Individual and dual trajectories of insomnia symptoms and body mass index before and after retirement and their associations with changes in subjective cognitive functioning.

BACKGROUND: We examined individual and dual trajectories of insomnia symptoms and body mass index (BMI) before and after retirement, and their associations with changes in subjective cognitive functioning after retirement. METHODS: We used the Helsinki Health Study's (n = 2360, 79% women, aged 40-60 at baseline, Finland) repeated surveys to identify the developmental patterns of insomnia symptoms and BMI (2000-2017) and changes in subjective cognitive functioning (2017-2022). We analysed the data using latent group-based dual trajectory modelling and logistic regression analysis. RESULTS: Three latent groups were identified for insomnia symptoms (stable low, decreasing and increasing symptoms) and BMI (stable healthy weight, stable overweight and stable obesity). Insomnia symptoms were associated with declining subjective cognitive functioning and largely explained the effects in the dual models. CONCLUSION: The association between dual trajectories of insomnia symptoms and BMI with subjective cognitive decline is dominated by insomnia symptoms.

Work-family conflicts and sickness absence-a register-linked cohort study among young and early midlife employees.

BACKGROUND: Work-family conflicts (WFC) have been associated with poor mental health, poor self-rated health and sickness absence. However, studies on short sickness absence are lacking and more information is needed also about long sickness absence regarding the direction of WFC, and potential explaining factors particularly among young and early middle-aged employees. METHODS: The Helsinki Health Study baseline survey (2017) among 19- to 39-year-old municipal employees (N = 3683, 80% women, response rate 51.5%) was linked to employer's sickness absence data. The associations of work-to-family conflicts (WTFC) and family-to-work conflicts (FTWC) with short (1-7 days) and long (over 7 days) sickness absence were analyzed using negative binomial regression analysis. Covariates were age, gender, family-related factors and work-related factors. Stratified analyses by occupational class were performed. The results are presented as rate ratios and their 95% confidence intervals. RESULTS: High WTFC were associated with short (1.25, 1.12-1.40) and long (1.37, 1.11-1.70) sickness absence. High FTWC were also associated with short (1.12, 1.03-1.22) and long (1.24, 1.06-1.45) sickness absence. Adjustment for family-related factors strengthened the associations, whereas adjustment for work-related factors abolished the associations between WTFC and sickness absence. Associations between WFC and sickness absence were observed among two lowest occupational classes only. CONCLUSION: WFC are associated with both short and long sickness absence. Work-related factors including the quality of supervisory work and shift work play a role in the association. Intervention studies could determine if improvements in combining work and family life lead to a reduction in sickness absence.

Dual trajectories of short-term and long-term sickness absence and their social- and health-related determinants among women in the public sector.

BACKGROUND: Short- and long-term sickness absence (SA) vary in their determinants. We examined short- and long-term SA contemporaneously as two interconnected phenomena to characterize their temporal development, and to identify employees with increasing SA at an early stage. METHODS: We extracted 46- to 55-year-old employed women from the Helsinki Health Study occupational cohort during 2000-17 (N = 3206) and examined the development of short- (1-14 days) and long-term (>14 days) SA using group-based dual trajectory modelling. In addition, we investigated the associations of social-, work- and health-related factors with trajectory group membership. RESULTS: For short-term SA, we selected a three-group solution: 'no short-term SA' (50%), 'low frequency short-term SA' (40%), and 'high frequency short-term SA' (10%) (7 spells/year). For long-term SA, we also selected three trajectory groups: 'no long-term SA' (65%), 'low long-term SA' (27%), and 'high long-term SA' (8%). No SA in the short-term SA model, indicated a high probability of no SA in the long-term model and vice versa. The developmental pattern was far less certain if participant was assigned to a trajectory of high SA in either one of the models (short- or long-term SA model). Low occupational class and poor health behaviours were associated with the trajectory groups with more SA. CONCLUSION: SA does not increase with age among most employees. If either SA rate was high, the developmental patterns were heterogenous. Employers' attention to health behaviours might aid in reducing both short- and long-term SA.

Excess mortality in Denmark, Finland, Norway and Sweden during the COVID-19 pandemic 2020-2022.

BACKGROUND: The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020-2022. METHODS: Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010-2019 used as reference period. We then compared excess mortality across the countries in 2020-2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses. RESULTS: While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29-122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14-90), 130 (83-177) and 88 (48-128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022. CONCLUSION: Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates-arguably the most accurate available for any region in capturing pandemic-related excess deaths-may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic.

Explanations for sickness absence due to common mental disorders: A narrative study of young health and social care workers.

Over recent decades, sickness absence due to common mental disorders has increased among young workers. The phenomenon is mostly understood on the basis of epidemiological research, and knowledge regarding the viewpoints of young workers themselves is lacking. Our study explored the explanations for mental health-related sickness absence in the narrative accounts of young workers in high-risk health and social care occupations. Semi-structured narrative interviews were conducted with 23 Finnish young workers (aged 21-34), with self-reported sickness absence related to common mental disorders over the previous year. Our analysis identified three narrative explanations for the onset of mental health problems leading to sick leave: work as the sole cause, work as an additional cause and work as a trigger. These findings indicate that mental health-related sickness absences form a complex phenomenon related to various life and work-related circumstances. More comprehensive preventive measures are needed in the health and social care sector to help tackle mental health problems among young workers.

Changes in occupational class differences in leisure-time physical activity and the contribution of retirement.

Occupational class differences in leisure-time physical activity (LTPA) are well recognized. Less is known about how these differences develop as individuals age, and how retirement is associated with this change. We investigated how occupational class differences in LTPA change in a cohort over a 15-17 years follow-up. We further examined, how the transition into mandatory or disability retirement contributed to the change in LTPA levels and occupational class differences. We used the data from the Helsinki Health Study surveying the aging City of Helsinki employees. In all, 8773 individuals were included in the analyses. We evaluated LTPA levels using weekly metabolic equivalent task (MET) hours and used generalized linear mixed effect models (GLMM) to estimate the development of LTPA levels. Commuting was included in the LTPA measure. Occupational class differences in LTPA emerged and widened during the follow-up. The physical activity levels decreased in the lower occupational class and slightly increased in the higher occupational class, resulting in a difference of 4.3 MET-hours at the end of follow-up, accounting for 50 min of brisk walking per week. The occupational class differences emerged during transition into mandatory retirement and persisted after this. Transition into disability retirement temporarily widened the occupational class differences in LTPA levels, but the differences diminished during the follow-up. Research on interventions to counteract the declining LTPA is needed to discover ways to prevent the widening of occupational health disparities during aging. The transition into old-age retirement could be an optimal period for focusing these interventions.

Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland.

BACKGROUND: Cardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement. We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants. METHODS: We used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000-2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution's reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression. RESULTS: Six trajectories of CVD medication were distinguished: "constant low" (35%), "late increase" (6%), "early increase" (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing" (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the "early increase" trajectory. CONCLUSIONS: Individuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.

Working conditions and mental health functioning among young public sector employees.

Background: The associations between adverse working conditions and mental disorders are well established. However, associations between adverse working conditions and poor mental health functioning is a less explored area. This study examines these associations among younger public sector employees of the City of Helsinki, Finland. Methods: We use data from the Young Helsinki Health Study with a representative sample of the employees of the City of Helsinki, aged 19-39 years (n=4 217). Mental health functioning was measured with mental composite summary of the Short Form 36. Working conditions included factors related to both the psychosocial (job control and job demands) and the physical work environment (physical workload). To examine the associations, we used logistic regression models with adjustments for socio-demographics, other working conditions and health-related covariates. Results: After adjustment for sociodemographic characteristics, poor health, health behaviours and other occupational exposures, high job demands (OR=1.69; 95% CI=1.45-1.97) and low job control (OR=1.65; 95% CI=1.40-1.94) were associated with poor mental health functioning. High physical workload was not associated with the outcome (OR=0.87; 95% CI=0.72-1.05) after the adjustments. Conclusions: Adverse psychosocial working conditions were associated with mental health functioning, whereas physical working conditions were not. As impaired functioning is likely to cause health-related lost productivity and can lead to work disability, further research and interventions with a balanced approach focusing on both psychosocial working conditions and mental health functioning are recommended.

Life-course socioeconomic circumstances in acute, chronic and disabling pain among young employees: a double suffering.

BACKGROUND: Pain is known to be socioeconomically patterned and associated with disability. However, knowledge is scarce concerning life-course socioeconomic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socioeconomic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees. METHODS: We analysed questionnaire data retrieved from the Young Helsinki Health Study (n=4683) covering 18-39-year-old employees of the City of Helsinki, Finland. We included multiple indicators of childhood and current socioeconomic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain-related disability was assessed by the chronic pain grade questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for sociodemographic, socioeconomic and health-related covariates. RESULTS: Childhood and current socioeconomic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low educational level (odds ratio (OR) 3.38, 95% confidence interval (CI) 2.18-5.24), manual occupation (OR 3.75, 95% CI 1.92-7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00-4.70). CONCLUSIONS: Pain is a common complaint that contributes to disability among young employees, particularly the most socioeconomically vulnerable. There is a socioeconomic gradient in both pain chronicity and the level of chronic pain-related disability. Life-course socioeconomic factors should be considered in pain-preventing strategies and in clinical practice.

Multiple socioeconomic circumstances and trajectories of fruit and vegetable consumption: the Helsinki Health Study.

AIMS: Fruit and vegetable consumption is essential in disease prevention. Socioeconomic differences in consumption have been observed but evidence from longitudinal studies incorporating multiple socioeconomic indicators is lacking. We examined long-term fruit and vegetable consumption trajectories and multiple socioeconomic circumstances as their determinants. METHODS: We used survey data from the Helsinki Health Study (phase 1 in 2000-2002, N=8960, response rate 67%; phases 2-4 in 2007, 2012 and 2017) among initially 40- to 60-year-old employees of City of Helsinki, Finland. Fruit and vegetable consumption was measured by a food frequency questionnaire and consumption times per month were calculated. Childhood (parental education, economic difficulties), conventional (own education, occupational class, household income) and material (housing tenure, wealth, current economic difficulties) socioeconomic circumstances were included. We used group-based trajectory modelling for identifying fruit and vegetable consumption trajectories and multinomial logistic regression for examining associations between socioeconomic circumstances and the trajectories. RESULTS: Four fruit and vegetable consumption trajectories were identified: increasing higher (12%), decreasing higher (10%), stable moderate (43%) and stable low (35% of participants). Childhood, conventional and material socioeconomic circumstances were all associated with the trajectories: belonging to a lower socioeconomic group was associated with belonging to the stable low and moderate trajectories. In multivariate models, the strongest associations were found for occupational class and household wealth. CONCLUSIONS: Disadvantageous childhood and adulthood socioeconomic circumstances were associated with lower long-term fruit and vegetable consumption. Socioeconomic circumstances should be considered in attempts to promote fruit and vegetable consumption, and people with disadvantageous circumstances need to be targeted in future interventions.

Associations between low parental education, childhood adversities and sickness absence in midlife public sector employees.

AIMS: Parental education and childhood adversities are associated with long-term work disability but their contribution to sickness absence is largely unknown. We aimed to examine the associations between parental education, childhood adversities and self-certified and medically-certified sickness absence among midlife employees. METHODS: The Helsinki Health Study baseline survey data (2000-2002) of 40-to-60-year-old municipal employees were linked with sickness absence data from the employer's register. Self-certified (1-3 days) and medically-certified (>3 days) sickness absence spells were followed from 2003 until the end of 2008. The study included 5728 employees. The analyses were made by Poisson regression and the results are presented as rate ratios (RRs) and their 95% confidence intervals (CIs). RESULTS: Low maternal education was associated with self-certified sickness absence (RR 1.32, 95% CI 1.13-1.55) among women only whereas both low maternal (1.49, 1.26-1.77) and low paternal education (1.48, 1.32-1.67) were associated with medically-certified sickness absence. Adjustment for own occupational class mainly abolished these associations. Having experienced any childhood adversity was associated with self-certified (1.18, 1.12-1.25) and medically-certified (1.22, 1.15-1.30) sickness absence. In addition, childhood economic difficulties, childhood illness, parental divorce, parental mental illness, parental alcohol problems and bullying were each associated both with self-certified and with medically-certified sickness absence. The associations mainly remained after adjustments for occupational class, marital status, working condition, body mass index and health behaviours. CONCLUSIONS: Low parental education and childhood adversities contributed to midlife sickness absence. Promoting well-being of families with children might help sustain adult work ability and prevent sickness absence still in midlife.

Internet-delivered cognitive behavioral therapy (iCBT) for common mental disorders and subsequent sickness absence: a systematic review and meta-analysis.

AIM: The study aimed to critically review and synthesize the best available evidence about the effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (iCBT) in terms of reducing sickness absence (SA). METHODS: We searched Medline (PubMed), Embase, PsycInfo, CINAHL, and Cochrane Central (up to November 2020) for English language peer-reviewed papers that described randomized controlled trials of therapist-guided iCBT compared with usual treatment for SA in adults with common mental disorders. Eligible studies were assessed with the Cochrane Risk of Bias 1 tool, meta-analysis was conducted using a random-effects model, and standardized mean differences (SMD) with 95% confidence intervals (CI) were reported. A subgroup analysis investigated potential moderating variables (diagnosis, SA at baseline, and estimated accuracy of self-report). RESULTS: We identified 2788 references, of which 68 remained after the completion of the systematic screening process. A hand search of reference lists yielded no additional studies. The full texts of these 68 studies were appraised critically, and 11 were deemed to be suitable for a meta-analysis. SA was similar for iCBT and usual treatment groups (SMD: 0.02, 95% CI, -0.08 to 0.11), and remained similar even after the removal of two studies in which the recall time was over 3 months (SMD: 0.00, -0.11 to 0.12). Similar SA levels in intervention and control groups at 6-month and 12-month follow-up were observed in studies of participants with depression symptoms. CONCLUSIONS: iCBT did not appear to be effective in terms of reducing (largely self-assessed) SA in adults with common mental disorders. There is a need to improve the method and consistency of assessing SA.

Long-term sickness absence trajectories among ageing municipal employees - the contribution of social and health-related factors.

BACKGROUND: The ageing work force is heterogeneous, following distinct development in work ability. This study aims to identify trajectories of long-term sickness absence (SA) in later careers and to examine potentially modifiable factors associated with the development of SA. METHODS: Data comprised of municipal employees of the city of Helsinki aged 50-60 years during 2004-2018 (N = 4729, 80% women). The developmental trajectories of long-term (> 10 working days) SA were examined with Group-based trajectory modelling (GBTM) using SA records of the Social Insurance Institution of Finland during 2004-2018. All-cause and diagnosis-specific (mental disorder- and musculoskeletal disease-related) SA days were analysed. The association of social and health-related factors with trajectory membership was examined using multinomial logistic regression (odds ratios and 95% confidence intervals). RESULTS: A model with three trajectories was selected for both all-cause and diagnosis-specific SA. Regarding all-cause long-term SA trajectories, 42% had no long-term SA, 46% had low levels of SA, and 12% had a high rate of SA during follow-up. Lower occupational class, reporting smoking, overweight or obesity, moderate or low leisure-time physical activity, and sleep problems were associated with a higher likelihood of belonging to the trajectory with a high rate of SA in both all-cause and diagnosis-specific models. CONCLUSIONS: Most ageing employees have no or little long-term SA. Modifiable factors associated with trajectories with more SA could be targeted when designing and timing interventions in occupational healthcare.

Work-family conflicts and long-term medically certified sickness absence due to mental disorders - a follow-up study of female municipal employees.

BACKGROUND: . Decreased work ability due to mental disorders is a growing concern in Europe. We studied the role of work-family conflicts in association with long-term sickness absence due to mental disorders (LTSA-MD). METHODS: . Baseline data were extracted from the Helsinki Health Study for women aged 40 to 55 in full-time work in 2001 - 2002 (N = 2386). Questionnaire responses were linked with register data from the Social Insurance Institution of Finland on SA spells due to mental disorders during 2004-2010. We studied an overall question on satisfaction with combining work and family (WFS) and composite scores of work-to-family conflicts (WTFC) and family-to-work-conflicts (FTWC), and their components in association with the first certified SA spell (≥ 12 calendar days) due to a mental disorder during the follow-up. We performed Cox regression analyses with hazard ratios (HR) and their 95% confidence intervals (CI) adjusted for sociodemographic factors, work schedule, perceived mental and physical strenuousness at work, and self-rated health. First, we examined all participants, and second, only those who reported no prior mental disorder. RESULTS: . Poor work-family satisfaction (WFS) was associated with subsequent LTSA-MD, adjusting for all covariates (HR 1.60; 95% CI 1.10-2.16). Both high WTFC (1.64; 1.15-2.23), and high FTWC (1.43; 1.02-2.00) increased the probability of LTSA-MD in the full model. When participants with prior mental disorder were excluded, the association between poor WFS and WTFC with LTSA-MD retained while that between FTWC and LTSA-MD attenuated; however, two items of the FTWC were still associated with LTSA-MD: 'Family worries and problems distract you from your work' and 'Family matters prevent you from sleeping enough to do your job well'. Of the WTFC items, the following remained associated with LTSA-MD: 'Problems at work make you irritable at home' and 'Your job takes so much energy you do not feel up to doing things that need attention at home'. The experience of decreased time for work or family did not associate with LTSA-MD. CONCLUSIONS: . Among female municipal employees, dissatisfaction with combining work and family and both work-to-family and family-to-work conflicts were associated with subsequent long-term sickness absence due to mental disorders.

Time use, time pressure and sleep: is gender an effect modifier?

BACKGROUND: The gendered division of labour contributes to differences in the way time is spent and experienced by women and men. Time spent in paid and unpaid labour is associated with sleep outcomes, therefore, we examined (i) the relationships between time use and time pressure, and sleep, and (ii) whether these relationships were modified by gender. METHODS: Adults from the Household Income and Labour Dynamics in Australia survey were included in the analysis (N = 7611). Two measures of time use (total time commitments, ≥50% of time spent in paid work) were calculated based on estimates of time spent in different activities. One measure of time pressure was also included. Three sleep outcomes (quality, duration and difficulties) were examined. Logistic regression and effect measure modification analyses were employed. RESULTS: Total time commitments were associated with sleep duration, whereby more hours of total time commitments were associated with an increase in the odds of reporting <7 h sleep. Gender was an effect modifier of the association between ≥50% of time spent in paid work and (i) sleep duration on the multiplicative scale, and (ii) sleep difficulties on the multiplicative and additive scales. Men who spent <50% of time in paid work reported more sleep difficulties than men who spent ≥50% of time spent in paid work. Feeling time pressured was associated with poor sleep quality, short sleep duration and sleep difficulties. CONCLUSIONS: Time use and time pressure were associated with sleep, with some effects experienced differently for men and women.

Level of and Changes in Perceived Work Ability Among Partial Disability Pensioners and the Risk of Full Disability Pension-A Register-Linked Cohort Study.

PURPOSE: To examine how the level of perceived work ability and its changes over time are associated with the risk of full disability pension (DP) among those receiving partial DP. METHODS: We retrieved survey data on perceived work ability and covariates (sociodemographic factors and health behaviors) from a cohort study of Finnish public sector employees at two time points: 2008 and 2012 and linked them with register data on DP obtained from the Finnish Centre for Pensions up to the end of 2018. Participants had begun receiving partial DP in 2008 and responded to either the 2008 survey (n = 159) or both surveys (n = 80). We used Cox regression for the analyses. RESULTS: During the follow-up, 61 (38%) of those receiving partial DP transitioned to full DP. Those with perceived poor work ability were at a higher risk of full DP (HR 1.93; 95% CI 1.11-3.38) than those with at least moderate work ability, after adjustment for covariates. During four years of receiving partial DP, perceived work ability decreased among 36% of the participants, and remained unchanged or improved among 64%. Change in work ability was not associated with a risk of full DP. CONCLUSION: Among those receiving partial DP, perceived poor work ability was a risk factor for full DP. Our findings highlight the importance of monitoring the level of perceived work ability of those receiving partial DP to enable identifying individuals at an increased risk of full DP.

Contributions of childhood adversities to chronic pain among mid-life employees.

Aims: Chronic pain is a notable burden on public health, with past and present factors contributing to it. This study aimed to examine the associations between childhood adversities and chronic pain. Methods: Data on seven childhood adversities, chronic pain and disabling pain were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among 40- to 60-year-old employees (response rate of 67%) of the City of Helsinki, Finland. The study included 8140 employees (80% women). Logistic regression was used in the analyses, and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, sex, the father's education, the participant's education, marital status, working conditions, sleep problems and common mental disorders were included as covariates. Results: In the age-adjusted models, childhood economic difficulties (OR=1.60, 95% CI 1.41-1.81), childhood illness (OR=1.74, 95% CI 1.45-2.08), parental divorce (OR=1.26, 95% CI 1.07-1.48), parental alcohol problems (OR=1.34, 95% CI 1.18-1.52) and bullying at school or among peers (OR=1.59, 95% CI 1.37-1.89) were associated with chronic pain. Working conditions, sleep problems and common mental disorders each slightly attenuated the associations between childhood adversities and chronic pain. Childhood economic difficulties among women (OR=1.72, 95% CI 1.40-2.10), childhood illness (OR=1.40, 95% CI 1.07-1.82) and bullying at school or by peers (OR=1.91 95% CI 1.48-2.46) were also associated with disabling pain. Conclusions: Childhood adversities were associated with chronic pain in mid-life, and the associations mainly remained after adjustments. Investing in the well-being of children might prevent pain and promote well-being in mid-life.

Sickness absence and disability pension after carpal tunnel syndrome diagnosis: A register-based study of patients and matched references in Sweden.

Aims: The aim of this study was to examine sickness absence and disability pension (SA/DP) during working lifespan among individuals diagnosed with carpal tunnel syndrome (CTS) and their matched references, accounting for sociodemographic factors. Methods: We used a register cohort of 78,040 individuals aged 19-60 years when diagnosed with CTS in secondary health care (hospitals and outpatient specialist health care) and their 390,199 matched references from the general population in 2001-2010. Sociodemographic factors and SA/DP net days during a three-year follow-up were included. Negative binomial regression was used. Results: For those not on DP at inclusion, the average number of SA/DP days per person-year was 58 days (95% confidence interval (CI) 56-60 days) among individuals with CTS and 20 days (95% CI 19-21 days) among the matched references. Among both groups, these numbers increased with age and were higher among women than among men. The rate ratio (RR) of SA/DP days was threefold higher among people with CTS than among the matched references (adjusted RR=3.00, 95% CI 2.91-3.10) Moreover, compared to the matched references, the RR for SA/DP was higher among men with CTS (RR=3.86, 95% CI 3.61-4.13) than among women with CTS (RR=2.69, 95% CI 2.59-2.78). The association between CTS and the number of SA/DP days was smaller among older age groups. Sociodemographic factors were similarly associated with SA/DP among people with and without CTS. Conclusions: Numbers of SA/DP days were higher among people with CTS than their matched references in all age groups, particularly among individuals in their early work careers, highlighting public-health relevance of the findings.

Psychiatric and neurodevelopmental diagnoses in adolescence and adulthood over-indebtedness among Finns born in 1987.

BACKGROUND: Adolescence psychiatric and neurodevelopmental diagnoses are common but their link to adulthood over-indebtedness is unknown. This study aims to determine this relationship and explores the possible mediating role of upper secondary education completion. METHODS: We analyzed the 1987 Finnish Birth Cohort, which consisted of a complete census of children born in Finland in 1987 and registered in the Medical Birth Register (n = 53 743). Records of debt payment defaults, at the age of 33, were used as a measure of over-indebtedness. Adolescent psychiatric and neurodevelopmental diagnoses at ages 13-17 were derived from the national hospital discharge register. Inverse probability treatment weighting was used to investigate the role of pre-exposure variables in this relationship, and the mediating role of upper secondary education completion. RESULTS: Compared to unexposed individuals, those affected by an adolescent psychiatric or neurodevelopmental diagnosis had a 15 percentage points higher prevalence of over-indebtedness in adulthood. This association was more common for males and was additionally notably strong for suicidality and conduct and oppositional disorders. Controlling for measured potential confounding factors, the diagnoses were linked to a 11-percentage point (95% confidence interval 9-12) higher risk of over-indebtedness. Completing at least upper secondary education reduced this effect by some 39%. CONCLUSION: People with psychiatric and neurodevelopmental disorders diagnosed in adolescence are at elevated risk of over-indebtedness in adulthood. Recognizing this high risk may help in efforts to prevent further debt problems. Better education may serve as a protective factor against over-indebtedness and perhaps similar other behavioural consequences.

Trajectories of working hours in later careers and their association with social and health-related factors: a follow-up study.

BACKGROUND: The aim was to identify working hours' trajectories in later work careers over a follow-up of 15-17 years and to examine their association with social factors and health. METHODS: A subsample from the Helsinki Health Study was extracted comprising employees of the City of Helsinki, Finland. Growth mixture modelling was used to identify different working hour trajectories. Age, gender, occupational class, marital status, health behaviour, physical and mental functioning and current pain were associated with trajectory membership. Relative risks (RRs) and their 95% confidence intervals (CIs) were estimated. RESULTS: A two-trajectory model was selected: 'Stable regular working hours' (90%) and 'Shorter and varying working hours' (10%). Women (RR 1.40, 95% CI 1.09-1.78), the oldest employees (RR 2.71, 95% CI 2.06-3.57), managers and professionals (RR 1.56, 95% CI 1.20-2.02), those reporting non-drinker (RR 1.66, 95% CI 1.32-2.10), those reporting sleeping more than 8 h per night (RR 1.74 95% CI 1.25-2.42) and those reporting poor mental functioning (RR 1.39 95% CI 1.15-1.68) had higher likelihood of belonging to the trajectory 'Shorter and varying working hours'. There were no differences between the trajectories in marital status, smoking, body mass index, current pain or physical functioning. However, routine non-manual workers (RR 0.74, 95% CI 0.55-0.98), and semi-professionals (RR 0.70, 95% CI 0.50-0.96) had lower likelihood of belonging to this trajectory. CONCLUSIONS: Trajectories of working hours in later work career differ by age, gender and occupational class but also by health behaviours and mental health functioning.