Disability by occupation in Finland 1986-90

The present paper describes differences in the standardized disability ratio between occupations in Finland in 1986-1990. Furthermore, it gives an overview of the relationship between occupational disability and mortality. The data are based on the 1985 census records in Finland linked with all disability pensions during the period 1986-1990. The study includes the entire male and female labor force aged 25-54 years in 1985. An indirect standardization method was used to calculate the standardized disability ratio for each occupation. Results indicated clear differences in disability by occupations for both men and women. Among both sexes, the manual workers occupations had higher standardized disability ratios and white-collar occupations had lower ratios than the entire labor force. The disability of male occupations correlated strongly with occupational mortality, whereas among women the correlation between mortality and disability was weaker

Aikuisten fibromyalgian monisäikeinen hoito

Vertaisarvioitu. English summaryFibromyalgiapotilaan hoito on usein vaativaa, ja siinä onnistuminen vaatii hyvää, pitkäjänteistä yhteistyötä potilaan kanssa. Uutta tietoa sekä lääkehoidon että lääkkeettömien hoitomuotojen vaikuttavuudesta on kertynyt viime vuosina runsaasti, ja uusia näyttöön perustuvia hoitosuosituksia on julkaistu. Myös potilasnäkökulmaa on hiljattain kartoitettu. Niin suositukset kuin usein potilaatkin asettavat lääkkeettömät vaihtoehdot ensisijaisiksi. Lääkehoitoa voidaan käyttää niiden tukena. Yleisperiaatteet fibromyalgian hoidossa ovat pitkälti yhtenevät muun hyvänlaatuisen pitkäaikaisen kivun hoidon kanssa. Tärkeää hoitosuhteessa on tiedon jakaminen fibromyalgiasta potilaan oman pystyvyyden tunteen ja muutosjoustavuuden tukemiseksi.Peer reviewe

New evidence on the association of occupation with amyotrophic lateral sclerosis : A register-based case-control study in Finland

ObjectivesAmyotrophic lateral sclerosis (ALS) is a serious neurodegenerative disease that usually leads to death within a few years from diagnosis. The risk factors for ALS are still largely unknown. However, it is assumed that environmental factors play a role in disease onset. Occupation is suggested as a potential risk factor, but findings are inconsistent. The aim of this study was to assess the association of occupation with ALS in Finland. Register data were used to avoid recall bias and to obtain a large enough sample to detect the potential associations. MethodsThis case-control study included ALS cases that occurred between 1980 and 2015 in Finland (n = 4,781). ALS cases were identified from the causes of death register. For each ALS case, six controls were selected matched for sex and birth-year. The date of death of the ALS case was set as index date. Information on occupation was obtained from Statistics Finland for all subjects. The focus was on the longest-held occupation on 2-digit level (70 groups). The association of occupation with ALS was analyzed using conditional logistic regression. ResultsCompared to "clerical work and other office work," the risk of ALS was increased in "packing and wrapping work" (OR 1.53, 95% CI 1.08-2.17), "laundering, dry cleaning and pressing work" (OR 1.83, 95% CI 1.08-3.08), and "travel service work" (OR 8.75, CI 2.76-27.74). A decreased risk was found in "planning, administrative and research work in the technical fields" (OR 0.69, 95% CI 0.48-0.98). Of the significant associations identified, only "travel service work" was significant after FDR multiple testing correction. ConclusionsThis study identified occupations in which the risk of ALS was increased. Further studies are needed to pinpoint the potential exposures in these occupations that may trigger the disease.Peer reviewe

Trajectories of multisite musculoskeletal pain in midlife : Associations with common mental disorders

Objectives We examined developmental trajectories of multisite musculoskeletal pain in midlife, and their associations with mental well-being. Methods Midlife municipal employees at baseline aged 40, 45, 50, 55 or 60 years (80% women) from the City of Helsinki, Finland, responded to a baseline questionnaire in 2000-02 (N = 8,960; response rate 67%) and follow-ups in 2007 (N = 7,332; 83%) and 2012 (N = 6,809; 78%). Trajectories of the number of pain sites (0-4) were modelled using latent class growth analysis (n = 6,527). Common mental disorders were assessed by the General Health Questionnaire (GHQ) 12-item version (trichotomized to low, intermediate or high). Information on health-related behaviour, comorbidity and socioeconomic position was obtained from the questionnaire. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Results We identified four distinct pain trajectories: high (15%), increasing (24%), decreasing (20%) and low (41%). After an initial increase, the high and increasing trajectories stabilized at around 2.5 and 1.5 pain sites respectively. In a multivariable model, high, increasing and decreasing trajectories of pain sites were associated with higher baseline GHQ scores. The association was strongest for the high trajectory (low GHQ: OR 3.7, 95% CI 2.8-4.9; high GHQ: OR 5.4, 95% 4.4-6.6). Trajectory membership also associated with unhealthy behaviours, musculoskeletal comorbidities and a low socioeconomic position at baseline. Average GHQ was consistently highest for the high pain trajectory and decreased in the decreasing trajectory over the follow-up. Conclusions Multisite musculoskeletal pain shows variable developmental patterns among midlife employees. The trajectories are associated with the level of common mental disorders. Significance Four developmental trajectories of multisite pain in midlife were described over 10-12 years of follow-up: low (41% of the sample), increasing (24%), high (15%) and decreasing (20%). Common mental disorders strongly associated with these. Belonging to the highest tertile of mental disorders at baseline increased the risk of membership in the high trajectory more than fivefold. On the other hand, together with a decrease in mental disorders, the number of pain sites decreased to zero.Peer reviewe

Vitamin D receptor gene polymorphisms and susceptibility of hand osteoarthritis in Finnish women

We examined whether polymorphisms of the vitamin D receptor (VDR) gene was associated with individual risk of hand osteoarthritis (OA). Radiographs of both hands of 295 dentists and of 248 teachers were examined and classified for the presence of OA using reference images. The VDR ApaI and TaqI genotypes were determined by PCR-based methods. No association was observed between the VDR polymorphisms and the odds of overall hand OA. However, the carriers of the VDR t allele or At haplotype were at almost half the odds of symmetrical hand OA (odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38–0.94 and OR = 0.59, 95% CI = 0.38–0.93, respectively) compared with the carriers of the T allele and of the non-At haplotype, respectively. Increased odds of this disease, on the contrary, was observed for women with two copies of the VDR a allele (OR = 1.93, 95% CI = 1.99–3.70) compared with women with the AA genotype. Conversely, the VDR a allele carriage was associated with a tendency of lowered odds of osteophyte (OR = 0.51, 95% CI = 0.25–1.03). When the genotype data were used to construct haplotypes, the VDR AaTt joint genotype appeared to pose a remarkably lower odds (OR = 0.26, 95% CI = 0.08–0.91) of osteophyte compared with the AAtt joint genotype. As a novel finding we observed a joint effect of a low calcium intake and VDR polymorphisms on symmetrical OA; the OR was 2.64 (95% CI = 1.29–5.40) for carriers of the aT haplotype with low daily calcium intake compared with non-carriers of the haplotype with high daily calcium intake. Our results suggest that VDR gene polymorphisms play a role in the etiology of symmetrical hand OA. Moreover, the association between the VDR gene and OA may be modified by calcium intake

Sairauspoissaolojen kesto, uusiutuminen ja onnistunut työhön paluu : Kuntatyöntekijöiden seurantatutkimus

Sairauspoissaolojen pitkittyminen ja uusiutuminen aiheuttavat haittaa ja kustannuksia sekä yksilölle että yhteiskunnalle. Oikea-aikainen työhön paluu on näin ollen tärkeää. Suomessa on pohdittu sairauspoissaolojen tarpeen ja keston arviointiin liittyvän ohjeistuksen laatimista. Tämä tutkimus tuotti uut- ta sairausryhmäkohtaista tietoa sairauspoissaolojen kestosta, uusiutumisesta ja onnistuneeseen työhön paluuseen kuluneesta ajasta vuosina 2005–2011 laajassa kuntatyöntekijöiden aineistossa. Tarkasteluun valittiin sairauspois- saolojen kannalta tärkeistä tuki− ja liikuntaelinten sekä mielenterveyden ja käyttäytymisen häiriöiden sairausryhmistä sellaisia keskeisiä sairauksia, jotka olivat useimmiten kuntatyöntekijöiden sairauspoissaolojen taustalla. Tällaisia olivat esimerkiksi selkäsärky ja masennus

Vaihdevuodet, monikipuisuus ja työkyky kuntatyöntekijöillä

VertaisarvioituJoissakin maissa on laadittu vaihdevuosiin liittyviä ohjeistuksia työnantajille ja ¬työntekijöille.Peer reviewe

Alcohol use and sickness absence due to all causes and mental- or musculoskeletal disorders : a nationally representative study

Background: Previous studies have not distinguished between different alcohol-use histories, which could have contributed to the current inconsistent evidence regarding the relationship between alcohol use and subsequent sickness absence. We thus examined alcohol use and subsequent diagnosis-specific sickness absence in groups with different levels of alcohol use, as well as in lifelong abstainers, former drinkers, and people with clinical alcohol use disorders. Methods: The data of the population-based Health 2000 Survey (BRIF8901) of 3666 Finns aged 30-55 were linked with national registers on medically certified sickness absences lasting for > 10 working days (long-term) for all causes (2000 -2010) and for mental or musculoskeletal disorders (2004-2010), as well as with registers on pensions and death (2000-2010). Alcohol use was assessed by questionnaire. Chronic somatic diseases were evaluated at baseline in a clinical examination, and common mental and alcohol use disorders using the Composite International Diagnostic Interview (CIDI). Cox regression analyses were conducted with censoring for death and retirement from work. Results: During an average 10-year follow-up, 56.0% of the participants had at least one long-term sickness absence period. Compared with light drinkers, those having an alcohol use disorder had increased risk of all-cause sickness absence (HR = 1.27; 95% CI = 1.04 - 1.54) and sickness absence due to mental disorders (HR = 2.16; 95% CI = 1.39 - 3.35), when somatic and mental disorders as well as demographic, lifestyle-related and occupational factors at baseline were accounted for. Lifelong abstainers did not differ from light drinkers. Also high-volume drinking (HR = 1.52; 95% CI 1.03 - 2.25) and former drinking (HR = 1.57; 95% CI = 1.15 - 2.15) were associated with long-term sickness absence due to mental disorders. Alcohol use was not predictive of sickness absence due to musculoskeletal disorders. Conclusions: These results highlight the need to distinguish between former drinking and lifelong abstinence, as only former drinking was associated with sickness absence. Alcohol use disorder and high-volume drinking were strongly predictive of sickness absence due to mental disorders. Identifying people with excessive alcohol use e.g. in occupational health care, and mapping and supporting their mental health may help in preventing sickness absences.Peer reviewe

Työkyvyn tuen vaikuttavuus Tutkimuskatsaus työkyvyn tukitoimien työkyky- ja kustannusvaikutuksista

Katsauksen tavoitteena oli tunnistaa yksilö-, työpaikka- ja yhteiskuntatason työkyvyttömyyttä ehkäiseviä ja varhaisen työkyvyn tuen toimenpiteitä sekä selvittää, miten niiden vaikutuksia on mitattu ja mitä vaikutuksista tiedetään. Tutkimuksissa työkykyä arvioitiin useimmiten työkyvyttömyyden, sairauden tai oirehtimisen näkökulmista. Eniten tutkimusta oli yksilötason toimenpiteistä. Vahvinta näyttöä löytyi elintapainterventioiden, yksilölähtöisen stressinhallinnan, korvaavan työn mallin ja työn muokkauksen, osasairauspäivärahan ja yksilöpsykoterapian myönteisistä vaikutuksista. Kohtuullista näyttöä löytyi työuravalmennuksen, työkykykoordinaattoritoiminnan, psykososiaalisen työympäristön ja fyysisen ergonomian kehittämisen myönteisistä vaikutuksista. Erilaisten toimenpiteiden yhdistäminen todettiin usein vaikuttavaksi. Elintapainterventiot, yksilölähtöinen stressinhallinta, fyysisen ergonomian kehittäminen ja osasairauspäiväraha sekä jotkut psykoterapiamuodot voivat tuottaa myönteisiä kustannusvaikutuksia. Näytön puuttuminen ei tarkoita vaikutusten puuttumista. Lisää tutkimusta tarvitaan työyhteisö- ja yhteiskuntatason toimenpiteistä, työkykyjohtamisen kokonaisuuden, työelämän joustojen ja sairauspoissaolojen omailmoituskäytäntöjen vaikuttavuudesta.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Common interleukin-6 promoter variants associate with the more severe forms of distal interphalangeal osteoarthritis

INTRODUCTION: The objective of this study was to investigate the relationship of the IL-6 promoter variants G-597A, G-572C and G-174C (rs1800797, rs1800796 and rs1800795, respectively), which have been shown to affect both the transcription and secretion of IL-6, to symptomatic distal interphalangeal (DIP) osteoarthritis (OA). METHODS: A total of 535 women aged 45 to 63 years were included. Radiographs of both hands were taken and each DIP joint was evaluated (grade 0 to 4) for the presence of OA. Information on symptoms (pain, tenderness) in each joint was collected by using a self-administered questionnaire. Symptomatic DIP OA was defined by the presence of both radiographic findings of grade 2 or more and symptoms in at least two DIP joints, and symmetrical DIP OA by the presence of radiographic findings of grade 2 or more in at least one symmetrical pair of DIP joints. Common polymorphic loci in the IL-6 gene were amplified and the promoter haplotypes were reconstructed from genotype data with the PHASE program. Logistic regression analysis was used to examine the association between the IL-6 genotypes/diplotypes and the DIP OA outcome. RESULTS: The G alleles of two promoter single nucleotide polymorphisms (SNPs) G-597A and G-174C were more common among the subjects with symptomatic DIP OA than among those with no disease (P = 0.020 and 0.024, corrected for multiple testing). In addition, the carriage of at least one G allele in these positions increased the risk of disease (P = 0.006 and P = 0.008, respectively). Carrying a haplotype with the G allele in all three promoter SNPs increased the risk of symptomatic DIP OA more than fourfold (odds ratio (OR) 4.45, P = 0.001). Carriage of the G-G diplotype indicated an increased risk of both symmetrical DIP OA (OR 1.52, 95% confidence interval 1.01 to 2.28) and symptomatic DIP OA (OR 3.67, 95% confidence interval 1.50 to 9.00). CONCLUSION: The present study showed that the presence of G alleles at common IL-6 polymorphic promoter loci was associated with the more severe DIP OA outcomes, symmetrical and symptomatic