA remained stable: for workers reporting high or low levels of OPA at midlife, the physical demands of work likely persisted, whereas people reporting moderate level OPA had high fluctuation in their exposure level. Members of high-persistent and moderate-fluctuating OPA-profiles had increased risk of subsequent MLs at old age. The RRs for ADL-disability did not differ between the profiles. CONCLUSIONS: Perceived OPA remains rather stable for workers reporting high or low physical work demands during midlife, yet fluctuating profiles also exist. Workers exposed to high or moderate OPA have higher risk for MLs when they reach old age. Establishing safe and health-promoting levels of OPA during late working life might have positive long-term consequences on healthy ageing.

Changes in life satisfaction during the transition to retirement: findings from the FIREA cohort study.

Life satisfaction is an essential construct of well-being that is tied to behavioral, emotional, social and psychological outcomes. This study aimed to examine changes in total and domain-specific life satisfaction during the retirement transition and additionally examine whether those changes differ by gender, occupation, health and spousal working status. Aging public sector employees (n = 3543) from the Finnish Retirement and Aging Study cohort study were followed up annually before and after retirement. Total life satisfaction score (range 4-20) was computed by summing up the responses in four domains (interestingness, happiness, easiness and togetherness). The mean and mean change estimates and their 95% CI were calculated by using the linear regression models with generalized estimating equations, adjusted for age, gender, occupation, health and marital status. Total life satisfaction score improved among the entire study population during the retirement transition and remained stable thereafter. The improvement was greater among women versus men (gender * time interaction p = 0.004), among those with suboptimal health before retirement vs. those who had good (health * time p < 0.0001) and those who had no spouse vs. those who had a retired or working spouse (spousal-status * time p < 0.0001). In case of domain-specific life satisfaction scores, the greatest improvement was observed in the easiness domain. Life satisfaction improves during the retirement transition period, especially among women, those with suboptimal health and those living without a spouse. The improvement was considerably greater in the easiness domain than any other domains. Life satisfaction remained improved and stable during the post-retirement period. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00745-8.

Effectiveness of interventions on the stress management of schoolteachers: a systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to analyse the effectiveness of interventions on the stress management of schoolteachers. METHODS: We searched the Medline, PsycINFO, CINAHL and Education Research Complete until 30 November 2021, to identify relevant studies using relevant key words. Job or occupational stress was used as the outcome measure. Stress was defined as Perceived Stress Scale, Teacher Stress Inventory, Maslach Burnout Inventory, Teacher's Distress, Brief Symptoms Inventory or Global Severity Index. Study selection, data extraction, risk of bias assessment was performed by two independent reviewers. The pooled estimate of the effect by the type of outcome measurement tool and by type of interventions used was calculated using random effects meta-analysis. We used Grades of Recommendations, Assessment, Development and Evaluation to assess the overall quality of the evidence. RESULTS: We reviewed 26 studies, of which 24 were randomised trials and 2 pre-test/post-test studies. Based on meta-analysis, a positive effect of intervention (pooled estimate -1.13, 95% CI -1.52 to -0.73) with high heterogeneity among studies (χ2=426.88, p<0.001, I2=94%) was found by type of interventions used. Cognitive-behavioural therapy had the strongest positive effect, followed by meditation among the types of interventions studied. We identified evidence of a moderate quality for interventions aiming to manage the stress level of schoolteachers. CONCLUSIONS: The meta-analysis showed a positive effect of interventions, suggesting that interventions might reduce the stress level among teachers. The quality of the evidence was moderate. PROSPERO REGISTRATION NUMBER: CRD42021225098.

Assessing the quality of evidence in studies estimating prevalence of exposure to occupational risk factors: The QoE-SPEO approach applied in the systematic reviews from the WHO/ILO Joint Estimates of the Work-related burden of disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) have produced the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). For these, systematic reviews of studies estimating the prevalence of exposure to selected occupational risk factors have been conducted to provide input data for estimations of the number of exposed workers. A critical part of systematic review methodology is to assess the quality of evidence across studies. In this article, we present the approach applied in these WHO/ILO systematic reviews for performing such assessments on studies of prevalence of exposure. It is called the Quality of Evidence in Studies estimating Prevalence of Exposure to Occupational risk factors (QoE-SPEO) approach. We describe QoE-SPEO's development to date, demonstrate its feasibility reporting results from pilot testing and case studies, note its strengths and limitations, and suggest how QoE-SPEO should be tested and developed further. METHODS: Following a comprehensive literature review, and using expert opinion, selected existing quality of evidence assessment approaches used in environmental and occupational health were reviewed and analysed for their relevance to prevalence studies. Relevant steps and components from the existing approaches were adopted or adapted for QoE-SPEO. New steps and components were developed. We elicited feedback from other systematic review methodologists and exposure scientists and reached consensus on the QoE-SPEO approach. Ten individual experts pilot-tested QoE-SPEO. To assess inter-rater agreement, we counted ratings of expected (actual and non-spurious) heterogeneity and quality of evidence and calculated a raw measure of agreement (Pi) between individual raters and rater teams for the downgrade domains. Pi ranged between 0.00 (no two pilot testers selected the same rating) and 1.00 (all pilot testers selected the same rating). Case studies were conducted of experiences of QoE-SPEO's use in two WHO/ILO systematic reviews. RESULTS: We found no existing quality of evidence assessment approach for occupational exposure prevalence studies. We identified three relevant, existing approaches for environmental and occupational health studies of the effect of exposures. Assessments using QoE-SPEO comprise three steps: (1) judge the level of expected heterogeneity (defined as non-spurious variability that can be expected in exposure prevalence, within or between individual persons, because exposure may change over space and/or time), (2) assess downgrade domains, and (3) reach a final rating on the quality of evidence. Assessments are conducted using the same five downgrade domains as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach: (a) risk of bias, (b) indirectness, (c) inconsistency, (d) imprecision, and (e) publication bias. For downgrade domains (c) and (d), the assessment varies depending on the level of expected heterogeneity. There are no upgrade domains. The QoE-SPEO's ratings are "very low", "low", "moderate", and "high". To arrive at a final decision on the overall quality of evidence, the assessor starts at "high" quality of evidence and for each domain downgrades by one or two levels for serious concerns or very serious concerns, respectively. In pilot tests, there was reasonable agreement in ratings for expected heterogeneity; 70% of raters selected the same rating. Inter-rater agreement ranged considerably between downgrade domains, both for individual rater pairs (range Pi: 0.36-1.00) and rater teams (0.20-1.00). Sparse data prevented rigorous assessment of inter-rater agreement in quality of evidence ratings. CONCLUSIONS: We present QoE-SPEO as an approach for assessing quality of evidence in prevalence studies of exposure to occupational risk factors. It has been developed to its current version (as presented here), has undergone pilot testing, and was applied in the systematic reviews for the WHO/ILO Joint Estimates. While the approach requires further testing and development, it makes steps towards filling an identified gap, and progress made so far can be used to inform future work in this area.

Quality of work community and workers' intention to retire.

PURPOSE: To study the workers' perception of the quality of work community and its association with intention to retire early, separately among women and men working in Finnish postal service. METHODS: A questionnaire survey was sent to all Finnish postal services employees aged ≥ 50 years in 2016 and 44% (n = 2096) replied to the survey (mean age 56.3, 40% women). Employee's intention to retire before statutory retirement was measured on a scale of 1-5 and dichotomized. The quality of work community was defined by four composite variables: equality at work, flexibility at work, supportive work environment and health or other reason and trichotomized by their tercile values. Odds ratio (ORs) and their 95% confidence intervals (CIs) for associations of quality of work community with intention to retire were calculated separately for men and women using log binomial regression models adjusted for potential confounders. RESULTS: About one-third of respondents intended to retire early with no significant gender difference in retirement intention. Low equality at work (women OR 2.77, 95% CI 1.60-4.81; men 2.84, 1.80-4.48) and low flexibility at work (women 3.30, 1.94-5.60; men 2.91, 1.88-4.50) was associated with higher likelihood of intention to retire. Among women intention to retire was found less likely due to low supportive work environment (0.52, 0.31-0.89) and among men due to intermediate health or other reason (0.65, 043-0.98). CONCLUSION: The results highlight the importance of the quality of work community as well as the promotion of work-related health in order to encourage employees to remain at workforce for longer.

Social relationships as predictors of extended employment beyond the pensionable age: a cohort study.

The aim is to examine whether characteristics of social relationships predict extended employment beyond the pensionable age among Finnish public sector workers. The study population consisted of 4014 participants (83% women, age 62.56 ± 1.21) of the Finnish Retirement and Aging Study followed between 2014 and 2019. Extended employment was defined as the difference between actual retirement date and individual age-related pensionable date and classified into three groups: no extension (retired on pensionable age or extended by < 3 months), short extension (3 months-< 1 year), and long extension (≥ 1 year) beyond the pensionable date. Characteristics of social relationships and engagement were assessed 18 months prior to the pensionable date. Social engagement was classified into consumptive social participation, formal social participation, informal social participation, and other social participation. Data were analyzed using multinomial regression analysis. Of total study participants, 17.8% belonged to short- and 16.5% belonged to long-extension group. Adjusted for age, occupational status, self-rated health and depression, and having a working spouse (OR 2.34, 95% CI 1.39-3.95) were associated with long extension of employment beyond the pensionable age when compared to no extension among men. Likewise, among women, living alone (OR 1.60, 95% CI 1.28-2.00), having a working spouse (1.85, 1.39-2.45), and high consumptive (1.32, 1.07-1.65), high formal (1.47, 1.17-1.85), and other social participation (0.79, 0.63-0.98) were associated with long extension. Having a working spouse, living alone, and high consumptive social participation were associated with short extension. Several characteristics of social relationships, such as having a working spouse, living alone, and high frequency of social engagement, predicted an extension of employment beyond the pensionable age. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10433-021-00603-z.

What Are the Key Workplace Influences on Pathways of Work Ability? A Six-Year Follow Up.

OBJECTIVE: To study the trajectories of work ability and investigate the impact of multisite pain and working conditions on pathways of work ability over a six-year period. METHODS: The longitudinal study was conducted with Finnish food industry workers (n = 866) with data collected every 2 years from 2003-2009. Questions covered musculoskeletal pain, physical and psychosocial working conditions (physical strain, repetitive movements, awkward postures; mental strain, team support, leadership, possibility to influence) and work ability. Latent class growth analysis and logistic regression were used to analyse the impact of multisite pain and working conditions on work ability trajectories (pathways). RESULTS: Three trajectories of work ability emerged: decreasing (5%), increasing (5%), and good (90%). In the former two trajectories, the mean score of work ability changed from good to poor and poor to good during follow-up, while in the latter, individuals maintained good work ability during the follow-up. In the multivariable adjusted model, number of pain sites was significantly associated with higher odds of belonging to the trajectory of poor work ability (Odds ratio (OR) 4 pain sites 2.96, 1.25-7.03). CONCLUSIONS: A substantial number of employees maintained good work ability across the follow up. However, for employees with poor work ability, multisite musculoskeletal pain has an important influence, with effective prevention strategies required to reduce its prevalence.

Trajectories of mobility limitations over 24 years and their characterization by shift work and leisure-time physical activity in midlife.

BACKGROUND: We aimed to investigate trajectories of mobility limitations (MLs) over a period of 24 years. In addition, we aimed to study how shift work and leisure-time physical activity (LTPA) in midlife predict assignment to MLs trajectories separately for those retired on statutory pensions (SPs) and on disability pensions (DPs). METHODS: Subjects who responded MLs questionnaires (1985-2009, N = 3048) in Finnish Longitudinal Study on Aging Municipal Employees were included in this prospective cohort study. LTPA and shift work were measured during baseline. International Classification of Functioning was used to code MLs. Growth mixture modeling was used to identify the trajectories of MLs. Odds ratio (OR) and their 95% Confidence interval (CI) were assessed by using multinomial logistic regression. RESULTS: We identified four trajectories of MLs, namely low persistent, low increasing, high decreasing and high persistent. Among the SP recipients, shift work with night shifts was associated with an increased risk (adjusted OR 1.49; 95% CI 1.03-2.14) of belonging to the high persistent MLs trajectory. The inactive LTPA (SP: OR 5.99, 95% CI 3.39-10.58, DP: OR 6.81, 95% CI 2.52-18.43) was similarly associated with high persistent MLs trajectory. CONCLUSION: Nearly two-thirds of the people retired due to disability belonged to high MLs trajectory. High persistent MLs trajectory was associated with physical inactivity in midlife among those retired on SP and on DP. Shift work with night shift predicted high persistent MLs in SP strata. Active involvement in LTPA during midlife could be beneficial to spend MLs free later life.

WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to occupational ergonomic risk factors and of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of disability-adjusted life years from osteoarthritis of hip or knee, and selected other musculoskeletal diseases respectively, attributable to exposure to occupational ergonomic risk factors to inform the development of the WHO/ILO joint methodology. OBJECTIVES: We aim to systematically review studies on exposure to occupational ergonomic risk factors (Systematic Review 1) and systematically review and meta-analyze estimates of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of the hip or knee, and selected other musculoskeletal diseases respectively (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way. DATA SOURCES: Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science and CISDOC. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference lists of previous systematic reviews and included study records; and consult additional experts. STUDY ELIGIBILITY AND CRITERIA: We will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (<15 years) and unpaid domestic workers. The included occupational ergonomic risk factors will be any exposure to one or more of: force exertion; demanding posture; repetitiveness; hand-arm vibration; lifting; kneeling and/or squatting; and climbing. Included outcomes will be (i) osteoarthritis and (ii) other musculoskeletal diseases (i.e., one or more of: rotator cuff syndrome; bicipital tendinitis; calcific tendinitis; shoulder impingement; bursitis shoulder; epicondylitis medialis; epicondylitis lateralis; bursitis elbow; bursitis hip; chondromalacia patellae; meniscus disorders; and/or bursitis knee). For Systematic Review 1, we will include quantitative prevalence studies of any exposure to occupational ergonomic risk factors stratified by country, gender, age and industrial sector or occupation. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control-studies and other non-randomized intervention studies with an estimate of the relative effect of any exposure with occupational ergonomic risk factors on the prevalence or incidence of osteoarthritis and/or selected musculoskeletal diseases, compared with the theoretical minimum risk exposure level (i.e., no exposure). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors will independently screen 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 qualifying studies. At least two review authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2. PROSPERO registration number: CRD42018102631.

Multisite musculoskeletal pain trajectories from midlife to old age: a 28-year follow-up of municipal employees.

OBJECTIVES: We studied the developmental trajectories of multisite musculoskeletal pain (MSP) to learn whether pain in midlife persists to old age, and whether pain trajectories associate with midlife work or lifestyle exposures or retirement from work. METHODS: Municipal employees aged 44-58 years were studied in 1981 (n=6257) with follow-ups in 1985, 1992, 1997 and 2009. Pain in the neck, low back, and upper and lower limbs was assessed in each survey. Trajectories of the number (0-4) of pain sites were defined using growth mixture modelling (n=3093). Workload, lifestyle and morbidity were elicited by questionnaire and retirement from registries. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Cumulative hazard curves for retirement by trajectory group were calculated. RESULTS: Three trajectories of pain over 28 years emerged: low (25%), moderate (52%) and high-decreasing (23%). In the latter, the number of pain sites first decreased sharply, stabilising to a moderate level after most subjects had retired. The disability pension rate was highest in this trajectory, which associated with high baseline morbidity, particularly musculoskeletal disorder (OR 8.06; 95% CI 5.97 to 10.87). Also high biomechanical exposure (2.86;95% CI 2.16 to 3.78), high job demands (1.79; 95% CI 1.39 to 2.30), high job control (OR 0.70; 95% CI 0.54 to 0.90), body mass index (BMI) ≥25.0 kg/m2 (1.40; 95% CI 1.09 to 1.80) and low leisure-time physical activity (LTPA) (1.39; 95% CI 1.09 to 1.78) at baseline were associated with this trajectory. However, high LTPA and BMI in repeated surveys also associated with the high-decreasing trajectory. CONCLUSION: MSP in midlife often persists to old age. However, high widespreadness of pain may decrease with retirement from work.

Work-Related Biomechanical Exposure and Job Strain as Separate and Joint Predictors of Musculoskeletal Diseases: A 28-Year Prospective Follow-up Study.

We investigated how work-related biomechanical exposure and job strain in midlife separately and jointly predicted back and degenerative musculoskeletal diseases (MSDs). A total of 6,257 employees participated in the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 and were followed up for 28 years. Risk ratios and the relative excessive risk due to interaction and 95% confidence intervals were modeled for separate and joint prediction estimates, respectively. After adjustment for confounders, job strain predicted degenerative MSDs among women after 4 and 11 years of follow-up. After 11 years, both exposures predicted both types of MSDs among men. Joint exposure predicted both types of MSDs after 4 years among women (for back MSDs, risk ratio (RR) = 1.58, 95% confidence interval (CI): 1.15, 2.18; for degenerative MSDs, RR = 1.59, 95% CI: 1.21, 2.07) and men (for back MSDs, RR = 1.50, 95% CI: 1.05, 2.15; for degenerative MSDs, RR = 1.61, 95% CI: 1.16, 2.22) and both types of MSDs after 11 years (for back MSDs, RR = 1.72, 95% CI: 1.21, 2.43; for degenerative MSDs, RR = 1.68, 95% CI: 1.25, 2.46) among men only, but the relative excessive risk due to interaction was not significant throughout. However, after 28 years, the separate and joint exposures did not predict MSDs. Workplace interventions should be focused on reducing job strain along with biomechanical exposure for possible prevention of MSDs in working life and around the time of retirement, but there may be other pathways of onset of MSDs in old age.

Impact of Malnutrition, Inflammation, and Atherosclerosis on the Outcome in Hemodialysis Patients.

Malnutrition, inflammation, and atherosclerosis are significant problems in patients on hemodialysis. A prospective, observational study in 100 hemodialysis patients for 2 years was conducted. The primary outcomes were hospitalizations and mortality at the end of 2 years. The mean age was 61 ± 11.3 years and 69% were male. Seven patients did not complete the study (five underwent transplant and two were shifted to other units). Serum albumin was significantly lower in malnourished patients at 6 months from the beginning of the study period (3.58 vs. 3.79 g/dl, P = 0.001). Malnutrition based on subjective global assessment (SGA) was seen in 30 (32%) patients: mild to moderate in 27 (29%) and severe in 3 (3%). Inflammation was seen in 73 (78.5%) patients and intimal-medial thickness of >1.1 mm indicating significant atherosclerosis was seen in 73 (78.5%) patients. Modified SGA score and malnutrition-inflammation score (MIS) were significantly more in the malnourished group. Statistically significant association was seen between hospitalization and mortality in the malnourished population, and the odds ratio of death in malnourished patients was 9.83 (95% confidence interval: 2.8-34.3, P < 0.001). There was a moderate correlation between malnutrition assessed by modified SGA and MIS score (r = 0.54, P < 0.001). Mortality rate was 37% in patients with mild to moderate and 67% in severe malnutrition. Hospital admission was seen in 43 (46%) patients and was significantly more common in malnourished compared to well-nourished patients (77% vs. 32%, P < 0.001). Multiple logistic regression analysis showed that malnutrition by Modified SGA was the only significant variable associated with mortality at 2 years, and addition of MIS score did not improve the predictive ability of the model to modified SGA. We recommend the use of modified SGA and serial serum albumin to monitor nutrition in hemodialysis patients.

Work-related biomechanical exposure and job strain in midlife separately and jointly predict disability after 28 years: a Finnish longitudinal study.

Objectives We investigated whether the extent of biomechanical exposures and job strain in midlife separately and jointly predict disability in old age. Methods Participants of the Finnish Longitudinal Study on Aging Municipal Employees (FLAME) in 1981 (aged 44-58 years) responded to disability questionnaires in 2009 (1850 women and 1082 men). Difficulties in performing five activities of daily living (ADL) and seven instrumental ADL (IADL) were used to assess severity of disability (score range: 0-12, 0=no disability). Information on biomechanical exposures and job strain was collected by questionnaire at baseline. Adjusted prevalence proportion ratios (PR) and 95% confidence intervals (95% CI) were modelled using mixed negative binomial regression with robust variance. The joint effect of two exposures was quantified using the concept of relative excessive risk due to interaction (RERI). Results The overall prevalence of disability (score: 1-12) was 46.7% (women: 41%; men: 57%). Compared to low-level exposures in an adjusted model, the PR of high baseline biomechanical exposures for each one unit increase in the disability score was 1.31 (95% CI 1.10-1.55) and PR of high job strain was 1.71 (95% CI 1.26-2.32). Associations were rather similar in gender-stratified analyses. Furthermore, the joint effect (high strain/high biomechanical) was multiplicative (women: PR 1.32, 95% CI 1.21-1.45; men: PR 1.27, 95% CI 1.13-1.44), but no additive effect was observed when fully adjusted. Conclusion High biomechanical exposure and job strain in midlife were strongly associated with the severity of disability in later life. The workplace could serve as arena for preventive interventions regarding disability in old age.

Midlife job profiles and disabilities in later life: a 28-year follow-up of municipal employees in Finland.

PURPOSE: Occupations during adult life may have long-term effects and subsequently increase the risk of disability in old age. We investigated the associations between job profile groups in midlife and disability in old age for women and men. METHODS: This prospective 28-year follow-up study (1981-2009) examined 2998 municipal employees (1892 women and 1106 men) aged 44-58 years at baseline. A detailed analysis of the demands of 88 occupations based on interviews and observations at the work places was made at baseline. Thirteen job profile clusters emerged. Questionnaire information on health, lifestyle and socio-demographic factors was collected at baseline. In 2009, five Activities of Daily Living and seven Instrumental Activities of Daily Living tasks were assessed. A sum score of '0-12' was calculated using 12 dichotomous tasks where '0' indicates no difficulties in any tasks and '1-12' indicates increasing disability. Negative binomial regression was used to calculate rate ratios (RR) and their 95 % confidence intervals (CIs) for disability due to midlife job profiles. RESULTS: After adjusting for age, socioeconomic, lifestyle and health-related characteristics, women in auxiliary (RR 2.1, 95 % CI 1.4-3.2), home care (2.1, 1.4-3.2), kitchen supervision (2.0, 1.1-3.6) and office (1.6, 1.1-2.4) job profiles had a higher risk of disability in later life than those in administrative jobs. Auxiliary (1.5, 1.1-2.9) and technical supervision (1.7, 1.1-2.7) job profiles carried an increased risk among men. CONCLUSION: Midlife job profiles mainly linked with physically heavy work were strong predictors of disability in later life. In women, office work also increased the risk of disability.

Overweight and obesity among women: analysis of demographic and health survey data from 32 Sub-Saharan African Countries.

BACKGROUND: Overweight and obesity are risk factors for many chronic diseases globally. However, the extent of the problem in low-income countries like Sub-Saharan Africa is unclear. We assessed the magnitude and disparity of both phenomena by place of residence, level of education and wealth quintile using cross-sectional data from 32 countries. METHODS: Demographic and Health Survey (DHS) data collected in 32 Sub-Saharan African countries between January 2005 and December 2013 were used. A total of 250651 women (aged 15-49 years) were analyzed. Trained personnel using a standardized procedure measured body weight and height. Body mass index (BMI) was calculated by dividing body weight by height squared. Prevalence of overweight (25.0-29.9 kg/m(2)) and obesity (≥ 30.0 kg/m(2)) were estimated for each country. Analysis of the relationships of overweight and obesity with place of residence, education and wealth index were carried out using logistic regression. RESULTS: The pooled prevalence of overweight for the region was 15.9% (95% CI, 15.7-16.0) with the lowest in Madagascar 5.6% (95% CI, 5.1-6.1) and the highest in Swaziland 27.7% (95% CI, 26.4-29.0). Similarly, the prevalence of obesity was also lowest in Madagascar 1.1% (95% CI, 0.9-1.4) and highest in Swaziland 23.0 (95% CI, 21.8-24.2). The women in urban residence and those who were classified as rich, with respect to the quintile of the wealth index, had higher likelihood of overweight and obesity. In the pooled results, high education was significantly associated with overweight and obesity. CONCLUSIONS: The prevalence of overweight and obesity varied highly between the countries and wealth index (rich vs. poor) was found to be the strongest predictor in most of the countries. Interventions that will address the socio-cultural barriers to maintaining healthy body size can contribute to curbing the overweight and obesity epidemic in Africa.

Cesarean deliveries among Nepalese mothers: changes over time 2001-2011 and determinants.

OBJECTIVES: To examine the most recent trends of cesarean delivery in Nepal and the association with socio-demographic characteristics of mothers. METHODS: Nationally representative cross-sectional data was used from three Demographic and Health Surveys conducted in Nepal in 2001 (N = 4,745), 2006 (N = 4,066) and 2011 (N = 4,148). Cesarean section delivery was measured in two categories with yes and no responses for the delivery in their latest pregnancy. Data on socio-demographic variables was obtained by interviewing the participants. The data was analysed using logistic regression models. RESULTS: The prevalence of cesarean section delivery was increased by more than 4 times from 2001 to 2011 both among rural and urban residents. After adjusting for mother's age, number of births in last 5 years and mother's education the prevalence of cesarean section delivery among all mothers was 1.71 times higher in 2006 (OR = 1.71, 95 % CI 1.23-2.37) and increased further in 2011 (OR = 2.42, 95 % CI 1.78-3.30) compared with year 2001. When adjusted for all the variables simultaneously, all variables except births in last 5 years remained significantly associated with cesarean section delivery of the mother. Older age, urban resident, being educated, having educated partners and being rich according to wealth index were associated with cesarean section delivery. CONCLUSIONS: The prevalence of cesarean section delivery continues to rise but still lower than the World Health Organization recommended rates. More studies are needed to examine the non-medical reason of increasing rates of cesarean section deliveries and their effect in maternal and infant morbidity and mortality in Nepal.