Return to Work Following Hip or Knee Arthroplasty: A One-Year Prospective Cohort Study in Participants with Direct Referral from Hospital to Occupational Health Care Services.

PURPOSE: In a new Finnish Coordinated Return to Work (CRTW) model, patients are referred to occupational health care after hip or knee arthroplasty. This study evaluated the CRTW model's effect on return to work (RTW), activities used in occupational health care and in the workplace, and the patient- and work-related factors affecting early RTW. METHODS: 209 participants with occupational health care service underwent primary hip (THA) or total/unicondylar knee (KJA) arthroplasty and completed self-reported questionnaires after arthroplasty and at time of RTW. Factors affecting RTW, and the roles of occupational health care and the workplace in RTW were evaluated. Time to RTW was determined as days between the arthroplasty and RTW. RESULTS: Mean time to RTW was 69 days after THA and 87 days after KJA. For easing RTW, work arrangements were made for 56% of the participants. The most utilized adjustments of work were enabling remote work and arranging limitations in work tasks. Participants with earlier RTW had lower physical workload, higher professional status and motivation to work, less pre-arthroplasty sick leave, and more positive personal expectations about the time to RTW compared to participants with later RTW (p < 0.001 for all). The linear regression and dominance analyses showed participants' own expectations and pre-arthroplasty sick leave as the strongest factors affecting time to RTW. CONCLUSIONS: The CRTW model seems to shorten time to RTW after THA and KJA. Occupational health care and workplace play important roles in supporting RTW. Patients' own expectations should be noted when giving pre-arthroplasty information.

Stability in health behavior patterns in middle adulthood: a 19-year follow-up study.

Objective: This study investigated subgroups of adults with particular health behavior patterns, their stability over 19 years, and the role of sociodemographic and personality characteristics in these.Methods and Measures: Data on smoking, alcohol consumption, and physical activity were collected at ages 42, 50, and 61 in the Jyväskylä Longitudinal Study of Personality and Social Development (n = 205-302). Latent class, latent transition, and logistic regression analyses were used.Results: Four similar classes of health behaviors were identified at each age. A class named low alcohol consumption (AC)-high physical activity (PA) included individuals with the lowest levels of alcohol consumption and the highest levels of physical activity, and a class named high AC-low PA vice versa. Classes between these extremes of alcohol consumption and physical activity levels were nonsmokers with the lowest proportion of smokers, and smokers vice versa. Although transitions emerged, class memberships were relatively stable. Women, those who were married, held a degree, had higher occupational status, and certain personality traits at age 42 were more likely to belong continuously to healthier classes compared to a stable membership in high AC-low PA.Conclusion: Health behaviors exist in patterns, are relatively stable across adulthood, and associated with sociodemographic and personality characteristics.

Longitudinal associations between emotional well-being and subjective health from middle adulthood to the beginning of late adulthood.

OBJECTIVE: Emotional well-being may predict future health and vice versa. We examined the reciprocal associations between emotional well-being and subjective health from age 36 to 61. METHODS AND MEASURES: The data were drawn from the Jyväskylä Longitudinal Study of Personality and Social Development and included information from 36-, 42-, 50- and 61-year-olds (N = 336). The emotional well-being indicators included life satisfaction and negative and positive mood. The subjective health indicators were self-rated health and psychosomatic symptoms. The analyses were conducted with random intercept cross-lagged panel models. RESULTS: Within-person cross-lagged associations were found between emotional well-being and subjective health. Fewer psychosomatic symptoms at ages 36 and 50 predicted higher life satisfaction at ages 42 and 61, respectively. A lower negative mood at age 42 and a higher positive mood at age 50 predicted fewer psychosomatic symptoms at 50 and 61, respectively. Conversely, a higher negative mood at ages 36 and 50 predicted better self-rated health at ages 42 and 61, respectively. CONCLUSION: The relationship between emotional well-being and subjective health appears to be reciprocal. Both emotional well-being and subjective health predicted each other even 6-11 years later. However, associations may depend on the variables and age periods investigated.

Effects of an individually targeted multicomponent counseling and home-based rehabilitation program on physical activity and mobility in community-dwelling older people after discharge from hospital: a randomized controlled trial.

OBJECTIVES: The aim of this study is to evaluate the effects of multicomponent rehabilitation on physical activity, sedentary behavior, and mobility in older people recently discharged from hospital. DESIGN: Randomized controlled trial. SETTING: Home and community. PARTICIPANTS: Community-dwelling people aged ⩾60 years recovering from a lower limb or back musculoskeletal injury, surgery, or disorder were recruited from local health center hospitals and randomly assigned into an intervention (n = 59) or a control (standard care, n = 58) group. INTERVENTION: The six-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counseling, and standard care. MEASUREMENTS: Physical activity and sedentary time were assessed using an accelerometer and a single question. Mobility was evaluated with the Short Physical Performance Battery, self-reported use of a walking aid, and ability to negotiate stairs and walk outdoors. Intervention effects were analyzed with generalized estimating equations. RESULTS: Daily physical activity was 127 ± 78 minutes/day and 121 ± 70 at baseline and 167 ± 81 and 164 ± 72 at six months in the intervention and control group, respectively; mean difference of 3.4 minutes (95% confidence interval (CI) = -20.3 to 27.1). In addition, no significant between-group differences were shown in physical performance. CONCLUSION: The rehabilitation program was not superior to standard care for increasing physical activity or improving physical performance. Mobility-limited older people who had recently returned home from hospital would have needed a longer and more frequently monitored comprehensive geriatric intervention.

Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: randomized controlled pilot trial.

BACKGROUND: Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training. OBJECTIVE: The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices. METHODS: This pilot study design was a small-scale randomized controlled trial that compared the P4Well intervention with a waiting list control group. In addition to personal health technologies for self-assessment, the intervention consisted of 3 psychologist-assisted group meetings. Self-assessed psychological measures through questionnaires were collected offline pre- and post-intervention, and 6 months after the intervention for the intervention group. Acceptance and usage of technology tools were measured with user experience questionnaires and usage logs. RESULTS: A total of 24 subjects were randomized: 11 participants were followed up in the intervention group (1 was lost to follow-up) and 12 participants did not receive any intervention (control group). Depressive and psychological symptoms decreased and self-rated health and working ability increased. All participants reported they had benefited from the intervention. All technology tools had active users and 10/11 participants used at least 1 tool actively. Physiological measurements with personal feedback were considered the most useful intervention component. CONCLUSIONS: Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms, self-rated health, and self-rated working ability. The intervention seemed to have a positive impact on certain aspects of burnout and job strain, such as cynicism and over-commitment. Future studies need to investigate the effectiveness, benefits, and possible problems of psychological interventions which incorporate new technologies. TRIAL REGISTRATION: The Finnish Funding Agency for Technology and Innovation (TEKES), Project number 40011/08.

Personality profiles and health: longitudinal evidence among Finnish adults.

This study investigates the associations of longitudinal Big Five personality profiles with long-term health in 304 adults (53% males). Personality traits (Neuroticism, Extraversion, Openness, Conscientiousness, Agreeableness) were assessed at ages 33, 42, and 50. Subjective (self-rated health, symptoms, psychological distress) and objective (body mass index, waist-to-hip ratio, blood pressure, cholesterol, triglycerides) indicators of health were measured at ages 42 and 50. Five longitudinally stable personality profiles were extracted over 17 years by latent profile analysis. The levels of traits were the same in each profile at each age. Resilient individuals (N = 65; Neuroticism low, other traits high) had the best subjective health and Overcontrolled individuals (N = 40; Neuroticism high, other traits low) the poorest health over eight years. Reserved individuals (N = 25; high Conscientiousness, other traits low), Undercontrolled (N = 41; high Openness and Extraversion, low Conscientiousness), and Ordinary (N = 133; all traits scored medium) individuals were in the middle of these extremes in subjective health. No differences between the profiles were found in the objective indicators of health. Thus, overcontrol and resilience were most discriminative in terms of good health. Moreover, personality profiles revealed associations with health to be more nuanced than simply being composed of single traits. High Extraversion needed to be combined with high Conscientiousness (Resilients) in order to be associated with the best health; high Extraversion with low Conscientiousness (Undercontrolled) was associated with average health; and low Extraversion with high Neuroticism (Overcontrolled) was associated with the poorest health.

Effects of exercise intensity and duration on nocturnal heart rate variability and sleep quality.

Acute physical exercise may affect cardiac autonomic modulation hours or even days during the recovery phase. Although sleep is an essential recovery period, the information on nocturnal autonomic modulation indicated by heart rate variability (HRV) after different exercises is mostly lacking. Therefore, this study investigated the effects of exercise intensity and duration on nocturnal HR, HRV, HR, and HRV-based relaxation, as well as on actigraphic and subjective sleep quality. Fourteen healthy male subjects (age 36 ± 4 years, maximal oxygen uptake 49 ± 4 ml/kg/min) performed five different running exercises on separate occasions starting at 6 p.m. with HR guidance at home. The effect of intensity was studied with 30 min of exercises at intensities corresponding to HR level at 45% (easy), 60% (moderate) and 75% (vigorous) of their maximal oxygen uptake. The effect of duration was studied with 30, 60, and 90 min of moderate exercises. Increased exercise intensity elevated nocturnal HR compared to control day (p < 0.001), but it did not affect nocturnal HRV. Nocturnal HR was greater after the day with 90- than 30- or 60-min exercises (p < 0.01) or control day (p < 0.001). Nocturnal HRV was lower after the 90-min exercise day compared to control day (p < 0.01). Neither exercise intensity nor duration had any impact on actigraphic or subjective sleep quality. The results suggest that increased exercise intensity and/or duration cause delayed recovery of nocturnal cardiac autonomic modulation, although long exercise duration was needed to induce changes in nocturnal HRV. Increased exercise intensity or duration does not seem to disrupt sleep quality.

Effects of vigorous late-night exercise on sleep quality and cardiac autonomic activity.

Sleep is the most important period for recovery from daily load. Regular physical activity enhances overall sleep quality, but the effects of acute exercise on sleep are not well defined. In sleep hygiene recommendations, intensive exercising is not suggested within the last 3 h before bed time, but this recommendation has not been adequately tested experimentally. Therefore, the effects of vigorous late-night exercise on sleep were examined by measuring polysomnographic, actigraphic and subjective sleep quality, as well as cardiac autonomic activity. Eleven (seven men, four women) physically fit young adults (VO(2max) 54±8 mL·kg(-1)·min(-1) , age 26±3 years) were monitored in a sleep laboratory twice in a counterbalanced order: (1) after vigorous late-night exercise; and (2) after a control day without exercise. The incremental cycle ergometer exercise until voluntary exhaustion started at 21:00±00:28 hours, lasted for 35±3 min, and ended 2:13±00:19 hours before bed time. The proportion of non-rapid eye movement sleep was greater after the exercise day than the control day (P<0.01), while no differences were seen in actigraphic or subjective sleep quality. During the whole sleep, no differences were found in heart rate (HR) variability, whereas HR was higher after the exercise day than the control day (54±7 versus 51±7, P<0.01), and especially during the first three sleeping hours. The results indicate that vigorous late-night exercise does not disturb sleep quality. However, it may have effects on cardiac autonomic control of heart during the first sleeping hours.

A concept to empower self-management of psychophysiological wellbeing: preliminary user study experiences.

In prevention of chronic diseases, health promotion and early interventions based on self-management should be emphasized. Mental health problems and stress cause a significant portion of healthcare costs, and also complicate the management of other chronic conditions. In addition to physical health, psychophysiological and social wellbeing should be equally promoted. Thus, we have previously designed and reported the P4Well or Pervasive Personal and PsychoPhysiological management of WELLness concept for working-age citizens. The concept supports the stress and recovery management on a daily basis through improved health management strategies, and combines psychological methods with personal health technologies. In this paper, we discuss the preliminary user study experiences of ongoing evaluations with two different user groups consisting of: 1) middle-aged men who are using the concept for managing their mental wellbeing or mild depression; and 2) entrepreneurs who are using the concept for coping with stress. Our results provide a preliminary assessment of the role and importance of experts, technologies, and peer-support in the concept.

A new heart rate variability-based method for the estimation of oxygen consumption without individual laboratory calibration: application example on postal workers.

Traditionally, the estimation of oxygen consumption (VO2) at work using heart rate (HR) has required the determination of individual HR/VO2 calibration curves in a separate exercise test in a laboratory (VO2-TRAD). Recently, a new neural network-, and heart rate variability-based method has been developed (Firstbeat PRO heartbeat analysis software) for the estimation of VO2 without individual calibration (VO2-HRV). In the present study, the VO2-values by the VO2-HRV were compared with the values by VO2-TRAD in 22 postal workers. Within individuals the correlation between the two methods was high (range 0.80-0.99). The VO2-TRAD gave higher values of VO2 compared to VO2-HRV (19%) especially during low physical activity work when non-metabolic factors may increase HR. When assessed in different HR categories, the smallest difference (11%), and highest correlations (range 0.83-0.99) in VO2 between the methods were observed at higher HR levels. The results indicate that the VO2-HRV is a potentially useful method to estimate VO2 in the field without laboratory calibration.

The factor structure and factorial invariance of the 12-item General Health Questionnaire (GHQ-12) across time: evidence from two community-based samples.

This study provides new knowledge about the factor structure of the 12-item General Health Questionnaire (GHQ-12; D. Goldberg, 1972) through the application of confirmatory factor analysis to longitudinal data, thereby enabling investigation of the factor structure, its invariance across time, and the rank-order stability of the factors. Two community-based longitudinal adult samples with 1-year (n = 640) and 6-year (n = 330) follow-up times were studied. As a result, the correlated 3-factor model (i.e., Anxiety/Depression, Social Dysfunction, and Loss of Confidence) showed a better fit with both samples than the alternative models. The correlated 3-factor structure was also relatively invariant across time in both samples, indicating that the scale has good construct validity. The rank-order stabilities of the factors were low across time, which suggests that the GHQ-12 measures temporal mental state.

The associations of emotion regulation and dysregulation with the metabolic syndrome factor.

OBJECTIVE: Emotion regulation has been associated with good, and dysregulation with poor subjective health; but it is unclear if emotion regulation is related to metabolic syndrome. METHODS: Associations between the metabolic syndrome factor (systolic and diastolic blood pressure, waist circumference, high-density lipoprotein, triglycerides, and glucose), emotion regulation (the strategies of repair and maintenance, self-perceived emotion regulation) and dysregulation (emotional ambivalence); and subjective health (self-rated health and psychosomatic symptoms) were studied using a structural equation modelling (SEM) approach. The participants (96 women, 85 men) were drawn from the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS). RESULTS: High repair was associated directly to the low metabolic syndrome factor, while high maintenance, high self-perceived emotion regulation, and low emotional ambivalence were related indirectly to the low metabolic syndrome factor through good subjective health. CONCLUSIONS: Successful emotion regulation may have an association not only with the subjective experience of health, but also with physiological regulation systems, leading to a reduced risk for metabolic syndrome.

Contribution of early and adult factors to socioeconomic variation in blood pressure: thirty-four-year follow-up study of school children.

OBJECTIVE: To prospectively examine the role of childhood and adulthood factors in the association between socioeconomic status (SES) and adult systolic and diastolic blood pressure (SBP, DBP). METHODS: One hundred and five boys and 101 girls who were 8 years of age at entry into the study were observed for 34 years in the Jyväskylä Longitudinal Study of Personality and Social Development, Finland. Data were gathered on educational attainment and occupational status, as indicators of SES, and potential explanatory factors related to 0, (14), 27, 36, and 42 years of age. SBP and DBP were assessed at 15 and 42 years of age. RESULTS: In a structural equation model adjusted for sex and childhood SBP, educational attainment was inversely associated with adult SBP (structural coefficient -0.17, p<.05). Incorporating the effects of parental SES and adult body mass index into the model attenuated this association so that it was no longer significant. Variation in birth weight, unemployment, smoking, alcohol consumption, and use of antihypertensive medication had marginal or no impact on the education-SBP association. No socioeconomic variation was found for DBP or occupational status. CONCLUSIONS: Prospective evidence suggests a weak association between low educational attainment and development of high SBP. Parental SES and adult BMI were the key explanatory factors for this association.