Evidence on bringing specialised care to the primary level-effects on the Quadruple Aim and cost-effectiveness: a systematic review.

BACKGROUND: To achieve the Quadruple Aim of improving population health, enhancing the patient experience of care, reducing costs and improving professional satisfaction requires reorganisation of health care. One way to accomplish this aim is by integrating healthcare services on different levels. This systematic review aims to determine whether it is cost-effective to bring a hospital specialist into primary care from the perspectives of commissioners, patients and professionals. METHODS: The review follows the PRISMA guidelines. We searched PubMed, Scopus and EBSCO (CINAHL and Academic Search Ultimate) for the period of 1992-2022. In total, 4254 articles were found, and 21 original articles that reported on both quality and costs, were included. The JBI and ROBINS-I tools were used for quality appraisal. In data synthesis, vote counting and effect direction plots were used together with a sign test. The strength of evidence was evaluated with the GRADE. RESULTS: Cost-effectiveness was only measured in two studies, and it remains unclear. Costs and cost drivers for commissioners were lower in the intervention in 52% of the studies; this proportion rose to 67% of the studies when cost for patients was also considered, while health outcomes, patient experience and professional satisfaction mostly improved but at least remained the same. Costs for the patient, where measured, were mainly lower in the intervention group. Professional satisfaction was reported in 48% of the studies; in 80% it was higher in the intervention group. In 24% of the studies, higher monetary costs were reported for commissioners, whereas the clinical outcomes, patient experience and costs for the patient mainly improved. CONCLUSIONS: The cost-effectiveness of the hospital specialist in primary care model remains inconclusive. Only a few studies have comprehensively calculated costs, evaluating cost drivers. However, it seems that when the service is well organised and the population is large enough, the concept can be profitable for the commissioner also. From the patient's perspective, the model is superior and could even promote equity through improved access. Professional satisfaction is mostly higher compared to the traditional model. The certainty of evidence is very low for cost and low for quality. TRIAL REGISTRATION: PROSPERO CRD42022325232, 12.4.2022.

Multidisciplinary management of persistent pain in primary care-A systematic review.

BACKGROUND AND OBJECTIVE: A multidisciplinary approach is the gold standard in the management of persistent pain and is current practice in tertiary pain clinics. However, such approaches seem to be a rarity in primary care, although pain is the most common reason for visiting a primary care physician. A comprehensive systematic review was conducted to explore whether studies on multidisciplinary management programs for persistent pain exist in primary care. DATABASES AND DATA TREATMENT: PubMed, Ovid MEDLINE, Scopus, CINAHL, and PsychINFO were searched from inception to October 2022, and supplementary research was conducted in June 2023. Screening, data extraction, and quality assessment were independently carried out by two researchers. The inclusion criteria were (1) adult patients (age >18 years); (2) non-cancer pain, persisting over 3 months; (3) multidisciplinary intervention (treatment included ≥3 heathcare professionals); (4) intervention conducted in a primary care setting; and (5) reports published in English. RESULTS: Of the 1250 initially identified studies, 17 were selected for final analysis. Only studies reporting empirical data were included (cohort, case-control, randomized controlled trial, and observational). The study settings and intervention characteristics showed great heterogeneity. The primary care practices also varied across different countries and cultures. Overall, the quality of the studies was rather low and sample sizes were relatively small. CONCLUSIONS: The review revealed that studies about such treatment interventions for persistent pain patients are scarce. The existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. Future studies are urgently needed. SIGNIFICANCE: Persistent pain is a growing challenge to the health care system, and most patients are treated in primary care. The biopsychosocial concept is the basis for the multidisciplinary management of pain. The review revealed that studies about treatment interventions for persistent pain patients are scarce. Existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. There is an urgent need for further studies on systematic multidisciplinary treatment protocols for managing persistent pain in primary care.

Family structure and multisite musculoskeletal pain in adolescence: a Northern Finland Birth Cohort 1986 study.

BACKGROUND: Family structure is suggested to be associated with adolescent pain, but evidence on its association with multisite MS pain is sparse. The purpose of this cross-sectional study was to investigate the potential associations between family structure ('single-parent family', 'reconstructed family', and 'two-parent family') and multisite musculoskeletal (MS) pain in adolescence. METHODS: The dataset was based on the 16-year-old Northern Finland Birth Cohort 1986 adolescents with available data on family structure, multisite MS pain, and a potential confounder (n = 5,878). The associations between family structure and multisite MS pain were analyzed with binomial logistic regression and modelled as unadjusted, as the evaluated potential confounder, mother's educational level, did not meet the criteria for a confounder. RESULTS: Overall, 13% of the adolescents had a 'single-parent family' and 8% a 'reconstructed family'. Adolescents living in a single-parent family had 36% higher odds of multisite MS pain compared to adolescents from two-parent families (the reference) (Odds Ratio [OR]: 1.36, 95% Confidence Interval [CI]: 1.17 to 1.59). Belonging to a 'reconstructed family' was associated with 39% higher odds of multisite MS pain (OR 1.39, 1.14 to 1.69). CONCLUSION: Family structure may have a role in adolescent multisite MS pain. Future research is needed on causality between family structure and multisite MS pain, to establish if there is a need for targeted support.

Chronic disease clusters are associated with prolonged, bothersome, and multisite musculoskeletal pain: a population-based study on Northern Finns.

BACKGROUND: Chronic diseases often accumulate with musculoskeletal (MSK) pain. However, less evidence is available on idiosyncratic patterns of chronic diseases and their relationships with the severity of MSK pain in general MSK pain populations. MATERIAL AND METHODS: Questionnaire-based data on physician-diagnosed chronic diseases, MSK pain and its dimensions (frequency, intensity, bothersomeness, and the number of pain sites), and confounders were collected from the Northern Finland Birth Cohort 1966 at the age of 46. Latent Class Analysis (LCA) was used to identify chronic disease clusters among individuals who reported any MSK pain within the previous year (n = 6105). The associations between chronic disease clusters, pain dimensions, and severe MSK pain, which was defined as prolonged (over 30 d within the preceding year), bothersome (Numerical Rating Scale >5), and multisite (two or more pain sites) pain, were analyzed using logistic regression and general linear regression models, adjusted for sex and educational level (n for the full sample = 4768). RESULTS: LCA resulted in three clusters: Metabolic (10.8% of the full sample), Psychiatric (2.9%), and Relatively Healthy (86.3%). Compared to the Relatively Healthy cluster, the Metabolic and Psychiatric clusters had higher odds for daily pain and higher mean pain intensity, bothersomeness, and the number of pain sites. Similarly, the odds for severe MSK pain were up to 75% (95% confidence interval: 44%-113%) and 155% (81%-259%) higher in the Metabolic and Psychiatric clusters, respectively, after adjustments for sex and educational level. CONCLUSIONS: Distinct patterns of chronic disease accumulation can be identified in the general MSK pain population. It seems that mental and metabolic health are at interplay with severe MSK pain. These findings suggest a potential need to screen for psychiatric and metabolic entities of health when treating working-aged people with MSK pain.Key messagesThis large study on middle-aged people with musculoskeletal pain aimed to examine the idiosyncratic patterns of chronic diseases and their relationships with the severity of musculoskeletal pain. Latent class cluster analysis identified three chronic disease clusters: Psychiatric, Metabolic, and Relatively Healthy. People with accumulated mental (Psychiatric cluster) or metabolic diseases (Metabolic cluster) experienced more severe pain than people who were relatively healthy (Relatively Healthy cluster). These findings suggest a potential need to screen for psychiatric and metabolic entities of health when treating working-aged people with MSK pain.

Accumulation of long-term diseases is associated with musculoskeletal pain dimensions among middle-aged individuals with musculoskeletal pain.

BACKGROUND: Long-term diseases often co-occur with musculoskeletal (MSK) pain. In middle-aged individuals with MSK pain, it remains unclear whether an accumulation (two or more) of long-term diseases is associated with MSK pain dimensions, including pain frequency, bothersomeness of pain, pain intensity and number of pain sites. METHODS: This cross-sectional study included data from the Northern Finland Birth Cohort 1966 collected in 2012-2014 when the participants were 46 years of age. We included participants who reported having MSK pain during the previous year (collected retrospectively) and provided self-reported information related to MSK pain dimensions, long-term diseases and potential confounders (n = 4469). The association between long-term diseases and pain dimensions was modelled by general linear and logistic regression models, with beta (ß) coefficients, odds ratios (ORs) and their 95% confidence intervals (CIs) being presented. Unadjusted models were followed by models adjusted for sex, educational level and smoking. RESULTS: The presence of accumulated long-term diseases was associated with over two-fold higher odds of daily pain (adjusted OR 2.6, 95% CI 2.0-3.4) and significantly higher levels of bothersomeness of pain and pain intensity (adjusted ß 1.1, 95% CI 0.9-1.4; adjusted ß 1.0, 95% CI 0.8-1.1, respectively), relative to the absence of long-term diseases. Females with accumulated long-term diseases had a stronger relationship to number of pain sites than males. Associations between one long-term disease and pain dimensions were significant but smaller in magnitude. CONCLUSION: There is a need for a better understanding of the relationships between accumulated long-term diseases and MSK pain. SIGNIFICANCE: This study on middle-aged individuals with musculoskeletal pain showed that the presence of long-term diseases was clearly associated with pain frequency, bothersomeness of pain, pain intensity and number of pain sites. Compared with no long-term diseases, the association between accumulated (two or more) long-term diseases and pain dimensions was stronger than the association between one long-term disease and pain dimensions.

The effects of mandatory home quarantine on mental health in a community sample during the COVID-19 pandemic.

OBJECTIVE: Major public and scientific interest exists on, whether quarantine as a containment measure, could have adverse effects on individual's mental health. We investigated psychic well-being and distress, symptoms of depression and anxiety among individuals imposed to home quarantine. METHODS: By total population sampling in a Finnish suburban city, a total of 57 quarantined cases (participation rate 97%) were identified and followed up for two weeks until expiration of the quarantine. A randomized control group (n = 53) was formed of people seeking laboratory testing for suspected Sars-CoV-2 infection. Primary outcome was the psychic well-being and distress experienced during quarantine measured by the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM). The cases were followed up by the Clinical Outcomes in Routine Evaluation-10 (CORE-10), Patient Health Questionnaire-9 (PHQ-9), and by the Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS: The median CORE-OM score for the cases was 3.53 (95% CI: 2.23-4.66), and for the controls 3.24 (1.76-3.82), being mostly in the nonclinical to mild range. The difference between the groups was statistically nonsignificant (p = .19). Higher levels of psychic distress were explained by previous psychiatric disorders and living alone, but not having been quarantined. In comparison to controls, the quarantined participants experienced significantly, but slightly lower level of life functioning. At the follow-up, the quarantined participants rated further low on the CORE-10 (median 2.00; 95% CI: 1.00-3.00), the PHQ-9 (1.50; 0.00-3.00), and the OASIS (0.00; 0.00-0.00). CONCLUSIONS: The distress associated with short-term home quarantine may not be to the degree of a mental disorder.

Determinants of responsiveness to multidisciplinary chronic pain management interventions: protocol for a systematic review and meta-analysis.

INTRODUCTION: The current manuscript presents a protocol for a systematic review and meta-analysis of the evidence regarding the determinants of responsiveness to multidisciplinary management of chronic pain, with pain intensity, pain-related interference, physical functioning and health-related quality of life as the main outcomes, with consideration to multiple secondary outcomes. METHODS AND ANALYSIS: To identify relevant studies, the Ovid MEDLINE, PubMed, Ovid PsycINFO, EBSCO CINAHL and Scopus databases will be searched for all studies exploring factors associated with responsiveness to multidisciplinary pain management from study inception to the present. Cohorts, case-control studies and randomised controlled trials will be included. Independent screening for eligible studies will be completed by a total of four researchers using defined criteria. Data extraction will be executed by two researchers. Study heterogeneity will be estimated using the I2 index. A meta-analysis will be performed using random effects models. Publication bias will be evaluated by means of funnel plots and Egger's test. ETHICS AND DISSEMINATION: The proposed study does not involve collection of primary data. Therefore, no ethical approval is required. The results of the systematic review and meta-analysis will be presented in a peer-reviewed journal and at conferences. PROSPERO REGISTRATION NUMBER: CRD42021236424.

Early Childhood Growth and Risk of Adult Cerebrovascular Disease: The NFBC1966.

BACKGROUND: Low birth weight is associated with an increased risk of adulthood cerebrovascular disease (CVD). Not much is known about effects of early childhood growth. We studied whether the risk of adult CVD is associated with growth or nutritional factors during early childhood. METHODS: Within the Northern Finland Birth Cohort 1966, 11 991 persons were followed from birth to 52 years of age. CVD diagnoses were extracted from national hospital and death registers with diagnostic coding based on the World Health Organization recommendations. Cox proportional hazard models were used to estimate associations of childhood growth variables, growth trajectories (by Latent Class Growth Modeling), and nutritional factors with adult CVD, for example, ischemic and hemorrhagic strokes. The analyses were adjusted for childhood socioeconomic status and birth weight. RESULTS: A total of 453 (3.8%) CVDs were recorded during follow-up. Among females, groups with low early childhood weight and height had an increased risk for adulthood ischemic CVDs, with an adjusted hazard ratio of 1.97 (95% CI, 1.21-3.20) and 2.05 (CI, 1.11-3.81), respectively. In addition, females with body mass index over 1 SD at body mass index rebound had an increased risk for ischemic CVDs (adjusted hazard ratio, 1.90 [CI, 1.19-3.04]) compared with females with body mass index -1 to +1 SD. These associations were not found among males. CONCLUSIONS: The findings suggest that timing of weight gain during childhood is of significance for development of CVD risk among females.

Chronotypes and disabling musculoskeletal pain: A Finnish birth cohort study.

BACKGROUND: It has been suggested that chronotype, the individual preference for 24-h circadian rhythms, influences health. Sleep problems and mental distress are amongst the greatest risk factors for musculoskeletal (MS) pain. The aims of this study were first, to explore the associations between chronotypes and MS pain, with special reference to disabling MS pain and second, to test whether mental distress and insomnia have a modifying role in the associations between chronotypes and MS pain. METHODS: The dataset of 4961 individuals was composed of Northern Finns surveyed on MS pain, chronotypes and confounding factors (sex, insomnia, sleep duration, smoking, mental distress, occupational status, education level and number of coexisting diseases) at 46 years. The relationships between chronotypes (evening [E], intermediate [I] and morning [M]) and MS pain were evaluated using multinomial logistic regression. To address the second aim, we included an interaction term (chronotype*mental distress, chronotype*insomnia) in the logistic model. RESULTS: Compared to the M-types, both the E- and I-types had increased odds of suffering 'disabling pain' in the unadjusted model (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.37-2.33; OR 1.54, 95% CI 1.29-1.84, respectively). However, the association remained statistically significant only after adjusting for all covariates amongst the I-types (OR 1.39, 95% CI 1.15-1.67). Neither mental distress nor insomnia was found to modify the chronotype-MS pain association. CONCLUSIONS: The results highlight the importance of chronotypes for individuals' MS health but suggest the presence of confounding factors in the interplay between these factors. SIGNIFICANCE: This study shows that evening and intermediate chronotypes are associated with disabling MS pain, but that mental distress, insomnia and coexisting diseases also play a role in these associations.

Eveningness intensifies the association between musculoskeletal pain and health-related quality of life: a Northern Finland Birth Cohort Study 1966.

ABSTRACT: People with an evening (E)-type preference (ie, chronotype) experience musculoskeletal (MSK) pain and reduced health-related quality of life (HRQoL) more often than morning (M) types. Musculoskeletal pain is a well-established contributor to reduced HRQoL. This study aimed to evaluate whether eveningness amplifies the association between MSK pain and HRQoL in contrast to morningness. Questionnaire data on MSK pain dimensions (intensity, disability at work, number of pain sites [NPSs], and frequency), chronotype, covariates (sex, sufficiency of sleep duration, mental distress, and presence of coexisting diseases), and HRQoL (measured by 15D) were collected among 46-year-old individuals belonging to the Northern Finland Birth Cohort 1966 (N = 4257). Individuals without any MSK pain were excluded. General linear models were conducted to estimate the associations between chronotypes, MSK pain dimensions, and HRQoL. The interaction terms (chronotype × pain dimension) were tested in the models. There were 13% E-types and 43% M-types in the study sample. Each pain dimension and chronotype were related to HRQoL. In the sex-adjusted chronotype-specific models, the reduction in HRQoL in relation to pain appeared to be stronger among E-types than among M-types in respect to all pain dimensions. After adjustments, this was particularly seen in terms of NPS and pain frequency. Our findings suggest that eveningness intensifies the association between MSK pain and HRQoL, and, thus, they are indicative of E-types being more sensitive than M-types to the consequences of MSK pain. As such, MSK pain treatment and rehabilitation actions to improve HRQoL should be especially targeted at E-types.

Cerebrovascular disease at young age is related to mother's health during the pregnancy-The Northern Finland Birth Cohort 1966 study.

BACKGROUND AND PURPOSE: For prevention of cerebrovascular diseases at younger age, it is important to understand the risk factors occurring early in life. We investigated the relationship between mothers' general health during pregnancy and the offspring's risk of cerebrovascular disease in age of 15 to 52 years. METHODS: Within the population-based prospective Northern Finland Birth Cohort 1966, 11,926 persons were followed from antenatal period to 52 years of age. Information on their mother's ill health conditions, i.e., hospitalizations, chronic diseases, medications, vitamin or iron supplement, fever, anemia, mood, and smoking was collected from 24th gestational week onwards. Ischemic and hemorrhagic cerebrovascular diseases of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of mother's health conditions with incidence of cerebrovascular disease in the offspring, with adjustments for potential confounders. RESULTS: During 565,585 person-years of follow-up, 449 (2.8%) of the offspring had a cerebrovascular disease. Hospitalization during pregnancy was associated with an increased risk of cerebrovascular disease in the offspring (hazard ratio (HR) = 1.49; 95% confidence interval (CI) 1.06-2.08) after adjustment for confounders, as was having more than three ill health conditions (HR = 1.89; CI 1.14-3.11). Not using vitamin or iron supplement was associated with increased risk for cerebrovascular disease in the offspring (HR = 1.39; CI 1.01-1.89). CONCLUSIONS: The results suggest that the risk of cerebrovascular disease may start as early as during the antenatal period, and the health characteristics of mothers during pregnancy may play a role in cerebrovascular disease risk of the offspring.

Association of temporomandibular disorders with pain sensitivity: A cohort study.

BACKGROUND: Pain related to temporomandibular disorders (TMD) can be linked with multiple site pain (MSP), and may associate with increased pain sensitivity, more frequently among women than men. The aim of the study was to examine the associations of pressure pain threshold (PPT) and tolerance (PPTo) with TMD and associated MSP in the Northern Finland Birth Cohort 1966 (NFBC1966) study. METHODS: Altogether 1961 NFBC1966 subjects attended clinical medical and dental examination at the Institute of Dentistry, University of Oulu in 2012-2013. Clinical examinations were carried out using a modified Diagnostic Criteria for TMD protocol (DC/TMD). MSP was defined based on questions regarding body pain sites. Additionally, PPT and PPTo were assessed using algometer measurements. Mann-Whitney U-test and Tobit regression models were used to analyse associations between TMD sub-diagnoses, MSP, PPT and PPTo, stratified by sex. Further models were adjusted with anxiety and depressive symptoms, which were assessed using Hopkins Symptom Checklist-25 (HSCL-25) and two-way interaction terms. RESULTS: Among females, lower PPT and PPTo were associated with myalgia and arthralgia. Among males, lower PPT and PPTo were associated with MSP-linked TMD. Tobit regression analysis showed significantly lower PPT and PPTo values in the myalgia and arthralgia subgroups among female TMD subjects. Among females, disc displacement with reduction had an inverse association with PPT and PPTo. Among males, lower PPTo was associated with degenerative joint disease and MSP-linked TMD. CONCLUSIONS: The pain regulatory mechanisms behind TMD act differently between the genders as local TMD among females and MSP-linked TMD among males were associated with pain sensitivity. SIGNIFICANCE: The study shows that there are differences in the associations of painful TMD with pressure pain tolerance, pressure pain sensitivity and MSP between male and female subjects.

Maternal smoking trajectory during pregnancy predicts offspring's smoking and substance use - The Northern Finland birth cohort 1966 study.

The aim was to characterize the association of maternal smoking trajectory during pregnancy with offspring's smoking, alcohol and substance use behavior. We used the prospective Northern Finland Birth Cohort 1966 study including 11,653 mothers and their offspring followed up from mothers' mid-pregnancy to age of 46 years. Main exposure was number of smoked cigarettes per day at each month of pregnancy. Outcome measures were offspring's smoking, alcohol and drug use at age 14, starting age of smoking, ever-smoking, and smoked pack-years until age 46. Four maternal smoking trajectories during pregnancy were identified with latent class trajectory modelling, namely "non-smokers" (86.0% of mothers), "early quitters" (2.0%), "late quitters" (2.1%), and "consistent smokers" (9.9%). In comparison to non-smokers, all maternal smoking was associated with offspring's increased odds of lifetime smoking adjusted for sex of the child, father's smoking, occupational status and place of residence of family, marital status and mood of mother, and desirability of pregnancy. The consistent smoker's class was associated with offspring's number of smoked pack years by midlife (median [interquartile range]: 8.3 [1.4-17.4] vs. 4.8 [0.0-13.0], p = 0.028), and alcohol use in young age (odds ratio 1.23 [95% confidence interval 1.05-1.43]). Overall, to prevent parent-offspring transmission of smoking, the cessation support should target women planning pregnancy. Negative effects of maternal continuous smoking during pregnancy include all substance use and reach up to offspring's middle age.

The association between physical activity and vertebral dimension change in early adulthood - The Northern Finland Birth Cohort 1986 study.

Small vertebral size is a well-known risk factor for vertebral fractures. To help understanding the factors behind vertebral size, we aimed to investigate whether physical activity and participation in high-impact exercise are associated with the growth rate of the vertebral cross-sectional area (CSA) among young adults. To conduct our study, we utilized the Northern Finland Birth Cohort 1986 as our study population (n = 375). Questionnaire data about physical activity was obtained at 16, 18 and 19 years of age and lumbar magnetic resonance imaging scans at two timepoints, 20 and 30 years of age. We used generalized estimating equation (GEE) models to conduct the analyses. We did not find any statistically significant associations between vertebral CSA, physical activity, and high-impact exercise in our study sample. We conclude that neither physical activity nor high-impact sports seem to influence the change in vertebral CSA among young adults.

Pregnancy Risk Factors as Predictors of Offspring Cerebrovascular Disease: The Northern Finland Birth Cohort Study 1966.

[Figure: see text].

Serum biomarkers for Modic changes in patients with chronic low back pain.

PURPOSE: Lumbar Modic change (MC) can serve as a diagnostic marker as well as an independent source of chronic low back pain (CLBP). This study aimed to test for the existence of serum biomarkers in CLBP patients with MC. METHODS: Age- and sex-matched CLBP patients with confirmed MC on lumbar MRI (n = 40) and pain-free controls (n = 40) were assessed. MC was classified into M1, predominating M1, predominating M2 and M2. MC volumes were calculated. Fasting blood samples were assessed for inflammatory mediators, signalling molecules, growth factors and bone turnover markers. Serum concentrations of 46 biomarkers were measured. RESULTS: Median concentrations of interleukin (IL)-15 (p < 0.001), IL-8 (p < 0.001), tumour necrosis factor (TNF)-alpha (p < 0.001), Eotaxin-1 (p < 0.05), Eotaxin-3 (p < 0.001), monocyte chemotactic protein (MCP)-1 (p < 0.05), macrophage inflammatory protein (MIP)-1alpha (p < 0.01), TEK receptor tyrosine kinase (Tie)-2 (p < 0.001), vascular cell adhesion molecule (VCAM)-1 (p < 0.001), RANTES (p < 0.001), C telopeptide of type I collagen (CTX)-1 (p < 0.001), vascular endothelial growth factor (VEGF)-C (p < 0.001), VEGF-D (p < 0.05), fms-related tyrosine kinase (Flt)-1 (p < 0.01) and intercellular adhesion molecule (ICAM)-1 (p < 0.01) were significantly higher among controls. IL-1sRII (23.2 vs. 15.5 ng/ml, p < 0.001) and hepatocyte growth factor (HGF)-1 (169 vs. 105 pg/ml, p < 0.01) concentrations were significantly higher among patients. Type or volume of MC was not associated with biomarker concentrations. CONCLUSIONS: This is the first study to assess the blood serum biomarker profile in individuals with CLBP with MC. Several biomarkers were suppressed, while two markers (IL-1sRII and HGF) were elevated among MC patients, irrespective of MC type or size, with CLBP compared with asymptomatic controls.

Lifelong smoking trajectories of Northern Finns are characterized by sociodemographic and lifestyle differences in a 46-year follow-up.

Smoking remains among the leading causes of mortality worldwide. Obtaining a comprehensive understanding of a population's smoking behaviour is essential for tobacco control. Here, we aim to characterize lifelong smoking patterns and explore underlying sociodemographic and lifestyle factors in a population-based birth cohort population followed up for 46 years. Our analysis is based on 5797 individuals from the Northern Finland Birth Cohort 1966 who self-reported their tobacco smoking behaviour at the ages of 14, 31 and 46. Data on sex, education, employment, body mass index, physical activity, alcohol consumption, and substance addiction were also collected at the follow-ups. We profile each individual's annual smoking history from the age of 5 to 47, and conduct a latent class trajectory analysis on the data. We then characterize the identified smoking trajectory classes in terms of the background variables, and compare the heaviest smokers with other classes in order to reveal specific predictors of non-smoking and discontinued smoking. Six smoking trajectories are identified in our sample: never-smokers (class size 41.0%), youth smokers (12.6%), young adult quitters (10.8%), late adult quitters (10.5%), late starters (4.3%), and lifetime smokers (20.7%). Smoking is generally associated with male sex, lower socioeconomic status and unhealthier lifestyle. Multivariable between-class comparisons identify unemployment (odds ratio [OR] 1.28-1.45) and physical inactivity (OR 1.20-1.52) as significant predictors of lifetime smoking relative to any other class. Female sex increases the odds of never-smoking and youth smoking (OR 1.29-1.33), and male sex increases the odds of adult quitting (OR 1.30-1.41), relative to lifetime smoking. We expect future initiatives to benefit from our data by exploiting the identified predictors as direct targets of intervention, or as a means of identifying individuals who may benefit from such interventions.

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

BACKGROUND: The relevance of health-related behaviors to exclusion from the labor market in early adulthood remains poorly studied in relation to the magnitude of the problem. We explored whether adolescents' accumulated unhealthy behaviors and psychosocial problems are associated with later labor market exclusion, and whether multisite musculoskeletal pain (MMSP) impacts these relations. METHODS: We gathered questionnaire data on unhealthy behaviors and psychosocial problems and MMSP among adolescents aged 15 to 16 belonging to the Northern Finland Birth Cohort 1986. The findings were combined with registry data on unemployment, employment and permanent work disability during a five-year follow-up between the ages of 25 and 29 (n = 6692). In the statistical modeling we used education, family leave and socioeconomic status of childhood family as potential confounders, as well as latent class and logistic regression analyses. RESULTS: The Externalizing behavior cluster associated with over one year of unemployment (RR 1.64, CI 1.25-2.14) and permanent work disability (OR 2.49, CI 1.07-5.78) in the follow-up among the men. The Sedentary cluster also associated with over one year (RR 1.41, CI 1.13-1.75) and under one year of unemployment (RR 1.25, CI 1.02-1.52) and no employment days (RR 1.93, CI 1.26-2.95) among the men. Obese male participants were at risk of over one year of unemployment (RR 1.50, CI 1.08-2.09) and no employment days (RR 1.93, CI 1.07-3.50). Among the women, the Multiple risk behavior cluster related significantly to over one year of unemployment (RR 1.77, CI 1.37-2.28). MMSP had no influence on the associations. CONCLUSIONS: Unhealthy behavior patterns and psychosocial problems in adolescence have long-term consequences for exclusion from the labor market in early adulthood, especially among men. Simultaneously supporting psychological well-being and healthy behaviors in adolescence may reduce labor market inclusion difficulties in the early phase of working life.

Smoking trajectories and risk of stroke until age of 50 years - The Northern Finland Birth Cohort 1966.

BACKGROUND: Smoking is a well-known risk factor for stroke. However, the relationship between smoking trajectories during the life course and stroke is not known. AIMS: We aimed to study the association of smoking trajectories and smoked pack-years with risk of ischemic and haemorrhagic strokes in a population-based birth cohort followed up to 50 years of age. METHODS: Within the Northern Finland Birth Cohort 1966, 11,999 persons were followed from antenatal period to age 50 years. The smoking behaviour was assessed with postal questionnaires at ages 14, 31 and 46 years. Stroke diagnoses were collected from nationwide registers using unique study number linkage. The associations between smoking behaviour and stroke risk were estimated using Cox regression models. RESULTS: Six different patterns in smoking habits throughout the life course were found in trajectory modelling. During 542,140 person-years of follow-up, 352 (2.9%) persons had a stroke. Continuous smoking during the life course was associated with increased stroke risk (HR = 1.69; 95% CI 1.10-2.60) after adjusting for sex, educational level, family history of strokes, leisure-time physical activity, body mass index, alcohol consumption, hypertension, hypercholesterolemia, and diabetes. Per every smoked pack-year the stroke risk increased 1.04-fold (95% CI 1.03-1.06). Other smoking trajectories were not significantly associated with stroke risk, nor were starting or ending age of smoking. CONCLUSION: Accumulation of smoking history is associated with increased risk of stroke until age of 50 years. The increased stroke risk does not depend on the age at which smoking started. Given that the majority starts smoking at young age, primary prevention of strokes should focus on adolescent smoking.

Longitudinal Analysis of Paraspinal Muscle Cross-Sectional Area During Early Adulthood - A 10-Year Follow-Up MRI Study.

Only a few previous studies have investigated paraspinal musculature (i.e., multifidus (MF), psoas major (PSM), erector spinae (ES)) in longitudinal, population-based settings. This study aimed to evaluate changes in the cross-sectional area (CSA) of the paraspinal muscles between the ages of 20 and 30 years. The study population consisted of a sub-cohort from the Northern Finland Birth Cohort 1986 (n = 298; 156 men, 142 women). Baseline magnetic resonance imaging was performed at a mean age of 21.3 years and follow-up imaging at 30.6 years. The CSA measurements were performed by tracing the paraspinal muscle outlines individually (MF, ES, PM) and all combined (total muscle area (TMA)) at the L4 cranial endplate level. The longitudinal data analysis was performed using generalized estimating equations modelling. The CSA of MF and ES increased during the follow-up among both sexes (men: MF + 5.7%, p < 0.001; ES + 2.7%, p = 0.001; and women: MF + 10.5%, p < 0.001; ES 9.2%, p = 0.001). The CSA of PM decreased among men (PM -4.0%, p < 0.001) but not among women (PM + 0.5%, p = 0.553). TMA increased significantly only among women (men: +0.5%, p = 0.425; women: +6.5%, p < 0.001). The increases in ES and TMA were more distinct among women than men (p < 0.001). Our study demonstrated clear age- and sex-related changes in paraspinal muscle size in early adulthood.