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Objective: This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities. Design and setting: A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018. Subjects: PHC patients aged 60 years or more with a T2D were included. Main outcome measures: Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR). Results: In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]). Conclusions: In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the effects of occupational class, physical and psychosocial working conditions, health behaviours, and pain in the low back and the neck on sciatic pain among middle-aged employees. METHODS: The participants were municipal employees without previous sciatica, aged 40, 45, 50, 55, and 60years at baseline (n=5261, 80% women). Sciatica was defined as low back pain radiating to the calf or the foot. Data on occupational class, physical and psychosocial working conditions, body mass index, smoking, leisure-time physical activity, neck pain, local low back pain, and sciatica were obtained from baseline questionnaire surveys in 2000-2002. The question on sciatica was repeated in a follow-up survey in 2007. Logistic regression analysis was used. RESULTS: In women, manual occupational class (OR 1.3; 95% CI 1.0-1.6 compared with managers/professionals), overweight (1.3; 1.1-1.5), obesity (1.4; 1.1-1.7), smoking (1.5; 1.2-1.7), low leisure-time physical activity (1.3; 1.0-1.7), previous acute (1.5; 1.3-1.7) and chronic (1.5; 1.1-2.0) local low back pain, and acute (1.20; 1.0-1.4) and chronic (1.5;1.2-1.9) neck pain predicted the onset of sciatica in a multivariable model. In men, semi-professionals (1.5; 1.1-2.1) and manual workers (2.0; 1.4-2.8) had an increased risk compared with managers/professionals; also acute (1.5; 1.2-2.0) and chronic (2.1; 1.2-3.9) local low back pain predicted sciatica. CONCLUSIONS: Manual occupational class in both genders and semi-professional occupations in men, unhealthy behaviours and previous pain both in the neck and the lower back predicted sciatica, while physical and psychosocial working conditions had no independent effect. [ABSTRACT FROM AUTHOR]

BACKGROUND: To further increase our understanding of socio-economic health inequalities, we need studies considering multiple socio-economic circumstances and comparing different cultural contexts. This study compared the associations of past and present socio-economic circumstances with physical functioning between employees from Finland and Britain. METHODS: Cross-sectional survey data from the Helsinki Health Study (n = 5866) and the Whitehall II Study (n = 3052) were used. Participants were white-collar public sector employees aged 45-60 years. Physical functioning was measured with the SF-36 physical component summary. The socio-economic indicators were parental and own education, childhood and current economic difficulties, occupational class, income, housing tenure. RESULTS: Childhood and current economic difficulties were independently associated with physical functioning in both cohorts, although in London women childhood difficulties did not reach statistical significance. Own education was independently associated with physical functioning in Helsinki. Occupational class showed associations with physical functioning in both cohorts. These were mainly attenuated by education and income, but in London women there was a strong independent association. The association of income with physical functioning was attenuated by education (Helsinki) and occupational class (London). Parental education and housing tenure showed no consistent associations. CONCLUSIONS: Past and present economic difficulties were independently associated with physical functioning. The conventional socio-economic indicators showed less consistent associations which were partly mediated through other indicators and modified by the national context. The associations that varied according to the indicators and between the cohorts highlight the importance of considering the multiplicity of socio-economic circumstances and comparing different cultural contexts in further studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study examined whether living in rented housing is associated with increased all-cause and cause-specific mortality, and whether the association between home ownership and mortality can be explained by household income, occupational class, and educational level. METHODS: A random sample including every seventh Finn aged 40-80 years at the end of 1997 (N = 308 291) was derived from the population register of Finland. The sample was followed up for mortality until the end of 2003 during which time there were 22,721 deaths. RESULTS: The hazard ratio for all-cause mortality among renters compared with owner-occupiers was 2.06 (95% CI 1.98 to 2.14) in men and 1.73 (1.65 to 1.81) in women. Adjusting for household income, occupational class, and educational level attenuated the excess mortality among renters by 30% in men and 19% in women. The effect of income was larger among the under 65 year olds than those aged 65 years or over. Excess mortality among renters was particularly high for alcohol-related diseases, respiratory diseases, lung cancer, as well as endocrine, metabolic and nutritional diseases, and infections. CONCLUSIONS: Renters had higher mortality than owner-occupiers even after adjusting for household income, occupational class, and educational level. Home ownership may indicate material living standards and cumulative wealth that cannot sufficiently be captured by conventional socioeconomic indicators. Analysing home ownership may thus increase understanding of the factors producing inequalities in health. [ABSTRACT FROM AUTHOR]

Work-family conflicts are common, but their effects on health are not well known. The aim of this study was to examine the associations between work-family conflicts and self-rated health among middle-aged municipal employees. In addition, the effect of social background factors on the association between work-family conflicts and self-rated health were examined. The data were based on cross-sectional postal surveys, which were carried out in 2001 and 2002, among female and male employees of the city of Helsinki, Finland. The participants were aged 40-60, and the response rate for women was 69%, and for men 60%. In the final analysis, 3,443 women and 875 men were included. For men and woman alike, work-to-family and family-to-work conflicts were associated with poor self-rated health. The association remained after adjusting for sociodemographic and socioeconomic factors. This study shows that a better balance between family life and work outside the home would probably have a health promoting effect. [ABSTRACT FROM AUTHOR]

AIMS: To examine the associations of mental health functioning with intentions to retire early among ageing municipal employees. METHODS: Cross-sectional survey data (n = 7,765) from the Helsinki Health Study in 2000, 2001, and 2002 were used. Intentions to retire early were sought with a question: 'Have you considered retiring before normal retirement age?' The dependent variable was divided into three categories: 1 = no intentions to retire early; 2 = weak intentions; 3 = strong intentions. Mental health functioning was measured by the Short Form 36 (SF-36) mental component summary (MCS). Other variables included age, sex, physical health functioning (SF-36), limiting longstanding illness, socioeconomic status, and spouse's employment status. Multinomial regression analysis was used to examine the association of mental health functioning with intentions to retire early. RESULTS: Employees with the poorest mental health functioning were much more likely to report strong intentions to retire early (OR 6.09, 95% CI 4.97-7.47) than those with the best mental health functioning. Adjustments for physical health, socioeconomic status, and spouse's employment status did not substantially affect this association. CONCLUSIONS: The findings highlight the importance of mental health for intentions to retire early. Strategies aimed at keeping people at work for longer should emphasize the importance of mental well-being and the prevention of poor mental health. More evidence is needed on why mental problems among ageing baby-boomer employees are giving rise to increasing social consequences, although the overall prevalence of mental problems has not increased. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of the study was to investigate (1) how much of the association between health and social class is accounted by psychosocial working conditions, and (2) whether health is related to working conditions after controlling for social class. METHODS: The data derive from the surveys of the Helsinki health study, collected in 2000, 2001, and 2002 from 40-60 year old employees working for the City of Helsinki (n=8970, response rate 67%). The study measured occupation based social class and Karasek's demand-control model. The health outcomes were self rated health as less than good and limiting longstanding illness. Age adjusted prevalence percentages and fitted logistic regression models were calculated. RESULTS: The individual effects of social class and psychosocial working conditions on self rated health and limiting longstanding illness were strong among both men and women. The relation between social class and both health outcomes considerably attenuated when job control was controlled for, but was reinforced when controlling for job demands. Controlling for both job control and job demands attenuated the relation between social class and self rated health and limiting longstanding illness among women, however, was reinforced among men. CONCLUSIONS: A substantial part of the relation between social class and health could be attributed to job control, however, job demands reinforced the relation. Although the effect of social class is mediated by psychosocial working conditions, both social class and working conditions were related to health after mutual adjustments. [ABSTRACT FROM AUTHOR]