Publications by authors named "Ville Aalto"

25 Publications

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Association of changes in work due to COVID-19 pandemic with psychosocial work environment and employee health: a cohort study of 24 299 Finnish public sector employees.

Occup Environ Med 2021 Sep 14. Epub 2021 Sep 14.

Department of Public Health, Turun Yliopisto, Turku, Finland.

Objectives: To examine the associations of COVID-19-related changes in work with perceptions of psychosocial work environment and employee health.

Methods: In a cohort of 24 299 Finnish public sector employees, psychosocial work environment and employee well-being were assessed twice before (2016 and 2018=reference period) and once during (2020) the COVID-19 pandemic. Those who reported a change (='Exposed') in work due to the pandemic (working from home, new tasks or team reorganisation) were compared with those who did not report such change (='Non-exposed').

Results: After adjusting for sex, age, socioeconomic status and lifestyle risk score, working from home (44%) was associated with greater increase in worktime control (standardised mean difference (SMD)=0.078, 95% CI 0.066 to 0.090; SMD=0.025, 95% CI 0.014 to 0.036), procedural justice (SMD=0.101, 95% CI 0.084 to 0.118; SMD=0.053, 95% CI 0.038 to 0.068), workplace social capital (SMD=0.094, 95% CI 0.077 to 0.110; SMD=0.034, 95% CI 0.019 to 0.048), less decline in self-rated health (SMD=-0.038, 95% CI -0.054 to -0.022; SMD=-0.081, 95% CI -0.095 to -0.067), perceived work ability (SMD=-0.091, 95% CI -0.108 to -0.074; SMD=-0.151, 95% CI -0.167 to -0.136) and less increase in psychological distress (risk ratio (RR)=1.06, 95% CI 1.02 to 1.09; RR=1.16, 95% CI 1.13 to 1.20). New tasks (6%) were associated with greater increase in psychological distress (RR=1.28, 95% CI 1.19 to 1.39; RR=1.10, 95% CI 1.07 to 1.12) and team reorganisation (5%) with slightly steeper decline in perceived work ability (SMD=-0.151 95% CI -0.203 to -0.098; SMD=-0.124, 95% CI -0.136 to -0.112).

Conclusion: Employees who worked from home during the pandemic had more favourable psychosocial work environment and health, whereas those who were exposed to work task changes and team reorganisations experienced more adverse changes.
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http://dx.doi.org/10.1136/oemed-2021-107745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8449846PMC
September 2021

Return to work after lumbar disc herniation surgery: an occupational cohort study.

Acta Orthop 2021 Jul 16:1-6. Epub 2021 Jul 16.

Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.

Background and purpose - Lumbar disc herniation is a common surgically treated condition in the working-age population. We assessed health-related risk factors for return to work (RTW) after excision of lumbar disc herniation. Previous studies on the subject have had partly contradictory findings.Patients and methods - RTW of 389 (n = 111 male, n = 278 female; mean age 46 years, SD 8.9) employees who underwent excision of lumbar disc herniation was assessed based on the Finnish Public Sector Study (FPS). Baseline information on occupation, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of RTW was analyzed using Cox proportional hazard univariable and multivariable modelling.Results - 95% of the patients had returned to work at 12 months after surgery, after on average 78 days of sickness absence. Faster RTW in the univariable Cox model was associated with a small number of sick leave days (< 30 days) before operation (HR 1.3, 95% CI 1.1-1.6); high occupational position (HR 1.6, CI 1.2-2.1); and age under 40 years (HR 1.5, CI 1.1-1.9). RTW was not associated with sex or the health-related risk factors obesity, physical inactivity, smoking, heavy alcohol consumption, poor self-rated health, psychological distress, comorbid conditions, or purchases of pain or antidepressant medications in either the univariable or multivariable model.Interpretation - Almost all employees returned to work after excision of lumbar disc herniation. Older age, manual job, and prolonged sick leave before the excision of lumbar disc herniation were risk factors for delayed return to work after the surgery.
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http://dx.doi.org/10.1080/17453674.2021.1951010DOI Listing
July 2021

Alternative duty work as workplace-initiated procedure to reduce sickness absence.

BMC Public Health 2021 06 16;21(1):1154. Epub 2021 Jun 16.

Finnish Institute of Occupational Health, Helsinki, Finland.

Purpose: Alternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector.

Methods: Two city administrations (A and D) that implemented an alternative duty work policy to their employees (n = 5341 and n = 7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (n = 6976 and n = 6720). The outcomes were the number of annual days, all episodes, and short-term (< 10 days) episodes during the 2 years before versus the 2 years after the intervention year. We applied repeated measures negative binomial regression analyses, using the generalized estimating equations method and the difference-in-difference analysis to compare the intervention and control cities (adjusted for sex, age, type of job contract, occupational class).

Results: During the five-year study period, the number of sickness absence days and episodes increased in both the intervention and control cities. Covariate-adjusted analysis of relative risk showed that the overall increase in post- versus pre-intervention sickness absence days was smaller in intervention City A, RR = 1.14 (95% CI = 1.09-1.21) than in control cities B and C, RR = 1.19 (95% CI =1.14-1.24), group × time interaction p < 0.02. In intervention City D, we found a corresponding result regarding all sickness absence episodes and short-term sickness absence episodes but not days.

Conclusions: This follow-up suggests that implementing an alternative duty work policy may marginally decrease employees' sickness absences.
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http://dx.doi.org/10.1186/s12889-021-11181-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207644PMC
June 2021

Psychological distress and sickness absence: Within- versus between-individual analysis.

J Affect Disord 2020 03 7;264:333-339. Epub 2020 Jan 7.

Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.

Background: Uncertainty remains whether associations for psychological distress and sickness absence (SA) observed between and within individuals differ, and whether age, gender and work-related factors moderate these associations.

Methods: We analyzed SA records of 41,184 participants of the Finnish Public Sector study with repeated survey data between 2000 and 2016 (119,024 observations). Psychological distress was measured by the General Health Questionnaire (GHQ-12), while data on SA days were from the employers' registers. We used a hybrid regression estimation approach adjusting for time-variant confounders-age, marital status, occupational class, body mass index, job contract type, months worked in the follow-up year, job demand, job control, and workplace social capital-and time-invariant gender (for between-individual analysis).

Results: Higher levels of psychological distress were consistently associated with SA, both within- and between-individuals. The within-individual association (incidence rate ratio (IRR) 1.68, 95% CI 1.61-1.75 for SA at high distress), however, was substantially smaller than the between-individual association (IRR 2.53, 95% CI 2.39-2.69). High levels of psychological distress had slightly stronger within-individual associations with SA among older (>45 years) than younger employees, lower than higher occupational class, and among men than women. None of the assessed work unit related factors (e.g. job demand, job control) were consistent moderators.

Limitations: These findings may not be generalizable to other working sectors or cultures with different SA policies or study populations that are male dominated.

Conclusions: Focus on within-individual variation over time provides more accurate estimates of the contribution of mental health to subsequent sickness absence.
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http://dx.doi.org/10.1016/j.jad.2020.01.006DOI Listing
March 2020

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress.

Eur J Public Health 2020 02;30(1):158-163

Finnish Institute of Occupational Health, Helsinki, Finland.

Background: Retirement has been associated with improved mental health, but it is unclear how much this is due to the removal of work-related stressors. We examined rates of psychotropic medication use before and after the transition to disability retirement due to mental, musculoskeletal and other causes by pre-retirement levels of perceived work stress (effort-reward imbalance, ERI).

Methods: Register-based date and diagnosis of disability retirement of 2766 participants of the Finnish Public Sector study cohort were linked to survey data on ERI, social- and health-related covariates, and to national records on prescribed reimbursed psychotropic medication, measured as defined daily doses (DDDs). Follow-up for DDDs was 2-5 years before and after disability retirement. We assessed differences in the levels of DDDs before and after retirement among those with high vs. low level of pre-retirement ERI with repeated measures regression.

Results: Those with high (vs. low) levels of ERI used slightly more psychotropic medication before disability retirement due to mental disorders [rate ratio (RR) 1.14, 95% confidence intervals (CI) 0.94-1.37], but after retirement this difference attenuated (RR 0.94, 95% CI 0.80-1.10, P for interaction 0.02). Such a change was not observed for the other causes of disability retirement.

Conclusions: The level of psychotropic medication use over the transition to disability retirement due to mental, but not musculoskeletal or other, causes was modified by pre-retirement perceived work-related stress. This suggests that among people retiring due to mental disorders those who had stressful jobs benefit from retirement more than those with low levels of work-related stress.
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http://dx.doi.org/10.1093/eurpub/ckz131DOI Listing
February 2020

Are patient-related pre-operative factors influencing return to work after total knee arthroplasty.

Knee 2019 Aug 22;26(4):853-860. Epub 2019 May 22.

Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland.

Background: Osteoarthritis is one of the leading causes of disability in working-age patients. The total number of working-age patients undergoing total-knee arthroplasty (TKA) is continuously increasing. The purpose of this study was to identify predictive factors related to general health, health risk behaviors and socioeconomic status influencing the rate of return to work after a TKA.

Methods: Overall there were 151,901 patients included in the Finnish Public Sector (FPS) study. The response rate varied between 65 and 73% during the study period. We used Cox proportional hazard models to examine patient-related predictive factors that may influence the rate of return to work after TKA in a cohort of patients (n = 452; n = 362 female; mean age 56.4 years). Predictive factors were measured on average 3.6 years before the operation.

Results: Of the patients, 87% returned to work within one year after TKA at a mean of 116 calendar days. In multivariate analysis, patients at sick-leave ≤30 days during the last year before surgery were 2.2 times (95% confidence interval 1.72-2.92) more likely to return to work compared with those with >30 days of sick-leave. Compared with patients in manual work, those in higher or lower level non-manual work showed a 2.6-fold (1.95-3.52) and 1.5-fold (1.15-1.92) increased probability of returning to work. Age, sex, health risk behaviors, obesity, physical comorbidities, common mental disorders, and other studied health-related factors were not associated with the rate of return to work.

Conclusions: Non-manual job, good self-rated general health and preoperative sick leave ≤30 days are associated with a higher rate of return to work.
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http://dx.doi.org/10.1016/j.knee.2019.04.015DOI Listing
August 2019

Return to work after primary total hip arthroplasty: a nationwide cohort study.

Acta Orthop 2019 06 25;90(3):209-213. Epub 2019 Mar 25.

g Department of Public Health , University of Turku , Turku , Finland.

Background and purpose - While the number of working-age patients undergoing total hip arthroplasty (THA) is increasing, the effect of the surgery on patients' return to work (RTW) is not thoroughly studied. We aimed to identify risk factors of RTW after THA among factors related to demographic variables, general health, health risk behaviors, and socioeconomic status. Patients and methods - We studied 408 employees from the Finnish Public Sector (FPS) cohort (mean age 54 years, 73% women) who underwent THA. Information on demographic and socioeconomic variables, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of return to work was examined using Cox proportional hazard modeling. Results - 94% of the patients returned to work after THA on average after 3 months (10 days to 1 year) of sickness absence. The observed risk factors of successful return to work were: having < 30 sick leave days during the last year (HR 1.8; 95% CI 1.4-2.3); higher occupational position (HR 2.2; CI 1.6-2.9); and BMI < 30 (HR 1.4; CI 1.1-1.7). Age, sex, preceding health status, and health-risk behaviors were not correlated with RTW after the surgery. Interpretation - Most employees return to work after total hip arthroplasty. Obese manual workers with prolonged sick leave before the total hip replacement were at increased risk of not returning to work after the surgery.
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http://dx.doi.org/10.1080/17453674.2019.1591081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534229PMC
June 2019

Change in physical activity and accumulation of cardiometabolic risk factors.

Prev Med 2018 07 29;112:31-37. Epub 2018 Mar 29.

Department of Public Health, University of Turku and Turku University Hospital, Finland.

This study aims to examine the association between change in physical activity over time and accumulation of cardiometabolic risk factors. Four consecutive surveys (Time 1 to 4) were conducted with 4-year intervals in 1997-2013 (the Finnish Public Sector study). Physical activity of 15,634 cardio-metabolically healthy participants (mean age 43.3 (SD 8.7) years, 85% women) was assessed using four-item survey measure and was expressed as weekly metabolic equivalent (MET) hours in Time 1, 2, and 3. At each time point, participants were categorised into low (<14 MET-h/week), moderate (≥14 to <30 MET-h/week), or high (≥30 MET-h/week) activity level and change in physical activity levels between Time 1 and 3 (over 8 years) was determined. The outcome was the number of incident cardiometabolic risk factors (hypertension, dyslipidemia, diabetes, and obesity) at Time 4. Cumulative logistic regression was used for data analysis. Compared to maintenance of low physical activity, increase in physical activity from low baseline activity level was associated with decreased accumulation of cardiometabolic risk factors in a dose-response manner (cumulative odds ratio [cOR] = 0.73, 95% CI 0.59-0.90 for low-to-moderate and cOR = 0.67, 95% CI 0.49-0.89 for low-to-high, P for trend 0.0007). Decrease in physical activity level from high to low was associated with increased accumulation of cardiometabolic risk factors (cOR = 1.60, 95% CI 1.27-2.01) compared to those who remained at high activity level. Thus even a modest long-term increase in physical activity was associated with reduction in cardiometabolic risk whereas decrease in physical activity was related to increased risk.
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http://dx.doi.org/10.1016/j.ypmed.2018.03.020DOI Listing
July 2018

Relationship transitions and change in health behavior: A four-phase, twelve-year longitudinal study.

Soc Sci Med 2018 07 19;209:152-159. Epub 2018 Mar 19.

University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.

Rationale: Extensive scientific evidence shows an association between involvement in social relationships and healthy lifestyle. Prospective studies with many participants and long follow-ups are needed to study the dynamics and change in social factors within individuals over time.

Objective: Our aim was to determine whether a change in relationship status (single, married, divorced, widow, cohabiting) is followed by a change in health behavior (smoking, alcohol consumption, physical activity, and body mass index).

Methods: We used data from 81,925 healthy adults participating in the prospective longitudinal Finnish Public Sector Study in the period 2000-2013. We analyzed 327,700 person-observations from four data collection phases. Missing data were multiply imputed. A within-individual methodology was used to minimize the possibility of selection effects affecting the interpretation.

Results: All four health behaviors showed associations with relationship status. The effects were very similar and in the same direction in women and men, although there were gender differences in the magnitudes of the effects. The end of a relationship was followed by a decrease in body mass index, increased odds of being a smoker, increase in physical activity, and increase in alcohol consumption (widowed men). The effects were reverse when forming a new relationship.

Conclusion: A change in relationship status is associated with a change in health behavior. The association is not explained by socioeconomic status, subjective health status, or anxiety level. People leaving or losing a relationship are at increased risk of unhealthy behavior (smoking and alcohol consumption), but at the same time they have a lower BMI and show higher physical activity compared to the time they were in a relationship. It is not clear if the cumulative health effect of these health behavior changes is positive or negative.
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http://dx.doi.org/10.1016/j.socscimed.2018.03.006DOI Listing
July 2018

Physical activity level as a predictor of healthy and chronic disease-free life expectancy between ages 50 and 75.

Age Ageing 2018 May;47(3):423-429

Department of Public Health, University of Turku and Turku University Hospital, Turku Finland.

Background: physical activity promotes healthy aging. However, little is known about the relationship between physical activity levels and healthy and chronic disease-free life expectancy (LE). The study aim was to examine healthy and chronic disease-free LE between ages 50 and 75 and across various levels of physical activity by sex and different occupational statuses.

Methods: overall, 34,379 women (mean age 53.2 (SD 2.9) years) and 8,381 men (53.6 (SD 3.2) years) from the Finnish Public Sector study were categorized into five physical activity levels (inactive to vigorously active) according to self-reported physical activity and into three occupational statuses at the first observation point. Partial LE between ages 50 and 75 based on discrete-time multistate life table models was defined using two health indicators: healthy LE based on self-rated health and chronic disease-free LE based on chronic diseases. The average follow-up time for health indicators was 6.8 (SD 5.2) years.

Results: a clear dose-response relationship between higher physical activity levels and increased healthy and chronic disease-free LE in men and women, and within occupational statuses was found. On average, vigorously active men and women lived 6.3 years longer in good health and 2.9 years longer without chronic diseases between ages 50 and 75 compared to inactive individuals. The difference in years in good health between vigorously active and inactive individuals was the largest in individuals with low occupation status (6.7 years).

Conclusion: higher levels of physical activity increase healthy and chronic disease-free years similarly in men and women, but more among persons with low than with high occupational status.
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http://dx.doi.org/10.1093/ageing/afy016DOI Listing
May 2018

Use of pain medication before and after lumbar discectomy: longitudinal analysis of a nation-wide cohort.

Minerva Chir 2018 Jun 1;73(3):280-287. Epub 2018 Feb 1.

Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.

Background: Previous studies have suggested that variation in results of lumbar discectomy depends on careful selection of patients. Numerous factors have been suggested to explain this variation with no direct examinations on this issue. The objective was to examine the use of pain medication before and after lumbar discectomy in patients with back pain.

Methods: Prospective occupational cohort study (N.=151,618) with linkage to national registers. Of the cohort members, 1538 (age 44 years) underwent discectomy. Records from purchases of pain medication were obtained during a 3-year period before and after hospital discharge.

Results: Purchases of pain medication increased during the follow-up period from 9.7±28.7 to 17.3±17.3 defined daily doses. Three groups were identified: 1) with constant, relatively low pain medication use; 2) with high use combined with further increases in purchases until the time of surgery and only a slight decrease thereafter; and 3) with a sharp rise in medication use before surgery and a return to no pain medication use approximately six months after the discharge. Non-manual profession (OR=1.34, 95% CI: 1.06 to 1.69) and open surgery technique increased (OR=1.32, 95% CI: 1.04 to 1.67) the probability of being included into the third group.

Conclusions: The greater decline in the use of pain medication after discectomy was associated with a sharp rise of that use within six months before surgery. This suggests that lumbar discectomy may benefit especially those with acute or subacute pain within the six-month window.
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http://dx.doi.org/10.23736/S0026-4733.18.07580-6DOI Listing
June 2018

Characteristics of Social Networks and Mortality Risk: Evidence From 2 Prospective Cohort Studies.

Am J Epidemiol 2018 04;187(4):746-753

Research Department of Epidemiology and Public Health, Faculty of Population Health Sciences, University College London, London, United Kingdom.

The size of a person's social network is linked to health and longevity, but it is unclear whether the number of strong social ties or the number of weak social ties is most influential for health. We examined social network characteristics as predictors of mortality in the Finnish Public Sector Study (n = 7,617) and the Health and Social Support Study (n = 20,816). Social network characteristics were surveyed at baseline in 1998. Information about mortality was obtained from the Finnish National Death Registry. During a mean follow-up period of 16 years, participants with a small social network (≤10 members) were more likely to die than those with a large social network (≥21 members) (adjusted hazard ratio (HR) = 1.23, 95% confidence interval (CI): 1.04, 1.46). Mortality risk was increased among participants with both a small number of strong ties (≤2 members) and a small number of weak ties (≤5 members) (HR = 1.55, 95% CI: 1.26, 1.79) and among participants with both a large number of strong ties and a small number of weak ties (HR = 1.28, 95% CI: 1.08, 1.52), but not among those with a small number of strong ties and a large number of weak ties (HR = 1.04, 95% CI: 0.87, 1.25). These findings suggest that in terms of mortality risk, the number of weak ties may be an important component of social networks.
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http://dx.doi.org/10.1093/aje/kwx301DOI Listing
April 2018

Social networks and patterns of health risk behaviours over two decades: A multi-cohort study.

J Psychosom Res 2017 08 14;99:45-58. Epub 2017 Jun 14.

Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.

Objective: To determine the associations between social network size and subsequent long-term health behaviour patterns, as indicated by alcohol use, smoking, and physical activity.

Methods: Repeat data from up to six surveys over a 15- or 20-year follow-up were drawn from the Finnish Public Sector study (Raisio-Turku cohort, n=986; Hospital cohort, n=7307), and the Health and Social Support study (n=20,115). Social network size was determined at baseline, and health risk behaviours were assessed using repeated data from baseline and follow-up. We pooled cohort-specific results from repeated-measures log-binomial regression with the generalized estimating equations (GEE) method using fixed-effects meta-analysis.

Results: Participants with up to 10 members in their social network at baseline had an unhealthy risk factor profile throughout the follow-up. The pooled relative risks adjusted for age, gender, survey year, chronic conditions and education were 1.15 for heavy alcohol use (95% CI: 1.06-1.24), 1.19 for smoking (95% CI: 1.12-1.27), and 1.25 for low physical activity (95% CI: 1.21-1.29), as compared with those with >20 members in their social network. These associations appeared to be similar in subgroups stratified according to gender, age and education.

Conclusions: Social network size predicted persistent behaviour-related health risk patterns up to at least two decades.
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http://dx.doi.org/10.1016/j.jpsychores.2017.06.003DOI Listing
August 2017

Change in body mass index during transition to statutory retirement: an occupational cohort study.

Int J Behav Nutr Phys Act 2017 06 26;14(1):85. Epub 2017 Jun 26.

Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.

Background: Retirement is a major life transition affecting health behaviors. The aim of this study was to examine within-individual changes in body mass index (BMI) during transition from full-time work to statutory retirement by sex and physical work characteristics.

Methods: A multiwave cohort study repeated every 4 years and data linkage to records from retirement registers. Participants were 5426 Finnish public-sector employees who retired on a statutory basis in 2000-2011 and who reported their body weight one to three times prior to (w, w, w), and one to three times after (w, w, w) retirement.

Results: During the 4-year retirement transition (w, vs. w) men showed decline in BMI, which was most marked among men with sedentary work (-0.18 kg/m, 95% CI -.30 to -0.05). In contrast, BMI increased during retirement transition in women and was most marked among women with diverse (0.14 kg/m, 95% CI 0.08 to 0.20) or physically heavy work (0.31 kg/m, 95% CI 0.16 to 0.45). Physical activity during leisure time or commuting to work, alcohol consumption or smoking did not explain the observed changes during retirement transition.

Conclusions: In this study statutory retirement was associated with small changes in BMI. Weight loss was most visible in men retiring from sedentary jobs and weight gain in women retiring from diverse and physically heavy jobs.
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http://dx.doi.org/10.1186/s12966-017-0539-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485586PMC
June 2017

Changes in Sleep Duration During Transition to Statutory Retirement: A Longitudinal Cohort Study.

Sleep 2017 07;40(7)

Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.

Study Objectives: This study examined whether sleep duration changes during the transition from full-time work to statutory retirement and, if this were the case, which preretirement factors, including sociodemographic, work, lifestyle, and health factors, predict these changes.

Methods: Data from repeated surveys of the Finnish Public Sector study, linked to records of retirement, were used. The study population consisted of 5785 participants who retired on a statutory basis in 2000-2011 and who had responded to surveys on sleep duration at least once immediately before and after their retirement (mean number of repeat study waves 3.6). Linear regression analyses with generalized estimating equations were used to examine changes in sleep duration around retirement.

Results: Before retirement there was a slight decrease in sleep duration. During the 4-year retirement transition, sleep duration increased from 7 hours 0 minutes (95% confidence interval [CI] 6 hours 54 minutes to 7 hours 6 minutes) to 7 hours and 22 minutes (95% CI 7 hours 16 minutes to 7 hours 27 minutes); thus, mean increase being 22 minutes. Increase in sleep duration was greatest in those who were short sleepers, heavy drinkers, or had sleep difficulties. After the retirement transition, sleep duration remained at approximately the same level, as no significant changes were observed.

Conclusions: This longitudinal study suggests that transition from full-time work to statutory retirement is associated with an increase in sleep duration.
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http://dx.doi.org/10.1093/sleep/zsx087DOI Listing
July 2017

Trajectories of risky drinking around the time of statutory retirement: a longitudinal latent class analysis.

Addiction 2017 Jul 16;112(7):1163-1170. Epub 2017 Apr 16.

Finnish Institute of Occupational Health, Helsinki/Kuopio, Finland.

Background And Aims: Life transitions such as retirement may influence alcohol consumption, but only a few studies have described this using longitudinal data. We identified patterns and predictors of risky drinking around the time of retirement.

Design: A cohort study assessing trajectories and predictors of risky drinking among employees entering statutory retirement between 2000 and 2011.

Setting And Participants: A total of 5805 men and women from the Finnish Public Sector study who responded to questions on alcohol consumption one to three times prior to (w , w , w ), and one to three times after (w , w , w ) retirement.

Measurements: We assessed trajectories of risky drinking (> 24 units per week among men, > 16 units among women, or an extreme drinking occasion during past year) from pre- to post-retirement, as well as predictors of each alcohol consumption trajectory.

Findings: Three trajectories were identified: sustained healthy drinking (81% of participants), temporary increase in risky drinking around retirement (12%) and slowly declining risky drinking after retirement (7%). The strongest pre-retirement predictors for belonging to the group of temporary increase in risky drinking were current smoking [odds ratio (OR) = 3.90, 95% confidence interval (CI) = 2.70-5.64], male sex (OR = 2.77, 95% CI = 2.16-3.55), depression (OR = 1.44, 95% CI = 1.05-1.99) and work-place in the metropolitan area (OR = 1.29, 95% CI = 1.00-1.66). Compared with the slowly declining risky drinking group, the temporary increase in risky drinking group was characterized by lower occupational status and education, and work-place outside the metropolitan area.

Conclusions: In Finland, approximately 12% of people who reach retirement age experience a temporary increase in alcohol consumption to risky levels, while approximately 7% experience a slow decline in risky levels of alcohol consumption. Male gender, smoking, being depressed and working in a metropolitan area are associated with increased likelihood of increased alcohol consumption.
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http://dx.doi.org/10.1111/add.13811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498817PMC
July 2017

Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study.

Int J Epidemiol 2016 08 2;45(4):1260-1270. Epub 2016 Aug 2.

Department of Public Health, University of Turku, Turku, Finland.

Background: Smoking, physical inactivity and obesity are modifiable risk factors for morbidity and mortality. The aim of this study was to examine the extent to which the co-occurrence of these behaviour-related risk factors predict healthy life expectancy and chronic disease-free life expectancy in four European cohort studies.

Methods: Data were drawn from repeated waves of four cohort studies in England, Finland, France and Sweden. Smoking status, physical inactivity and obesity (body mass index ≥30 kg/m) were examined separately and in combination. Health expectancy was estimated by using two health indicators: suboptimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years.

Results: Compared with men and women with at least two behaviour-related risk factors, those with no behaviour-related risk factors could expect to live on average8 years longer in good health and 6 years longer free of chronic diseases between ages 50 and 75. Having any single risk factor was also associated with reduction in healthy years. No consistent differences between cohorts were observed.

Conclusions: Data from four European countries show that persons with individual and co-occurring behaviour-related risk factors have shorter healthy life expectancy and shorter chronic disease-free life expectancy. Population level reductions in smoking, physical inactivity and obesity could increase life-years lived in good health.
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http://dx.doi.org/10.1093/ije/dyw126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937009PMC
August 2016

Changes in physical activity during transition to retirement: a cohort study.

Int J Behav Nutr Phys Act 2016 Apr 16;13:51. Epub 2016 Apr 16.

Department of Public Health, University of Turku, Turku, Finland.

Background: Retirement is a major life transition which may affect lifestyle. The aim of this study is to examine within-individual changes in physical activity during the transition from full-time work to retirement.

Methods: The study population consisted of 9,488 Finnish public-sector employees who retired in 2000-2011 and who reported their leisure-time and commuting physical activity before and after retirement. On average, participants provided data at 3.6 (of the four) repeat examinations during 10 years before and 10 years after the retirement. Physical activity was self-reported and was expressed as weekly metabolic equivalent task (MET) hours. Generalized estimating equations were used to examine physical activity trajectories around retirement.

Results: Among participants entering to statutory retirement physical activity first increased by 1.81 MET-hours (95% confidence interval [CI] 1.20 to 2.42) during 4-year retirement transition, but then decreased by -1.80 MET hours (95% CI -2.83 to -0.79) during the subsequent post-retirement period. Older retirement age, higher occupational status and fewer chronic diseases were associated with greater increase in physical activity during transition to statutory retirement.

Conclusions: Statutory retirement appears to be associated with a temporary increase in physical activity. Future research should examine ways to maintain the increased activity level after retirement.
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http://dx.doi.org/10.1186/s12966-016-0375-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833915PMC
April 2016

International Genome-Wide Association Study Consortium Identifies Novel Loci Associated With Blood Pressure in Children and Adolescents.

Circ Cardiovasc Genet 2016 Jun 11;9(3):266-278. Epub 2016 Mar 11.

Background: Our aim was to identify genetic variants associated with blood pressure (BP) in childhood and adolescence.

Methods And Results: Genome-wide association study data from participating European ancestry cohorts of the Early Genetics and Lifecourse Epidemiology (EAGLE) Consortium was meta-analyzed across 3 epochs; prepuberty (4-7 years), puberty (8-12 years), and postpuberty (13-20 years). Two novel loci were identified as having genome-wide associations with systolic BP across specific age epochs: rs1563894 (ITGA11, located in active H3K27Ac mark and transcription factor chromatin immunoprecipitation and 5'-C-phosphate-G-3' methylation site) during prepuberty (P=2.86×10(-8)) and rs872256 during puberty (P=8.67×10(-9)). Several single-nucleotide polymorphism clusters were also associated with childhood BP at P<5×10(-3). Using a P value threshold of <5×10(-3), we found some overlap in variants across the different age epochs within our study and between several single-nucleotide polymorphisms in any of the 3 epochs and adult BP-related single-nucleotide polymorphisms.

Conclusions: Our results suggest that genetic determinants of BP act from childhood, develop over the lifecourse, and show some evidence of age-specific effects.
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http://dx.doi.org/10.1161/CIRCGENETICS.115.001190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279885PMC
June 2016

Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function.

Nat Commun 2016 Jan 21;7:10023. Epub 2016 Jan 21.

Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands.

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways.
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http://dx.doi.org/10.1038/ncomms10023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735748PMC
January 2016

Quantification of myocardial blood flow in absolute terms using (82)Rb PET imaging: the RUBY-10 Study.

JACC Cardiovasc Imaging 2014 Nov 8;7(11):1119-1127. Epub 2014 Oct 8.

Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.

Objectives: The purpose of this study was to compare myocardial blood flow (MBF) and myocardial flow reserve (MFR) estimates from rubidium-82 positron emission tomography ((82)Rb PET) data using 10 software packages (SPs) based on 8 tracer kinetic models.

Background: It is unknown how MBF and MFR values from existing SPs agree for (82)Rb PET.

Methods: Rest and stress (82)Rb PET scans of 48 patients with suspected or known coronary artery disease were analyzed in 10 centers. Each center used 1 of 10 SPs to analyze global and regional MBF using the different kinetic models implemented. Values were considered to agree if they simultaneously had an intraclass correlation coefficient >0.75 and a difference <20% of the median across all programs.

Results: The most common model evaluated was the Ottawa Heart Institute 1-tissue compartment model (OHI-1-TCM). MBF values from 7 of 8 SPs implementing this model agreed best. Values from 2 other models (alternative 1-TCM and Axially distributed) also agreed well, with occasional differences. The MBF results from other models (e.g., 2-TCM and retention) were less in agreement with values from OHI-1-TCM.

Conclusions: SPs using the most common kinetic model-OHI-1-TCM-provided consistent results in measuring global and regional MBF values, suggesting that they may be used interchangeably to process data acquired with a common imaging protocol.
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http://dx.doi.org/10.1016/j.jcmg.2014.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260449PMC
November 2014

Planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT/CT, 11C-methionine PET/CT, or selective venous sampling before reoperation of primary hyperparathyroidism?

J Nucl Med 2013 May 3;54(5):739-47. Epub 2013 Apr 3.

Division of Endocrinology, Department of Medicine, University of Helsinki, Helsinki, Finland.

Unlabelled: All patients with primary hyperparathyroidism should undergo localization studies before reoperation, but it is not known which method is most accurate. The purpose of this prospective study was to compare the performance of planar scintigraphy with (123)I/(99m)Tc-sestamibi, (99m)Tc-sestamibi SPECT (SPECT/CT), (11)C-methionine PET/CT, and selective venous sampling (SVS) in persistent primary hyperparathyroidism.

Methods: Twenty-one patients referred for reoperation of persistent hyperparathyroidism were included and investigated with (123)I/(99m)Tc-sestamibi, SPECT/CT (n = 19), (11)C-methionine PET/CT, and SVS (n = 18) before reoperation. All patients had been operated on 1-2 times previously because of hyperparathyroidism. The results of the localization studies were compared with operative findings, histology, and biochemical cure.

Results: Eighteen (86%) of 21 patients were biochemically cured. Nineteen parathyroid glands (9 adenomas, 1 atypical adenoma, and 9 hyperplastic glands) were removed from 17 patients, and 1 patient who was biochemically cured had an unclear histology result. The accuracy for localizing a pathologic parathyroid gland to the correct side of the neck was 59% (95% confidence interval [CI], 36%-79%) for (123)I/(99m)Tc-sestamibi, 19% (95% CI, 5%-42%) for SPECT/CT, 65% (95% CI, 43%-84%) for (11)C-methionine PET/CT, and 40% (95% CI, 19%-65%) for SVS (P < 0.01 for (123)I/(99m)Tc-sestamibi vs. SPECT/CT). The corresponding accuracy for the correct quadrant or more specific site was 48% (95% CI, 27%-69%) for (123)I/(99m)Tc-sestamibi, 14% (95% CI, 3%-36%) for SPECT/CT, 61% (95% CI, 39%-80%) for (11)C-methionine PET/CT, and 25% (95% CI, 9%-49%) for SVS (P < 0.02 for (123)I/(99m)Tc-sestamibi vs. SPECT/CT). In the 3 patients not cured, preoperative (123)I/(99m)Tc-sestamibi and SPECT/CT remained negative, SVS was false predictive in all, and (11)C-methionine PET/CT in 1. (11)C-methionine PET/CT accurately revealed the pathologic gland in 4 of 8 (50%) patients with a negative (123)I/(99m)Tc-sestamibi scan result, all of whom were biochemically cured after reoperation.

Conclusion: Planar scintigraphy with (123)I/(99m)Tc-sestamibi performs well in complicated primary hyperparathyroidism and is recommended as first-line imaging before reoperation. (11)C-methionine PET/CT provides valuable additional information if (123)I/(99m)Tc-sestamibi scan results remain negative. (99m)Tc-sestamibi SPECT/CT and SVS provide no additional information, compared with the combined results of (123)I/(99m)Tc-sestamibi and (11)C-methionine PET/CT imaging.
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http://dx.doi.org/10.2967/jnumed.112.109561DOI Listing
May 2013

Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture.

Nat Genet 2012 Apr 15;44(5):491-501. Epub 2012 Apr 15.

Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.

Bone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top BMD-associated markers for replication in 50,933 independent subjects and for association with risk of low-trauma fracture in 31,016 individuals with a history of fracture (cases) and 102,444 controls. We identified 56 loci (32 new) associated with BMD at genome-wide significance (P < 5 × 10(-8)). Several of these factors cluster within the RANK-RANKL-OPG, mesenchymal stem cell differentiation, endochondral ossification and Wnt signaling pathways. However, we also discovered loci that were localized to genes not known to have a role in bone biology. Fourteen BMD-associated loci were also associated with fracture risk (P < 5 × 10(-4), Bonferroni corrected), of which six reached P < 5 × 10(-8), including at 18p11.21 (FAM210A), 7q21.3 (SLC25A13), 11q13.2 (LRP5), 4q22.1 (MEPE), 2p16.2 (SPTBN1) and 10q21.1 (DKK1). These findings shed light on the genetic architecture and pathophysiological mechanisms underlying BMD variation and fracture susceptibility.
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http://dx.doi.org/10.1038/ng.2249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338864PMC
April 2012

Cardiac Function, Perfusion, Metabolism, and Innervation following Autologous Stem Cell Therapy for Acute ST-Elevation Myocardial Infarction. A FINCELL-INSIGHT Sub-Study with PET and MRI.

Front Physiol 2012 30;3. Epub 2012 Jan 30.

Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital Turku, Finland.

Purpose: Beneficial mechanisms of bone marrow cell (BMC) therapy for acute ST-segment elevation myocardial infarct (STEMI) are largely unknown in humans. Therefore, we evaluated the feasibility of serial positron emission tomography (PET) and MRI studies to provide insight into the effects of BMCs on the healing process of ischemic myocardial damage.

Methods: Nineteen patients with successful primary reteplase thrombolysis (mean 2.4 h after symptoms) for STEMI were randomized for BMC therapy (2.9 × 10(6) CD34+ cells) or placebo after bone marrow aspiration in a double-blind, multi-center study. Three days post-MI, coronary angioplasty, and paclitaxel eluting stent implantation preceded either BMC or placebo therapy. Cardiac PET and MRI studies were performed 7-12 days after therapies and repeated after 6 months, and images were analyzed at a central core laboratory.

Results: In BMC-treated patients, there was a decrease in [(11)C]-HED defect size (-4.9 ± 4.0 vs. -1.6 ± 2.2%, p = 0.08) and an increase in [(18)F]-FDG uptake in the infarct area at risk (0.06 ± 0.09 vs. -0.05 ± 0.16, p = 0.07) compared to controls, as well as less left ventricular dilatation (-4.4 ± 13.3 vs. 8.0 ± 16.7 mL/m(2), p = 0.12) at 6 months follow-up. However, BMC treatment was inferior to placebo in terms of changes in rest perfusion in the area at risk (-0.09 ± 0.17 vs. 0.10 ± 0.17, p = 0.03) and infarct size (0.4 ± 4.2 vs. -5.1 ± 5.9 g, p = 0.047), and no effect was observed on ejection fraction (p = 0.37).

Conclusion: After the acute phase of STEMI, BMC therapy showed only minor trends of long-term benefit in patients with rapid successful thrombolysis. There was a trend of more decrease in innervation defect size and enhanced glucose metabolism in the infarct-related myocardium and also a trend of less ventricular dilatation in the BMC-treated group compared to placebo. However, no consistently better outcome was observed in the BMC-treated group compared to placebo.
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http://dx.doi.org/10.3389/fphys.2012.00006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277266PMC
October 2012

Temporal relationship between environmental influenza A and Epstein-Barr viral infections and high multiple sclerosis relapse occurrence.

Mult Scler 2011 Jun 6;17(6):672-80. Epub 2011 Jan 6.

Aerobiology Unit, University of Turku, Finland.

Background: Multiple sclerosis (MS) relapses have been associated with viral and bacterial infection epidemics in MS patients who have not used interferon.

Objectives: We studied whether environmental viral infections in the general population can be associated with increased MS relapse occurrence using retrospective data from 1986 to 1995 when interferons were not yet available.

Methods: Logistic regression modelling was used to compare retrospectively the monthly relapse occurrence from 407 MS patients in Turku University hospital archives and data on ten different specifically diagnosed viral infection epidemics in the general population of Southwestern Finland from 1986 to 1995. The outcome was the odds ratio (OR) of very high relapse occurrence versus low relapse occurrence, or moderate versus low relapse occurrence.

Results: After a peak in diagnosed influenza A cases in the general population, the MS relapse occurrence was 6.5 times more likely to be very high (95% CI 1.8-24.0) and 7.1 times more likely to be moderately high (95% CI 1.5-33.2). An increase in MS relapse counts also followed Epstein-Barr virus (EBV) infections (OR 4.4, 95% CI 1.3-15.1), but we found no significant association with adenovirus infections and MS relapses. The MS relapse occurrence was lowest in the summer months July-August (Chi-square test, p<0.01).

Conclusions: Our findings suggest that influenza A and EBV viral infections in the general population are associated with a higher occurrence of exacerbations in MS patients, and thus environmental infection data should be included in epidemiological models on MS relapses.
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http://dx.doi.org/10.1177/1352458510394397DOI Listing
June 2011
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