Tuula Oksanen

Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies

Abstract.  Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB, Bonenfant S, Borritz M, Burr H, Casini A, Clays E, Dragano N, Erbel R, Geuskens GA, Goldberg M, Hooftman WE, Houtman IL, Jöckel K‐H, Kittel F, Knutsson A, Koskenvuo M, Leineweber C, Lunau T, Madsen IEH, Magnusson Hanson LL, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pentti J, Rugulies R, Siegrist J, Suominen S, Vahtera J, Virtanen M, Westerholm P, Westerlund H, Zins M, Ferrie JE, Theorell T, Steptoe A, Hamer M, Singh‐Manoux A, Batty GD, Kivimäki M, for the IPD‐Work Consortium (Finnish Institute of Occupational Health, Helsinki, Finland; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Jönköping University, Jönköping, Sweden; Ghent University, Ghent, Belgium; National Research Centre for the Working Environment, Copenhagen, Denmark; Versailles‐Saint Quentin University, Versailles, France; Centre for Research in Epidemiology and Population Health, Villejuif, France; Bispebjerg University Hospital, Copenhagen, Denmark; Centre for Maritime Health and Safety, Esbjerg, Denmark; Université Libre de Bruxelles, Brussels, Belgium; University Duisburg‐Essen, Essen, Germany; West‐German Heart Center Essen, University Duisburg‐Essen, Essen, Germany; TNO, Hoofddorp, the Netherlands; Mid Sweden University, Sundsvall, Sweden; University of Helsinki, Helsinki, Finland; Stockholm University, Stockholm, Sweden; University College London, London, UK; Bispebjerg University Hospital, Copenhagen, Denmark; Umeå University, Umeå, Sweden; Finnish Institute of Occupational Health, Turku, Finland; Harvard School of Public Health, Boston, MA, USA; University of Copenhagen, Copenhagen, Denmark; University of Düsseldorf, Düsseldorf, Germany; University of Turku, Turku; Folkhälsan Research Center, Helsinki; Turku University Hospital, Turku, Finland; Uppsala University, Uppsala; Karolinska Institutet, Stockholm, Sweden; University of Bristol, Bristol; University of Edinburgh, Edinburgh, UK; and University of Helsinki, Helsinki, Finland). Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies. J Intern Med 2012; 272: 65–73.

Workplace Social Capital and All-Cause Mortality: A Prospective Cohort Study of 28 043 Public-Sector Employees in Finland

OBJECTIVES We examined the association between workplace social capital and all-cause mortality in a large occupational cohort from Finland. METHODS We linked responses of 28 043 participants to surveys in 2000 to 2002 and in 2004 to national mortality registers through 2009. We used repeated measurements of self- and coworker-assessed social capital. We carried out Cox proportional hazard and fixed-effects logistic regressions. RESULTS During the 5-year follow-up, 196 employees died. A 1-unit increase in the mean of repeat measurements of self-assessed workplace social capital (range 1-5) was associated with a 19% decrease in the risk of all-cause mortality (age- and gender-adjusted hazard ratio [HR] = 0.81; 95% confidence interval [CI] = 0.66, 0.99). The corresponding point estimate for the mean of coworker-assessed social capital was similar, although the association was less precisely estimated (age- and gender-adjusted HR = 0.77; 95% CI = 0.50, 1.20). In fixed-effects analysis, a 1-unit increase in self-assessed social capital across the 2 time points was associated with a lower mortality risk (odds ratio = 0.81; 95% CI = 0.55, 1.19). CONCLUSIONS Workplace social capital appears to be associated with lowered mortality in the working-aged population.

Insomnia symptoms as a predictor of incident treatment for depression: Prospective cohort study of 40,791 men and women

OBJECTIVE To examine the quantity and quality of insomnia symptoms as predictors of treatment for depression in the largest cohort study to date. METHODS Forty thousand seven hundred and ninety-one Finnish public sector employees (mean age 43.9 years, 81% female), free of depression at baseline, participated in this prospective observational cohort study. Participants responded to the survey in 2000-2002 or 2004 and the mean follow-up was 3.3 years. Self-reported sleep was linked to comprehensive individual-level health registers to assess treatment for depression (antidepressant medication, commencements of psychotherapy or hospitalization due to depression). RESULTS One thousand seven hundred and three participants fulfilled any of our set criteria for depression-related treatment. After adjustments for baseline characteristics, insomnia symptoms five to seven nights/week were associated with an increased risk of incident treatment for depression, hazard ratio 1.64 (95% confidence interval 1.44-1.86). Hazard ratio for symptoms two to four nights/week was 1.46 (1.29-1.64). Difficulties initiating or maintaining sleep and non-refreshing sleep increased the risk when analyzed separately. Those reporting all four symptoms at least twice a week had 2.09-fold (1.75-2.49) risk. The findings did not materially change after excluding depression cases within the first two years of the follow-up. CONCLUSIONS These data suggest an association between insomnia symptoms and moderately increased risk of clinically significant depression outcomes. Insomnia should be considered as a component in prediction models for new-onset depression.

Workplace social capital and risk of chronic and severe hypertension: a cohort study.

Objective: The association between workplace factors and the development of hypertension remains uncertain. We examined the risk of hypertension as a function of workplace social capital, that is, social cohesion, trust and reciprocity in the workplace. Methods: A total of 11 777 male and 49 145 female employees free of chronic hypertension at baseline in 2000–2004 were followed up for incident hypertension until the end of 2005 (the Finnish Public Sector Study). We used survey responses from the participants and their coworkers in the same work unit to assess workplace social capital at baseline. Follow-up for incident hypertension was based on record linkage to national health registers (mean follow-up 3.5 years, 1424 incident hypertension cases). Results: Male employees in work units characterized by low workplace social capital were 40–60% more likely to develop chronic hypertension compared to men in work units with high social capital [age-adjusted hazard ratio 1.57, 95% confidence interval (CI) 1.15–2.14 for self-assessed social capital and 1.41, 95% CI 1.01–1.97 for coworkers’ assessment]. According to path analysis adjusted for covariates, the association between low self-reported social capital and hypertension was partially mediated by obesity (P for pathway = 0.02) and alcohol consumption (P = 0.03). For coworker-assessed social capital, the corresponding mediation pathways did not reach statistical significance (P = 0.055 and 0.22, respectively). No association between workplace social capital and hypertension was found for women. Conclusion: These data suggest that low self-reported workplace social capital is associated with increased near-term risk of hypertension in men in part due to unhealthy lifestyle.

Association between binge drinking, type of friends and gender: A cross-sectional study among Brazilian adolescents

BackgroundHazardous drinking among adolescents is a major public health concern. The purpose of this study was to examine the prevalence of binge drinking/alcohol consumption and its association with different types of friendship networks, gender and socioeconomic status among students in Belo Horizonte, Minas Gerais, Brazil.MethodsWe conducted a cross-sectional study on a representative random sample of 891 adolescents (41% male, aged 15–19 years) from public and private schools in 2009–2010. Information on friendship networks and binge drinking was collected using two validated self-administered questionnaires: the Integrated Questionnaire for the Measurement of Social Capital and the first 3 items in the Alcohol Use Disorders Identification Test (AUDIT C). We used the area-based Social Vulnerability Index (SVI), mother and father’s educational background, and the type of school to assess socioeconomic status. The chi-squared test was used to examine the associations between sample characteristics or the type of friends and binge drinking (p-values <0.05 were considered statistically significant). Ordinal logistic regression was used to estimate the association between binge drinking and the independent variables.ResultsA total of 321 (36%) adolescents reported binge drinking (5 or more drinks in one occasion), and among them, 233 (26.2%) adolescents reported binge drinking less than monthly to monthly, and 88 (9.9%) weekly to daily. Binge drinking was associated with being male (OR = 1.52, 95% CI 1.01–2.28) and with living in a low vulnerability area (having the best housing conditions, schooling, income, jobs, legal assistance and health) (OR = 1.66, 95% CI 1.05–2.62). Students who reported that their closest friends were from school (as opposed to friends from church) had an increased risk of binge drinking (OR = 3.55, 95% CI 1.91–5.87). In analyses stratified by gender, the association was significant only among the female students.ConclusionsThe prevalence of binge drinking was high in this sample of Brazilian adolescents, and gender, low social vulnerability and friendship network were associated with binge drinking.

Influence of retirement and work stress on headache prevalence: a longitudinal modelling study from the GAZEL Cohort Study.

Aims: The aims of this study were to examine trajectories of headache in relation to retirement and to clarify the role of work stress and stress-prone personality. Methods: Headache prevalence during the 7 years before and after retirement was measured by annual questionnaires from GAZEL cohort comprising French national gas and electricity company employees (n = 12,913). Odds ratios and 95% confidence intervals for headache during pre- peri- and post-retirement were calculated. The role of effect modifiers (work stress, type A or hostile personality) was tested by multiplicative interactions and synergy indices. Results: An 11–13% reduction in headache prevalence was found during pre- and post-retirement, whereas decline was much steeper (46%) during the retirement transition. In absolute terms, the decline was greater among persons with high work stress or stress-prone personality than among other participants. Conclusions: Retirement is associated with a decrease in headache prevalence, particularly among persons with a high amount of work stress or proneness to over-react to stress.

Optimism and pessimism as predictors of work disability with a diagnosis of depression: A prospective cohort study of onset and recovery

BACKGROUND Personality characteristics are assumed to affect to the vulnerability to depression and its outcomes. The aim of this study was to examine optimism and pessimism as predictors of depression-related work disability and subsequent return to work. METHODS We conducted a prospective cohort study of 38,214 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R). Records of long-term (>90 days) work disability with a diagnosis of depression and subsequent return to work until the end of 2005 were obtained from the national health registers. RESULTS During the mean follow-up of 4.0 (SD=2.3) years, 287 employees encountered work disability with a diagnosis of depression. Of them, 164 (57%) returned to work during the follow-up. One unit increase in the optimism mean score (range 1-4) was associated with a 25% lower risk of work disability due to depression and a 37% higher probability of returning to work after a work disability period when adjusted for age and sex. In the fully-adjusted model hazard ratios per one unit increase in optimism were 0.79 (95% CI 0.66-0.96) for work disability and 1.30 (95% CI 1.01-1.66) for return to work. The pessimism mean score (range 1-4) was only associated with a lower probability of returning to work (fully-adjusted HR per one unit increase 0.66, 95% Cl 0.49-0.88). CONCLUSION The level of optimism was a stronger predictor of work disability with a diagnosis of depression than the level of pessimism, while both optimism and pessimism predicted returning to work.

Influence of retirement on nonadherence to medication for hypertension and diabetes

Background: The extent to which common life transitions influence medication adherence among patients remains unknown. We examined whether retirement is associated with a change in adherence to medication in patients with hypertension or type 2 diabetes. Methods: Participants in the Finnish Public Sector study were linked to national registers. We included data for the years 1994–2011. We identified and followed 3468 adult patients with hypertension and 412 adult patients with type 2 diabetes for medication adherence for the 3 years before their retirement and the 4 years after their retirement (mean follow-up 6.8 yr). Our primary outcome was proportion of patients with poor adherence to medication, which we defined as less than 40% of days covered by treatment. We determined these proportions before and after retirement using data from filled prescriptions. Results: The preretirement prevalence of poor adherence to medication was 6% in men and women with hypertension, 2% in men with diabetes and 4% in women with diabetes. Among men, retirement was associated with an increased risk of poor adherence to both antihypertensive agents (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.03–1.68) and antidiabetic drugs (OR 2.40, 95% CI 1.37–4.20). Among women, an increased risk of poor adherence was seen only for antihypertensive agents (OR 1.25, 95% CI 1.07–1.46). Similar results were apparent for alternative definitions of poor adherence. Our results did not differ across strata of age, socioeconomic status or comorbidity. Interpretation: We found a decline in adherence to medication after retirement among men and women with hypertension and men with type 2 diabetes. If these findings can be confirmed, we need randomized controlled trials to determine whether interventions to reduce poor adherence after retirement could improve clinical outcomes of treatments for hypertension and diabetes.

Job insecurity and risk of diabetes: a meta-analysis of individual participant data

Background: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes. Methods: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate. Results: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09–1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01–1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I2 = 24%, p = 0.2; multivariable-adjusted model: I2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04–1.35). Interpretation: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.

PREDICTIVE FACTORS OF FUTURE PARTICIPATION IN REHABILITATION IN THE WORKING POPULATION: THE FINNISH PUBLIC SECTOR STUDY

OBJECTIVE To examine factors that predict the probability of an employee being granted in-patient multidisciplinary rehabilitation to sustain worklife participation. DESIGN A prospective cohort study. SUBJECTS A total of 49,264 public sector employees. METHODS Baseline characteristics were measured from survey responses and registers. Two types of rehabilitation were identified: early (for employees only at risk of their work capacity deteriorating in the near future) and later (for employees whose work capacity has already deteriorated substantially). RESULTS During the mean 5.0-year follow-up, 1551 participants were granted early rehabilitation and 1293 received later rehabilitation. Early rehabilitation was predicted by a permanent job, high occupational status, good job control and job security, non-smoking and high physical activity. Both early and later rehabilitation were predicted by the use of painkillers, anxiety, and sickness absence. Later rehabilitation was also predicted by older age, poor self-rated health, and low educational level. CONCLUSION Early rehabilitation and, to a lesser extent, later rehabilitation were more often granted to employees with few known risk factors. This finding suggests that preventive measures to reduce the risk of disability pension amongst high-risk employees through rehabilitation are not targeted as intended.