Physical activity and peripheral artery disease: Two prospective cohort studies and a systematic review

Background and aims Physical activity is a modifiable risk factor for cardiovascular disease and an important therapy in individuals with intermittent claudication. However, its role in the development of peripheral artery disease (PAD) is unclear. We have examined the evidence of the association between physical activity and development of PAD. Methods We searched PubMed, EMBASE and CINAHL Plus in August 2018 for original studies of physical activity and PAD. Studies reporting prevalence or incidence of PAD by categories of physical activity (an amount of activity per unit of time) were included. In addition, we analysed unpublished individual-level data from two register-linked cohort studies, Finnish Public Sector Study (n = 63,924) and Whitehall II (n = 10,200). Due to heterogeneity in the assessment of physical activity and PAD, we provide a qualitative synthesis of the findings. Results Evidence from 18 studies (15 cross-sectional/case-control and 7 prospective studies) of the association between physical activity and PAD in total of 152,188 participants, including 3971 PAD patients, suggests that individuals with a diagnosis or clinical findings of PAD were less physically active, regardless of whether activity was self-reported or measured using accelerometers. The findings from the longitudinal studies point to more intense physical activity being associated with lower odds of developing PAD; however, the study-specific findings lacked power to precisely estimate this relationship. Conclusions Individuals with PAD were less physically active than those without PAD. The longitudinal findings suggest that physical activity decreases the risk of PAD, although better powered studies are needed to confirm this

Changes in drinking as predictors of changes in sickness absence: a case-crossover study

BACKGROUND: We investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design. METHODS: Finnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey. RESULTS: Periods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence. CONCLUSION: Increase in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk

Changes in drinking as predictors of changes in sickness absence: a case-crossover study

BACKGROUND: We investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design. METHODS: Finnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey. RESULTS: Periods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence. CONCLUSION: Increase in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk

Change in neighborhood disadvantage and change in smoking behaviors in adults: a longitudinal, within-individual study

BACKGROUND: Evidence for an association between neighborhood disadvantage and smoking is mixed and mainly based on cross-sectional studies. To shed light on the causality of this association we examined whether change in neighborhood socioeconomic disadvantage is associated with within-individual change in smoking behaviors. METHODS: The study population comprised participants of the Finnish Public Sector study who reported a change in their smoking behavior between surveys in 2008/09 and 2012/13. We linked participants' residential addresses to a total population database on neighborhood disadvantage with 250 × 250m resolution. The outcome variables were changes in smoking status (being a smoker vs. not) as well as the intensity (heavy/moderate vs. light smoker). We used longitudinal case-crossover design, a method that accounts for time-invariant confounders by design. We adjusted models for time-varying covariates. RESULTS: Of the 3443 participants, 1714 quit while 967 began to smoke between surveys. Smoking intensity increased among 398 and decreased among 364 participants. The level of neighborhood disadvantage changed for 1078 participants because they moved residence. Increased disadvantage was associated with increased odds of being a smoker (odds ratio (OR) of taking up smoking 1.23 (95% CI 1.04-1.47) per 1 standard deviation (SD) increase in standardized national disadvantage score). OR for being a heavy/moderate (vs. light) smoker was 1.14 (95% CI 0.85-1.52) when disadvantage increased by 1 SD. CONCLUSIONS: These within-individual results link an increase in neighborhood socioeconomic disadvantage, due to move in residence, with subsequent smoking behaviors

Childhood adversity, adult socioeconomic status and risk of work disability: a prospective cohort study.

OBJECTIVES: To examine the combined effects of childhood adversities and low adult socioeconomic status (SES) on the risk of future work disability. METHODS: Included were 34 384 employed Finnish Public Sector study participants who responded to questions about childhood adversities (none vs any adversity, eg, parental divorce or financial difficulties) in 2008, and whose adult SES in 2008 was available. We categorised exposure into four groups: neither (reference), childhood adversity only, low SES only or both. Participants were followed from 2009 until the first period of register-based work disability (sickness absence >9 days or disability pension) due to any cause, musculoskeletal or mental disorders; retirement; death or end of follow-up (December 2011). We ran Cox proportional hazard models adjusted for behavioural, health-related and work-related covariates, and calculated synergy indices for the combined effects. RESULTS: When compared with those with neither exposure, HR for work disability from any cause was increased among participants with childhood adversity, with low SES, and those with both exposures. The highest hazard was observed in those with both exposures: HR 2.53, 95% CI 2.29 to 2.79 for musculoskeletal disability, 1.55, 95% CI 1.36 to 1.78 for disability due to mental disorders and 1.29, 95% CI 1.20 to 1.39 for disability due to other reasons. The synergy indices did not indicate synergistic effects. CONCLUSIONS: These findings indicate that childhood psychosocial adversity and low adult SES are additive risk factors for work disability

Change in Job Strain as a Predictor of Change in Insomnia Symptoms: Analyzing Observational Data as a Non-randomized Pseudo-Trial

Study objectives: To examine whether change in job strain leads to change in insomnia symptoms. Methods: Among 24873 adults (82% women, mean age 44 years) who participated in a minimum of three consecutive study waves (2000–2012), job strain was assessed at the first and second wave and insomnia symptoms at all three waves. We analyzed observational data as a “pseudo-trial” including participants with no job strain in the first wave and no insomnia symptoms in the first and second wave (n = 7354) to examine whether the onset of job strain between the first and second waves predicted the onset of insomnia symptoms in the third wave. We used a corresponding approach, including those with job strain in the first wave and insomnia symptoms in the first and second wave (n = 2332), to examine whether the disappearance of job strain between the first two waves predicted remission of insomnia symptoms in the third wave. Results: The onset of job strain predicted the onset of subsequent insomnia symptoms after adjustment for sex, age, marital status, education, smoking, physical activity, alcohol consumption, body mass index, and comorbidities (odds ratio compared to no onset of job strain 1.32, 95% CI 1.16–1.51). The disappearance of job strain was associated with lower odds of repeated insomnia symptoms (odds ratio compared to no disappearance of job strain 0.78, 95% CI 0.65–0.94). Further adjustment for shift work or sleep apnea did not change these associations. Conclusions: These results suggest that job strain is a modifiable risk factor for insomnia symptoms

Association Between Distance From Home to Tobacco Outlet and Smoking Cessation and Relapse

IMPORTANCE: Reduced availability of tobacco outlets is hypothesized to reduce smoking, but longitudinal evidence on this issue is scarce. OBJECTIVE: To examine whether changes in distance from home to tobacco outlet are associated with changes in smoking behaviors. DESIGN, SETTING, AND PARTICIPANTS: The data from 2 prospective cohort studies included geocoded residential addresses, addresses of tobacco outlets, and responses to smoking surveys in 2008 and 2012 (the Finnish Public Sector [FPS] study, n = 53 755) or 2003 and 2012 (the Health and Social Support [HeSSup] study, n = 11 924). All participants were smokers or ex-smokers at baseline. We used logistic regression in between-individual analyses and conditional logistic regression in case-crossover design analyses to examine change in walking distance from home to the nearest tobacco outlet as a predictor of quitting smoking in smokers and smoking relapse in ex-smokers. Study-specific estimates were pooled using fixed-effect meta-analysis. EXPOSURES: Walking distance from home to the nearest tobacco outlet. MAIN OUTCOMES AND MEASURES: Quitting smoking and smoking relapse as indicated by self-reported current and previous smoking at baseline and follow-up. RESULTS: Overall, 20 729 men and women (age range 18-75 years) were recruited. Of the 6259 and 2090 baseline current smokers, 1744 (28%) and 818 (39%) quit, and of the 8959 and 3421 baseline ex-smokers, 617 (7%) and 205 (6%) relapsed in the FPS and HeSSup studies, respectively. Among the baseline smokers, a 500-m increase in distance from home to the nearest tobacco outlet was associated with a 16% increase in odds of quitting smoking in the between-individual analysis (pooled odds ratio, 1.16; 95% CI, 1.05-1.28) and 57% increase in within-individual analysis (pooled odds ratio, 1.57; 95% CI, 1.32-1.86), after adjusting for changes in self-reported marital and working status, substantial worsening of financial situation, illness in the family, and own health status. Increase in distance to the nearest tobacco outlet was not associated with smoking relapse among the ex-smokers. CONCLUSIONS AND RELEVANCE: These data suggest that increase in distance from home to the nearest tobacco outlet may increase quitting among smokers. No effect of change in distance on relapse in ex-smokers was observed

Road traffic noise is associated with increased cardiovascular morbidity and mortality and all-cause mortality in London.

AIMS: Road traffic noise has been associated with hypertension but evidence for the long-term effects on hospital admissions and mortality is limited. We examined the effects of long-term exposure to road traffic noise on hospital admissions and mortality in the general population. METHODS AND RESULTS: The study population consisted of 8.6 million inhabitants of London, one of Europe's largest cities. We assessed small-area-level associations of day- (7:00-22:59) and nighttime (23:00-06:59) road traffic noise with cardiovascular hospital admissions and all-cause and cardiovascular mortality in all adults (≥25 years) and elderly (≥75 years) through Poisson regression models. We adjusted models for age, sex, area-level socioeconomic deprivation, ethnicity, smoking, air pollution, and neighbourhood spatial structure. Median daytime exposure to road traffic noise was 55.6 dB. Daytime road traffic noise increased the risk of hospital admission for stroke with relative risk (RR) 1.05 [95% confidence interval (CI): 1.02-1.09] in adults, and 1.09 (95% CI: 1.04-1.14) in the elderly in areas >60 vs. 60 vs. <55 dB]. Positive but non-significant associations were seen with mortality for cardiovascular and ischaemic heart disease, and stroke. Results were similar for the elderly. CONCLUSIONS: Long-term exposure to road traffic noise was associated with small increased risks of all-cause mortality and cardiovascular mortality and morbidity in the general population, particularly for stroke in the elderly

Changes in Smoking During Retirement Transition: A Longitudinal Cohort Study

AIMS: We examined the effect of retirement transition on changes in smoking, identified trajectories of smoking around the retirement transition, and investigated factors predicting the membership in the trajectories. METHODS: This longitudinal cohort study included 1,432 current or former smokers who entered into statutory retirement in 2000-2011 and who filled out two to four questionnaires sent at four-year intervals. Effect of retirement on smoking was analysed as a non-randomized pseudo-trial in which we compared the likelihood of quitting and relapsing smoking between two subsequent survey waves among those who retired and did not retire. We used latent class analysis to identify trajectories of smoking status and smoking intensity (low: <10 cigarettes/day or high: ⩾10 cigarettes/day), and multinomial logistic regression models to assess pre-retirement factors associated with smoking trajectories. RESULTS: Retirement transition was associated with 1.7-fold odds of quitting smoking (95% confidence intervals 1.3-2.2) compared with no retirement transition. We identified three smoking status trajectories: 'sustained non-smoking' (61% of the participants), 'sustained smoking' (23%) and 'decreasing smoking' (16%). For 489 baseline smokers, we identified three smoking intensity trajectories: 'sustained high intensity smoking' (32% of the participants), 'sustained low intensity smoking' (32%) and 'decreasing high intensity smoking' (35%). Living outside an inner urban area predicted membership in the 'decreasing smoking' versus 'sustained smoking' trajectory. CONCLUSIONS: Smokers are more likely to quit smoking during transition to retirement than before or after it. Characteristics of the smoking environment may affect smoking behaviour around retirement

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

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