Showing papers by "Jussi Vahtera published in 2021"

Hospital-treated infectious diseases and the risk of dementia: a large, multicohort, observational study with a replication cohort.

Abstract: Summary Background Infections have been hypothesised to increase the risk of dementia. Existing studies have included a narrow range of infectious diseases, relied on short follow-up periods, and provided little evidence for whether the increased risk is limited to specific dementia subtypes or attributable to specific microbes rather than infection burden. We aimed to compare the risk of Alzheimer's disease and other dementias across a wide range of hospital-treated bacterial and viral infections in two large cohorts with long follow-up periods. Methods In this large, multicohort, observational study, the analysis was based on a primary cohort consisting of pooled individual-level data from three prospective cohort studies in Finland (the Finnish Public Sector study, the Health and Social Support study, and the Still Working study) and an independent replication cohort from the UK Biobank. Community-dwelling adults (≥18 years) with no dementia at study entry were included. Follow-up was until Dec 31, 2012, in the Health and Social Support study, Dec 31, 2016, in the public sector study and the Still Working study, and Feb 7, 2018, in the replication cohort. Through record linkage to national hospital inpatient registers, we ascertained exposure to 925 infectious diseases (using the International Classification of Diseases 10th Revision codes) before dementia onset, and identified incident dementia from hospital records, medication reimbursement entitlements, and death certificates. Hazard ratios (HRs) for the associations of each infectious disease or disease group (index infection) with incident dementia were assessed by use of Cox proportional hazards models. We then repeated the analysis after excluding incident dementia cases that occurred during the first 10 years after initial hospitalisation due to the index infection. Findings From March 1, 1986, to Jan 1, 2005, 260 490 people were included in the primary cohort, and from Dec 19, 2006, to Oct 1, 2010, 485 708 people were included in the replication cohort. In the primary cohort analysis based on 3 947 046 person-years at risk (median follow-up 15·4 years [IQR 9·8–21·0]), 77 108 participants had at least one hospital-treated infection before dementia onset and 2768 developed dementia. Hospitalisation for any infectious disease was associated with increased dementia risk in the primary cohort (adjusted HR [aHR] 1·48 [95% CI 1·37–1·60]) and replication cohort (2·60 [2·38-2·83]). The association remained when analyses were restricted to new dementia cases that occurred more than 10 years after infection (aHR 1·22 [95% CI 1·09–1·36] in the primary cohort, the replication cohort had insufficient follow-up data for this analysis), and when comorbidities and other dementia risk factors were considered. There was evidence of a dose-response association between the number of episodes of hospital-treated infections and dementia risk in both cohorts (ptrend=0·0007). Although the greatest dementia risk was seen for central nervous system (CNS) infections versus no infection (aHR 3·01 [95% CI 2·07–4·37]), excess risk was also evident for extra-CNS infections (1·47 [1·36–1·59]). Although we found little difference in the infection-dementia association by type of infection, associations were stronger for vascular dementia than for Alzheimer's disease (aHR 2·09 [95% CI 1·59–2·75] versus aHR 1·20 [1·08–1·33] in the primary cohort and aHR 3·28 [2·65–4·04] versus aHR 1·80 [1·53–2·13] in the replication cohort). Interpretation Severe infections requiring hospital treatment are associated with long-term increased risk of dementia, including vascular dementia and Alzheimer's disease. This association is not limited to CNS infections, suggesting that systemic effects are sufficient to affect the brain. The absence of infection specificity combined with evidence of dose-response relationships between infectious disease burden and dementia risk support the hypothesis that increased dementia risk is driven by general inflammation rather than specific microbes. Funding UK Medical Research Council, US National Institute on Aging, Wellcome Trust, NordForsk, Academy of Finland, and Helsinki Institute of Life Science.

Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study

Abstract: BACKGROUND: Observational studies have identified a link between unfavourable neighbourhood characteristics and increased risk of morbidity, but it is unclear whether changes in neighbourhoods affe ...

Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies

Abstract: Objectives To examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association. Design Multicohort study with three sets of analyses. Setting United Kingdom, Europe, and the United States. Participants Three associations were examined: cognitive stimulation and dementia risk in 107 896 participants from seven population based prospective cohort studies from the IPD-Work consortium (individual participant data meta-analysis in working populations); cognitive stimulation and proteins in a random sample of 2261 participants from one cohort study; and proteins and dementia risk in 13 656 participants from two cohort studies. Main outcome measures Cognitive stimulation was measured at baseline using standard questionnaire instruments on active versus passive jobs and at baseline and over time using a job exposure matrix indicator. 4953 proteins in plasma samples were scanned. Follow-up of incident dementia varied between 13.7 to 30.1 years depending on the cohort. People with dementia were identified through linked electronic health records and repeated clinical examinations. Results During 1.8 million person years at risk, 1143 people with dementia were recorded. The risk of dementia was found to be lower for participants with high compared with low cognitive stimulation at work (crude incidence of dementia per 10 000 person years 4.8 in the high stimulation group and 7.3 in the low stimulation group, age and sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 to 0.92, heterogeneity in cohort specific estimates I2=0%, P=0.99). This association was robust to additional adjustment for education, risk factors for dementia in adulthood (smoking, heavy alcohol consumption, physical inactivity, job strain, obesity, hypertension, and prevalent diabetes at baseline), and cardiometabolic diseases (diabetes, coronary heart disease, stroke) before dementia diagnosis (fully adjusted hazard ratio 0.82, 95% confidence interval 0.68 to 0.98). The risk of dementia was also observed during the first 10 years of follow-up (hazard ratio 0.60, 95% confidence interval 0.37 to 0.95) and from year 10 onwards (0.79, 0.66 to 0.95) and replicated using a repeated job exposure matrix indicator of cognitive stimulation (hazard ratio per 1 standard deviation increase 0.77, 95% confidence interval 0.69 to 0.86). In analysis controlling for multiple testing, higher cognitive stimulation at work was associated with lower levels of proteins that inhibit central nervous system axonogenesis and synaptogenesis: slit homologue 2 (SLIT2, fully adjusted β −0.34, P Conclusions The risk of dementia in old age was found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs. The findings that cognitive stimulation is associated with lower levels of plasma proteins that potentially inhibit axonogenesis and synaptogenesis and increase the risk of dementia might provide clues to underlying biological mechanisms.

Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries

Abstract: SUMMARY Background Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints. Methods The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers. Findings 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality. Interpretation Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality. Funding NordForsk, the Medical Research Council, the National Institute on Aging, the Wellcome Trust, Academy of Finland, and Finnish Work Environment Fund.

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.

Abstract: 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)Exposed=0.078, 95% CI 0.066 to 0.090; SMDNon-exposed=0.025, 95% CI 0.014 to 0.036), procedural justice (SMDExposed=0.101, 95% CI 0.084 to 0.118; SMDNon-exposed=0.053, 95% CI 0.038 to 0.068), workplace social capital (SMDExposed=0.094, 95% CI 0.077 to 0.110; SMDNon-exposed=0.034, 95% CI 0.019 to 0.048), less decline in self-rated health (SMDExposed=−0.038, 95% CI −0.054 to –0.022; SMDNon-exposed=−0.081, 95% CI −0.095 to –0.067), perceived work ability (SMDExposed=−0.091, 95% CI −0.108 to –0.074; SMDNon-exposed=−0.151, 95% CI −0.167 to –0.136) and less increase in psychological distress (risk ratio (RR)Exposed=1.06, 95% CI 1.02 to 1.09; RRNon-exposed=1.16, 95% CI 1.13 to 1.20). New tasks (6%) were associated with greater increase in psychological distress (RRExposed=1.28, 95% CI 1.19 to 1.39; RRNon-exposed=1.10, 95% CI 1.07 to 1.12) and team reorganisation (5%) with slightly steeper decline in perceived work ability (SMDExposed=−0.151 95% CI −0.203 to –0.098; SMDNon-exposed=−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.

The Effect of Consumer-based Activity Tracker Intervention on Physical Activity among Recent Retirees-An RCT Study.

Abstract: Purpose The randomized controlled trial REACT (NCT03320746) examined the effect of a 12-month consumer-based activity tracker intervention on accelerometer-measured physical activity among recent retirees. Methods Altogether 231 recently retired Finnish adults (age, 65.2 ± 1.1 yr, mean ± SD; 83% women) were randomized to intervention and control groups. Intervention participants were requested to wear a commercial wrist-worn activity tracker (Polar Loop 2; Polar, Kempele, Finland) for 12 months, to try to reach the daily activity goals shown on the tracker display, and to upload their activity data to a Web-based program every week. The control group received no intervention. Accelerometer-based outcome measurements of daily total, light physical activity (LPA), and moderate to vigorous (MVPA) physical activity were conducted at baseline and at 3-, 6-, and 12-month time points. Hierarchical linear mixed models were used to examine the differences between the groups over time. All analyses were performed by intention-to-treat principle and adjusted for wake wear time. Results The use of a commercial activity tracker did not increase daily total activity, LPA, or MVPA over the 12-months period when compared with nonuser controls (group-time interaction, P = 0.39, 0.23, and 0.77, respectively). There was an increase in LPA over the first 6 months in both the intervention (26 min·d-1, 95% confidence interval [CI] = 13 to 39) and the control (14 min·d-1, 95% CI = 1 to 27) groups, but the difference between the groups was not significant (12 min·d-1, 95% CI = -6 to 30). In both groups, LPA decreased from 6 to 12 months. Conclusion The 12-month use of a commercial activity tracker does not appear to elicit significant changes in the daily total activity among a general population sample of recent retirees, thus highlighting the need to explore other alternatives to increase physical activity in this target group.

Daily Physical Activity Patterns and Their Association With Health-Related Physical Fitness Among Aging Workers-The Finnish Retirement and Aging Study

Abstract: BACKGROUND This study aimed to identify accelerometer-measured daily physical activity patterns, and to examine how they associate with health-related physical fitness among aging workers. METHODS The study population consisted of 263 participants (mean age 62.4 years, SD 1.0) from the Finnish Retirement and Aging study, who used wrist-worn ActiGraph accelerometer for at least 1 week including both workdays and days off. Health-related physical fitness measures included body composition (waist circumference, bioimpedance), cardiorespiratory fitness (bicycle ergometer test), and muscular fitness (push-up and chair rise tests). RESULTS Based on the latent class trajectory analysis, 6 trajectories were identified for workdays showing variation in activity level on working hours and on evening hours. Moderate activity during working hours and increase of activity level in the evening was associated with the most favorable health-related fitness in comparison to low activity throughout the workday: waist circumference 90.0 cm (95% confidence interval [CI] 85.5-94.5) versus 99.5 cm (95% CI 96.8-102.3), fat mass 13.9 kg (9.3-18.5) versus 23.8 kg (20.2-27.4), cardiorespiratory fitness 33.4 mL/kg/min (95% CI 31.4-35.3) versus 29.1 mL/kg/min (95% CI 27.8-30.3) (adjusted for age, sex, days off activity, smoking, and alcohol). For the days off, 2 different trajectories were identified, but they differed only in terms of level and not by timing of physical activity. CONCLUSIONS A large variation in the workday physical activity patterns was observed among aging workers. Independent of worktime activity, people who were more active in the evenings had more favorable health-related physical fitness than those who were less active throughout the day.

Social network ties before and after retirement: a cohort study.

Abstract: Social networks are associated with individual’s health and well-being. Working life offers opportunities to create and maintain social networks, while retirement may change these networks. This study examined how the number of ties in social network changes across the retirement transition. The study population consisted of 2319 participants (84% women, mean age 63.2 years) from the Finnish Retirement and Aging study. Information about social network ties, including the number of ties in the inner, middle and outer circles of the social convoy model, was gathered using annual postal surveys before and after retirement. Three repeat surveys per participant covered the retirement transition and the post-retirement periods. Mean number of network ties was 21.6 before retirement, of which 5.6 were situated in the inner, 6.9 in the middle and 9.1 in the outer circle. The number of ties in the outer circle decreased by 0.67 (95% CI − 0.92, − 0.42) during the retirement transition period, but not during the post-retirement period (0.11, 95% CI − 0.33, 0.12) (interaction period * time, p = 0.006). The pattern of change in these ties did not differ by gender, occupational status, marital status, number of chronic diseases and mental health during the retirement transition period. The number of ties in the inner and middle circles overall did not decrease during these periods. The number of peripheral relationships decreased during the retirement transition but not after that, suggesting that the observed reduction is more likely to be associated with retirement rather than aging.

Internal consistency and factor structure of Jenkins Sleep Scale: cross-sectional cohort study among 80 000 adults.

Abstract: Objectives To assess the internal consistency and construct validity of the Finnish translation of the Jenkins Sleep Scale (JSS) in a large healthy working-age population with diverse work characteristics. Design Survey-based cross-sectional cohort study. Setting Survey conducted by an institute of occupational health. Participants Employees of 10 towns and 6 hospital districts. Primary and secondary outcome measures The internal consistency defined by a Cronbach’s alpha. Exploratory and confirmatory factor analyses to evaluate the construct structure of the JSS. Results Of 81 136 respondents, 14 890 (18%) were men and 66 246 (82%) were women. Their average age was 52.1 (13.2) years. Of the respondents, 41 823 (52%) were sleeping 7 or less hours per night. The mean JSS total score was 6.4 (4.8) points. The JSS demonstrated high internal consistency with an alpha of 0.80 (lower 95% confidence limit 0.80). Exploratory factor analysis supported a one-factor solution with eigenvalue of 1.94. Confirmatory factor analysis showed that all four items were positively correlated with a single common factor explaining 44%–61% of common factor’s variance. Conclusions The Finnish translation of JSS was found to be a unidimensional scale with good internal consistency. As such, the scale may be recommended as a practicable questionnaire when studying sleep difficulties in a healthy working-age population.

Changes in prolonged sedentary behaviour across the transition to retirement

Abstract: Background Prolonged sedentary behaviour is associated with a higher risk of cardiometabolic diseases. This longitudinal study examined changes in daily total, prolonged (≥30 min) and highly prolonged (≥60 min) sedentary time across the transition to retirement by gender and occupational status. Methods We included 689 aging workers (mean (SD) age before retirement 63.2 (1.6) years, 85% women) from the Finnish Retirement and Aging Study (FIREA). Sedentary time was measured annually using a wrist-worn triaxial ActiGraph accelerometer before and after retirement with on average 3.4 (range 2–4) measurement points. Results Women increased daily total sedentary time by 22 min (95% CI 13 to 31), prolonged sedentary time by 34 min (95% CI 27 to 42) and highly prolonged sedentary time by 15 min (95% CI 11 to 20) in the transition to retirement, and remained at the higher level of sedentary time years after retirement. The highest increase in total and prolonged sedentary time was observed among women retiring from manual occupations. Men had more total and prolonged sedentary time compared with women before and after retirement. Although no changes in men’s sedentary time were observed during the retirement transition, there was a gradual increase of 33 min (95% CI 6 to 60) in prolonged sedentary time from pre-retirement years to post-retirement years. Conclusion The transition to retirement was accompanied by an abrupt increase in prolonged sedentary time in women but a more gradual increase in men. The retirement transition may be a suitable time period for interventions aiming to decrease sedentary behaviour.

The effect of a consumer-based activity tracker intervention on accelerometer-measured sedentary time among retirees: a randomized controlled REACT trial.

Abstract: Background Effective strategies to reverse the increasing trend of sedentary behavior after retirement are needed. The aim of this study was to examine the effect of 12-month activity tracker-based intervention on daily total and prolonged sedentary time (≥60 min) among recent retirees. Methods Randomization to intervention and control groups was performed to 231 retirees (mean age 65.2 (SD 1.1) years, 83% women). Intervention participants wore a consumer-based wrist-worn activity tracker (Polar Loop 2, Polar, Kempele, Finland), including daily activity goal, every day and night for 12 months. The activity tracker also gave vibrating reminders to break up uninterrupted inactivity periods after 55 minutes. A wrist-worn triaxial ActiGraph wGT3X-BT accelerometer was used to measure sedentary time at baseline and at 3-, 6- and 12-month time points. Results The use of an activity tracker did not reduce daily total or prolonged sedentary time over 12 months (p values for time*group interaction 0.27 and 0.39, respectively). In the post-hoc analysis focusing on short- and medium-term effects on prolonged sedentary time, no differences between the intervention and control groups over three months were found, but a tendency for a greater decrease in prolonged sedentary time in the intervention group over six months was seen (mean difference in changes between the groups 29 min, 95% CI -2 to 61). Conclusions The activity tracker with inactivity alerts did not elicit changes in sedentary time over 12 months among recent retirees. Alternative approaches may be needed to achieve long-term changes in sedentary time among retirees.

Association of rotating shift work schedules and the use of prescribed sleep medication: A prospective cohort study

Abstract: We examined whether working rotating shifts, with or without night work, is associated with the purchase of prescribed sleep medication, and whether the association is dependent on age. Data were obtained from a longitudinal cohort study of Finnish public sector employees who responded to questions on work schedule and background characteristics in 2000, 2004 and 2008. The data were linked to national register data on redeemed prescriptions of hypnotic and sedative medications, with up to 11 years of follow-up. Age stratified Cox proportional hazard regression models were computed to examine incident use of medication comparing two groups of rotating shift workers (those working shifts that included night shifts and those whose schedules did not include night shifts) with day workers who worked in a similar range of occupations. Shift work with night shifts was associated with increased use of sleep medication in all age groups, after adjustments for sex, occupational status, marital status, alcohol consumption, smoking and physical activity levels (hazard ratio [HR], [95% confidence interval, CI] 1.14 [1.01-1.28] for age group ≤39 years; 1.33 [1.19-1.48] for age group 40-49 years; 1.28 [1.13-1.44] for age group ≥50 years). Shift work without nights was associated with medication use in the two older age groups (HR [95% CI] 1.14 [1.01-1.29] and 1.17 [1.05-1.31] for age groups 40-49 years and >50 years, respectively). These findings suggest that circadian disruption and older age puts rotating shift workers, and especially those who work nights, at increased risk of developing clinically significant levels of sleep problems.

Psychological Distress During the Retirement Transition and the Role of Psychosocial Working Conditions and Social Living Environment.

Abstract: OBJECTIVES Mental health is determined by social, biological, and cultural factors and is sensitive to life transitions. We examine how psychosocial working conditions, social living environment, and cumulative risk factors are associated with mental health changes during the retirement transition. METHOD We use data from the Finnish Retirement and Aging study on public sector employees (n = 3,338) retiring between 2014 and 2019 in Finland. Psychological distress was measured with the General Health Questionnaire annually before and after retirement and psychosocial working conditions, social living environment, and accumulation of risk factors at the study wave prior to retirement. RESULTS Psychological distress decreased during the retirement transition, but the magnitude of the change was dependent on the contexts individuals retire from. Psychological distress was higher among those from poorer psychosocial working conditions (high job demands, low decision authority, job strain), poorer social living environment (low neighborhood social cohesion, small social network), and more cumulative risk factors (work/social/both). During the retirement transition, greatest reductions in psychological distress were observed among those with poorer conditions (work: absolute and relative changes, p [Group × Time interactions] < .05; social living environment and cumulative risk factors: absolute changes, p [Group × Time interactions] < .05). DISCUSSION Psychosocial work-related stressors lead to quick recovery during the retirement transition but the social and cumulative stressors have longer-term prevailing effects on psychological distress. More studies are urged incorporating exposures across multiple levels or contexts to clarify the determinants of mental health during the retirement transition and more generally at older ages.

Shift work, work time control, and informal caregiving as risk factors for sleep disturbances in an ageing municipal workforce.

Abstract: Objectives This study aimed to examine the contribution of shift work, work time control (WTC) and informal caregiving, separately and in combination, to sleep disturbances in ageing employees. Methods Survey data were obtained from two prospective cohort studies with repeated measurements of working conditions, informal caregiving, and sleep disturbances. We used fixed-effect conditional logistic regression analysis to examine whether within-individual changes in shift work, WTC and informal caregiving were associated with changes in sleep. Secondary analyses included between-individuals comparison using standard logistic regression models. Results from the two cohorts were pooled using meta-analysis. Results Low WTC and informal caregiving were associated with sleep disturbances in within-individual analyses [odds ratios (OR) ranging between 1.13 (95% confidence interval 1.01-1.27) and 1.48 (95% CI 1.29-1.68)] and in between-individuals analyses [OR 1.14 (95% CI 1.03-1.26) to 1.33 (1.19-1.49)]. Shift work alone was not associated with sleep disturbances, but accumulated exposure to shift work, low WTC and informal caregiving was associated with higher risk of sleep disturbances (OR range 1.21-1.76). For some of the sleep outcomes, informal caregiving was related to a higher risk of sleep disturbances when WTC was low and a lower risk when WTC was high. Conclusions Informal caregiving and low WTC are associated with risk of sleep disturbances among ageing employees. The findings also suggest that low WTC in combination with informal caregiving may increase the risk of sleep disturbances whereas high WTC may alleviate the adverse impact of informal caregiving on sleep.

Contexts of sedentary time and physical activity among ageing workers and recent retirees: cross-sectional GPS and accelerometer study.

Abstract: Objectives We examined sedentary time and physical activity in different contexts among ageing workers, between their workdays and days off, and recent retirees, between their weekdays and weekend days. Design Cross-sectional study. Setting Finnish Retirement and Aging study and Enhancing physical activity and healthy ageing among recent retirees—Randomised controlled in-home physical activity trial. Participants 137 workers (544 measurement days) and 53 retirees (323 days), who provided data for at least 1 workday/weekday and 1 day off/weekend day. Primary and secondary outcome measures Physical activity behaviour was measured with a combined Global Positioning System and accelerometer device (SenseDoc V.2.0), providing information on sedentary time, light physical activity and moderate-to-vigorous physical activity (MVPA) by locations (home or non-home) and trips (active travel, ie, speed Results Workers accumulated more sedentary time and physical activity at non-home locations than at home on workdays, while the opposite was confirmed for days off (p 0.05). Regardless of the day, retirees accumulated 33 min of daily MVPA, of which 14 min was accrued during active travel. Conclusions Workers accumulated more MVPA on days off than on workdays, and their activity behaviour varied between workdays and days off at different locations. Our results showed that a large proportion of the MVPA was accumulated during travel at slower speeds, which suggests that active travel could be a feasible way to increase MVPA among older adults. Trial registration number NCT03320746.

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

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

Association of changes in lifestyle with changes in sleep difficulties: an analysis of 38 400 participants over a 16-year follow-up.

Abstract: Objectives To investigate the association between changes in lifestyle risk factors and changes is sleep difficulties. Design Longitudinal repeated measures cohort study. Setting University and national institute of occupational health. Participants Participants of the Finnish Public Sector study with information on sleep and lifestyle-related risk factors collected in five repeat surveys with 4‐year intervals from 2000 to 2017. The participants were those, who had responded at least twice and had a change in sleep difficulties (having sleep difficulties vs not) (142 969 observations from 38 400 respondents (mean age 45.5 (SD 9.2) years, 83% women). Primary and secondary outcome measures Changes in sleep quality over time. Longitudinal fixed effects analysis, a method that accounts for time-invariant confounders by design, was used. Results At first available response, sleep difficulties were experienced by 13 998 (36%) of the respondents. Respectively, the mean age was 44.3 (10.0) years, 7526 (20%) were obese, 13 487 (35%) reported low physical activity, 3338 (9%) extensively drinking and 6547 (17%) were smoking. Except for smoking, the changes in the studied modifiable risks were associated with changes in sleep difficulties. The ORs for having sleep difficulties were 1.41 (95% CI 1.35 to 1.48) for obesity, 1.10 (95% CI 1.06 to 1.13) for low physical activity and 1.43 (95% CI 1.35 to 1.51) for heavy drinking. For smoking, the association was negative with OR 0.81 (95% CI 0.76 to 0.86). Including all four modifiable risks into model changed the estimates only little. Conclusions The results of this longitudinal study suggest that changes in sleep quality are interconnected with changes in lifestyle.

Workplace discrimination as risk factor for long-term sickness absence: Longitudinal analyses of onset and changes in workplace adversity

Abstract: Workplace discrimination may affect the health of the exposed employees, but it is not known whether workplace discrimination is also associated with an increased risk of long-term sickness absence. The aim of this study was to examine the longitudinal associations of changes in and onset of workplace discrimination with the risk of long-term sickness absence. Data on workplace discrimination were obtained from 29,597 employees participating in survey waves 2004, 2006, 2008 and/or 2010 of the Finnish Public Sector Study. Four-year changes in long-term sickness absence (≥10 days of medically certified absence with a mental or non-mental diagnosis) were assessed. This covered successive study waves in analyses of onset of workplace discrimination as well as fixed effect analyses of change in workplace discrimination (concurrent i.e. during the exposure year and 1-year lagged i.e. within one year following exposure), by using each employee as his/her own control. The risk of long-term sickness absence due to mental disorders was greater for employees with vs. without onset of workplace discrimination throughout the 4-year period, reaching a peak at the year when the onset of discrimination was reported (adjusted risk ratio 2.13; 95% confidence interval (CI) 1.80-2.52). The fixed effects analyses showed that workplace discrimination was associated with higher odds of concurrent, but not 1-year lagged, long-term sickness absence due to mental disorders (adjusted odds ratio 1.61; 95% CI 1.33-1.96 and adjusted odds ratio 1.02; 95% CI 0.83-1.25, respectively). Long-term sickness absence due to non-mental conditions was not associated with workplace discrimination. In conclusion, these findings suggest that workplace discrimination is associated with an elevated risk of long-term sickness absence due to mental disorders. Supporting an acute effect, the excess risk was confined to the year when workplace discrimination occurred.

'Return to Work' Coordinator Model and Work Participation of Employees: A Natural Intervention Study in Finland.

Abstract: Purpose Employers increasingly use ‘return to work’ (RTW) coordinators to support work ability and extend working careers, particularly among employees with reduced work ability We examined whether applying this model was associated with changes in employee sickness absence and disability retirements Methods We used data from the Finnish Public Sector study from 2009 until 2015 Employees where the model was introduced in 2012 constituted the cases (n = 4120, one municipality) and employees where the model was not in use during the follow-up, represented the controls (n = 5600, two municipalities) We analysed risk of disability retirement in 2013–2015 and risk of sickness absence after (2013–2015) vs before (2009–2011) intervention by case–control status Results The incidence of disability retirement after the intervention was lower in cases compared to controls both in the total population (hazard ratio HR = 049, 95% CI 030–079) and in the subgroup of participants with reduced work ability (HR = 034, 95% CI 012–099) The risk of sickness absence increased from pre-intervention to post-intervention period both among cases and controls although the relative increase was greater among cases (RRpost- vs pre-intervention = 126, 95% CI 114–140) than controls (RRpost- vs pre-intervention = 103, 95% CI 097–108) In the group of employees with reduced work ability, no difference in sickness absence trends between cases and controls was observed Conclusions These findings suggest that RTW-coordinator model may increase employee sickness absence, but decrease the risk of disability retirement, ie, permanent exclusion from the labour market

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

Abstract: 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 excisi...

Does working beyond the statutory retirement age have an impact on health and functional capacity? The Finnish Retirement and Aging cohort study.

Abstract: Objective This study aimed to compare the development of self-rated health, psychological distress and physical functioning between those retired on time and those who continued working beyond the individual retirement age. Methods The study population consisted of 2340 public sector employees from the Finnish Retirement and Aging study. Participants were categorised into no extension of employment (retired at the individual retirement date or Results The prevalence of suboptimal self-rated health and psychological distress changed a little among the extension group during the follow-up from 1 year before (T1) to 18 months (T2) and 30 months (T3) after individual pensionable date. Compared with no extension, the risk of having suboptimal self-rated health in the extension group was 0.89 (95% CI 0.68 to 1.17) at T1, 1.16 (95% CI 0.88 to 1.53) at T2 and 0.96 (95% CI 0.68 to 1.37) at T3. For psychological distress, the corresponding risk ratios were 0.93 (0.65 to 1.32), 1.15 (0.78 to 1.69) and 1.04 (0.61 to 1.79). The mean differences in the number of physical functioning difficulties between the extension and no-extension groups were 0.06 (−0.16 to 0.29) at T1, 0.05 (−0.18 to 0.27) at T2 and −0.11 (−0.39 to 0.17) at T3. Conclusions This study found no evidence that voluntarily extending the working career beyond retirement age would pose a risk to health and physical functioning among ageing workers.

Persistence of sleep difficulties for over 16 years amongst 66,948 working-aged adults.

Abstract: The objective was to investigate the persistence of sleep difficulties for over 16 years amongst a population of working age. In this prospective cohort study, a group-based trajectory analysis of repeated surveys amongst 66,948 employees in public sector (mean age 44.7 [SD 9.4] years, 80% women) was employed. The main outcome measure was sleep difficulties based on Jenkins Sleep Scale (JSS). Up to 70% of the respondents did not experience sleep difficulties whereas up to 4% reported high frequency of notable sleep difficulties through the entire 16-year follow-up. Heavy drinking predicted sleep difficulties (OR 2.3 95% CI 1.6 to 3.3) except for the respondents younger than 40 years. Smoking was associated with sleep difficulties amongst women younger than 40 years (OR 1.2, 95% CI 1.0 to 1.5). Obesity was associated with sleep difficulties amongst men (OR 1.9, 95% CI 1.4 to 2.7) and women (OR 1.2, 95% CI 1.1 to 1.3) of middle age and amongst women older than 50 (OR 1.5, 95% CI 1.2 to 1.8) years. Physical inactivity predicted sleep difficulties amongst older men (OR 1.3, 95% CI 1.1 to 1.6). In this working-age population, sleep difficulties showed a great persistence over time. In most of the groups, the level of sleep difficulties during the follow-up was almost solely dependent on the level of initial severity. Depending on sex and age, increasing sleep problems were sometimes associated with high alcohol consumption, smoking, obesity and physical inactivity, but the strength of these associations varied.

Work participation and physicality of work in young adulthood and the development of unhealthy lifestyle habits and obesity later in life: a prospective cohort study.

Abstract: Objective To determine the effects of early entry into the labour market and physicality of work in young adulthood on the development of obesity and unhealthy lifestyle habits later in life. Methods This study is a part of the Young Finns Study. Entry into the labour market and physicality of work were measured at baseline, when participants were aged 18, 21, or 24 years in 1986 or 18 years in 1989. Follow-up of lifestyle habits were conducted in 2001, 2007 and 2011. The outcomes were obesity (n=5558 observations), abdominal obesity (n=4060 observations), daily smoking (n=5628) and leisure time physical activity (n=5946) and analysed with generalised estimating equation. Results Compared with sedentary work, physicality of work in young adulthood increased the odds of future obesity (adjusted OR=1.32, 95% CI 1.01 to 1.74 for light/moderate work and OR=1.44, 95% CI 0.99 to 2.08 for heavy manual work (particularly in women OR=2.03, 95% CI 1.07 to 3.84)) and future smoking (OR=1.79, 95% CI 1.39 to 2.30 for light/moderate work and OR=2.01, 95% CI 1.47 to 2.76 for heavy manual work (particularly in women OR=2.81, 95% CI 1.60 to 4.91)). For those who entered the labour market at ages 18–21 or younger, the odds of smoking was 1.85 times (95% CI 1.26 to 2.73) and that of obesity 1.45 times (95% CI 1.01 to 2.10) higher, and the rate of leisure time physical activity was 0.73 times (95% CI 0.58 to 0.93) lower compared with those who entered the labour market at ages 22–24 years. Conclusion Early entry into the labour market and physicality of work in young adulthood shape the development of obesity and unhealthy behaviours in later adulthood.

Association of job strain with accelerometer-based sleep duration and timing of sleep among older employees.

Abstract: Job strain has been associated with poor sleep quality and could lead to changes in duration and timing of sleep as well. This study examined the association of job strain with sleep duration, bedtimes and awakening times among public sector employees close to their retirement age. Differences in these sleep parameters between workdays and free days across job strain groups were examined. Duration and timing of sleep were measured repeatedly with accelerometers among 466 public sector employees in Finland (mean age 63 years, 86% women), who contributed to 759 measurements in total. Job demands (low/high) and control (low/high) measured by self-reports and job exposure matrix were used to identify low strain (low demand, high control), passive (low, low), active (high, high) and high strain (high, low) jobs. No differences in sleep duration were observed on workdays, whereas on free days those in the high strain group had longer sleep duration than those in the low strain and passive job groups. The high strain group also extended their sleep from workdays to free days more, the extension being on average 59 min (95% CI 42 min-75 min) when adjusted for several sociodemographic, work and health factors. This extension of sleep duration resulted mostly from a greater delay of awakening times from workdays to free days. Psychosocial work factors, such as job strain, need to be considered when promoting sufficient sleep duration among older employees, as those with job strain may have a greater need for recovery and sleep.

Trajectories of work ability from mid-life to pensionable age and their association with retirement timing.

Abstract: Background This study aimed to identify the trajectories of work ability over 16 years preceding the individual pensionable age and to examine the association with retirement timing. Methods The study population consisted of 2612 public sector employees from the Finnish Retirement and Aging study and the Finnish Public Sector study. Participants were grouped into ‘no-extension’ (retired at the individual pensionable date or worked no longer than 6 months after that date) and ‘extension’ (worked more than 6 months after individual pensionable age). Trajectories of self-reported work ability score (0–10) in maximum of eight measurement points over 16 years preceding retirement were examined using the group-based latent trajectory analysis. Log-binomial regression was used to analyse the association between trajectory groups and extended employment. Results Four stable (‘Stable excellent’, 7%; ‘Stable high’, 62%; ‘Stable medium’, 24%; ‘Low’, 4%) and one decreasing (‘Declining’, 3%) work ability trajectories were identified. After taking into account gender, age, occupational status, marital status and self-rated health, ‘Stable excellent’ trajectory was associated with a higher likelihood of extended employment compared with the ‘Low’ (risk ratio (RR) 2.38, 95% CI 1.21 to 4.68) and to the ‘Declining’ (RR 2.82, 95% CI 1.32 to 6.01) trajectories. There was no difference in retirement timing between ‘Declining’, ‘Low’ and ‘Stable medium’ trajectories. Conclusion Work ability remained relatively stable among majority of the participants over 16 years of follow-up. Stable excellent work ability from mid-life to late career was associated with higher likelihood of extending employment beyond individual pensionable age than those with low or declining work ability.

Long-term cumulative light exposure from the natural environment and sleep: A cohort study.

Abstract: We analysed (A) the association of short-term as well as long-term cumulative exposure to natural light, and (B) the association of detailed temporal patterns of natural light exposure history with three indicators of sleep: sleep duration, sleep problems, and diurnal preference. Data (N = 1,962; 55% women; mean age 41.4 years) were from the prospective Young Finns Study, which we linked to daily meteorological data on each participant's neighbourhood natural light exposure using residential postal codes. Sleep outcomes were self-reported in 2011. We first examined associations of the sleep outcomes with cumulative light exposure of 5-year, 2-year, 1-year, and 2-month periods prior to the sleep assessment using linear and Poisson regression models adjusting for potential confounders. We then used a data-driven time series approach to detect clusters of participants with different light exposure histories and assessed the associations of these clusters with the sleep outcomes using linear and Poisson regression analyses. A greater cumulative light exposure over ≥1 year was associated with a shorter sleep duration (β = -0.10, 95% confidence interval [CI] -0.15 to -0.04), more sleep problems (incident rate ratio [IRR] 1.04, 95% CI 1.0-1.07) and diurnal preference towards eveningness (β = -0.09, 95% CI -0.14 to -0.03). The data-driven exposure pattern of "slowly increasing" light exposure was associated with fewer overall sleep problems (IRR 0.93, 95% CI 0.88-0.98) compared to a "recently declining" light exposure group representing the "average-exposure" group. These findings suggest that living in an area with relatively more intense light exposure for a longer period of time influences sleep.

The Effect of Commercial Activity Tracker Based Physical Activity Intervention on Body Composition and Cardiometabolic Health Among Recent Retirees

Abstract: The REACT is a commercial activity tracker based intervention, which primarily aimed to increase physical activity. This study examines the secondary outcomes of the physical activity intervention on body composition and cardiometabolic health indicators. Overall 231 recently retired Finnish men and women (65.2 (SD 1.1) years, 83% women) took part to the study. The participants were randomized into intervention (n=117) and control (n=114) groups. The intervention group members used a commercial activity tracker (Polar Loop 2, Polar, Kempele, Finland) with a daily activity goal and inactivity alerts every day for 12 months. Controls received no intervention. Secondary health outcomes included body weight, fat mass, fat free mass, waist circumference, blood pressure, indicators of glucose and lipid metabolisms, and high-sensitivity C-reactive protein, and they were measured at baseline and at 12-month end point. Hierarchical linear mixed models were used to examine the differences between the groups over time, and no differences in the mean changes of the body composition and cardiometabolic health indicators between the groups were found (group*time interaction >0.20 for all measures). Fat free mass, waist circumference, blood pressure, and low density lipoprotein levels decreased in both groups over the 12 months. These findings state that one-year daily use of commercial activity tracker does not induce different cardiometabolic health effects when compared to the non-user controls among general population of recent retirees.

Sleep duration and sleep difficulties as predictors of occupational injuries: a cohort study.

Abstract: Study objectives To examine the association between sleep duration and sleep difficulties with different types and causes of workplace and commuting injuries. Methods The data were derived from the Finnish Public Sector study including 89.543 participants (178.309 person-observations). Participants reported their sleep duration and sleep difficulties between 2000 and 2012. These were linked to occupational injury records from the national register maintained by the Federation of Accident Insurance Institutions. Risk of injuries was followed up 1 year after each study wave. Logistic regression analysis with generalised estimating equations (GEEs) was used to examine the association between sleep duration/difficulties and risk of injuries, and multinomial logistic regression with GEE was used to examine the association with injury types and causes. Results Both sleep duration and difficulties were associated with injuries. Employees with short sleep (≤6.5 hours) had 1.07-fold odds of workplace injuries (95% CI 1.00 to 1.14) and 1.14 times higher odds of commuting injuries (95% CI 1.04 to 1.26) compared with employees with normal sleep duration. For employees with disturbed sleep, the corresponding ORs were 1.09-fold (95% CI 1.02 to 1.17) and 1.14-fold (95% CI 1.04 to 1.26) compared with those without sleep difficulties, respectively. The risk of commuting injuries was higher among those who had difficulty in falling asleep (OR 1.29, 95% CI 1.07 to 1.55), woke up too early (OR 1.11, 95% CI 1.00 to 1.23) or had non-restorative sleep (OR 1.18, 95% CI 1.05 to 1.33). Conclusions Short sleep duration and sleep difficulties are associated with slightly increased risk of workplace and commuting injuries.