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Purpose Physical work exposures are associated with sickness absence among older employees. We aimed to examine if they similarly contribute to all-cause sickness absence during early and mid-careers. Methods We used questionnaire data on physical work exposures linked to register data on sickness absence from 3542 municipal employees aged 19–39 years. Follow-up for the number of sickness absence days was 12 months. Exposures to physical workload, occupational environmental hazards, and sedentary work were divided into quartiles. In addition, duration of daily exposure to heavy work was included. Negative binomial regression models were used. Results Higher exposure to physical workload or hazardous exposures was associated with a higher number of sickness absence days. The age and gender adjusted rate ratios for sickness absence days among the participants whose exposure to physical workload was in the highest exposure quartile were 2.1 (95% CI 1.8‒2.5) compared with those whose exposure was in the lowest quartile. In addition, rate ratios for sickness absence days among participants who reported that they do heavy physical work 1.1‒2.0 h, 2.1‒4.0 h or over 4 h daily were 1.6 (1.3‒1.9), 1.5 (1.3‒1.8) and 1.7 (1.5‒2.1), respectively, compared with those who reported not doing physical work. Further adjustment for lifestyle factors or health characteristics attenuated the associations only slightly. Conclusion Exposure to physically demanding work is associated with a higher number of sickness absence days among municipal employees below 40 years of age. Physical working conditions should be considered when aiming to support later work ability.

Objectives We examined whether frequent short-term sickness absence (FSTSA) and primary care use in occupational health service (OHS) were associated with medically-certified long-term sickness absence (LTSA) due to mental disorders among young employees. Methods We used record-linkage data covering the young employees (n = 8,282) from 2010 to 2014. The outcome was LTSA due to mental disorders. Cox regression models were fitted. Results FSTSAs were associated with subsequent LTSA. Also OHS use predicted LTSA due to mental disorders; however, this association was not found for those with prior FSTSA. Conclusions Both FSTSA and primary care use indicate subsequent LTSA independently, and together these indicators identify a larger proportion of individuals at risk of LTSA due to mental disorders.

ObjectiveAn intervention was carried out at the occupational healthcare services (OHS) of the City of Helsinki beginning in 2016. We investigated the association between the intervention and employee sick leaves using interrupted time series analysis.DesignRegister-based cohort study with a quasi-experimental study design.SettingEmployees of the City of Helsinki.ParticipantsWe analysed individual-level register-based data on all employees who were employed by the city for any length of time between 2013 and 2018 (a total 86 970 employees and 3 014 075 sick leave days). Sick leave days and periods that were OHS-based constituted the intervention time series and the rest of the sick leave days and periods contributed to the comparison time series.InterventionRecommendations provided to physicians on managing pain and prescribing sick leave for low back, shoulder and elbow pain.Outcome measuresNumber of sick leave days per month and sick leave periods per year.ResultsFor all sick leave days prescribed at OHS, there was no immediate change in sick leave days, whereas a gradual change showing decreasing number of OHS-based sick leave days was detected. On average, the intervention was estimated to have saved 2.5 sick leave days per year per employee. For other sick leave days, there was an immediate increase in the level of sick leave days after the intervention and a subsequent gradual trend showing decreasing number of sick leave days.ConclusionsThe intervention may have reduced employee sick leaves and therefore it is possible that it had led to direct cost savings. However, further evidence for causal inferences is needed.

This study examines the association between digital information technology (DIT) use and the utilization of transnational healthcare (THC) in older migrants, and investigates how this relationship depends on social integration or perceived discrimination in health services in the destination country. The data from a population-based study conducted in Finland in 2019, which targeted Russian-speaking residents aged 50 and above (n = 1082) nationwide, are analyzed. The analysis demonstrates that those who had a high level of DIT use were significantly more likely to use THC than those who had a low level of use. However, the findings do not show that the relationship depends on social integration or perceived discrimination. Older migrants can actively use transnational networks to address their health and well-being issues by using DIT and seeking healthcare abroad. Their health service use can be illustrated as an active process involving various geographical domains.

Purpose We examined the associations between recurrent single- and multisite pain and incident sickness absence (SA) of different lengths and the risk of disability pension (DP). Methods The data were derived from the Finnish Helsinki Health Study. Pain measures were recorded for panel 1 in 2000/2 and 2007, and for panel 2 in 2007 and 2012 (altogether 3191 employees). SA data were obtained from the employer’s personnel register and DP events from the Finnish Centre for Pensions. Negative binomial regression models with generalized estimation equations were used to model the incidence of self-certified short- (1–3 days), and medically certified medium- (4–14 days) and long-term (more than 14 days) SA episodes. Cox regression models were fitted for the associations between pain and all-cause DP and competing risk models for DP by diagnostic groups. Social and health-related covariates were adjusted for. Results Recurrent pain was associated with short-, medium- and long-term SA. Additionally, recurrent single- and multisite pain increased the risk of long-term SA. Recurrent single or multisite pain was further associated with an increased risk of DP, while a single instance of pain did not increase the risk. Conclusions These results suggest that recurrent pain is a robust determinant of subsequent SA and DP risk. Improved understanding of determinants of recurrent pain is needed to inform the development of targeted measures to reduce SA and premature exit from employment.

Publisher Copyright: © 2021 The Authors This study aimed to examine the associations of perceived physical and mental working conditions with subsequent antidepressant medication purchases among 18-39-year-old municipal employees. Survey data collected in 2017 among employees of the City of Helsinki (n=5897, response rate 51.5%) were linked to register data on psychotropic medication purchases (82% gave permission to register linkage). The analysis included 3570 women and 972 men. We used three single-item measures of working conditions: perceived mental and physical strenuousness of work, and time spent in physical work. Covariates included age, gender, marital status, employment status, body mass index, smoking, alcohol use and previous medication. Cox regression analysis was used to calculate hazard ratios (HR) for the first antidepressant medication (ATC class N06A) purchase during a one-year follow-up. Those with mentally strenuous work (HR 1.85) as well as those spending more than four hours in physical work per workday (HR 1.60) had an statistically significantly increased risk of antidepressant medication use when adjusting for age and gender. Further adjustments for covariates attenuated these associations, which however remained statistically significant. Improving working conditions to avoid excess mental and physical workload is likely to be beneficial for preventing mental health problems already among younger employees.

Mental health problems are a major public health and work-life issue. We examined in a quasi-experimental design whether occupational health psychologist (OHP) appointment reduces subsequent sickness absence (SA) due to mental disorders among younger Finnish employees. The present study was conducted among 18–39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We examined differences in SA days due to mental disorders (ICD-10, F-diagnosed sickness allowances) between those treated (at least one OHP appointment for work ability support) and the comparison group (no OHP appointment) during a one-year follow-up. The full sample (n = 2286, 84% women) consisted of employees with SA due to a diagnosed mental disorder during 2008–2017. To account for the systematic differences between the treatment and comparison groups, the included participants were matched according to age, sex, occupational class, education, previous SA, occupational health primary care visits and psychotropic medication. The weighted matched sample included 1351 participants. In the weighted matched sample, the mean of SA days due to mental disorders was 11.4 (95% CI, 6.4–16.5) for those treated (n = 238) and 20.2 (95% CI, 17.0–23.4) for the comparison group (p Mental health problems are a major public health and work-life issue. We examined in a quasi-experimental design whether occupational health psychologist (OHP) appointment reduces subsequent sickness absence (SA) due to mental disorders among younger Finnish employees. The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We examined differences in SA days due to mental disorders (ICD-10, F-diagnosed sickness allowances) between those treated (at least one OHP appointment for work ability support) and the comparison group (no OHP appointment) during a one-year follow-up. The full sample (n = 2286, 84% women) consisted of employees with SA due to a diagnosed mental disorder during 2008-2017. To account for the systematic differences between the treatment and comparison groups, the included participants were matched according to age, sex, occupational class, education, previous SA, occupational health primary care visits and psychotropic medication. The weighted matched sample included 1351 participants. In the weighted matched sample, the mean of SA days due to mental disorders was 11.4 (95% CI, 6.4-16.5) for those treated (n = 238) and 20.2 (95% CI, 17.0-23.4) for the comparison group (p < 0.01) during the follow-up year. The corresponding figures in the full sample were (11.1, 6.7-15.4) days for those treated (n = 288) and (18.9, 16.7-21.1) days for the comparison group (p < 0.01). This quasi-experimental study suggests that seeing an OHP to support work ability reduces SA due to mental disorders.

Community paramedic (CP) units are becoming more popular in enhancing a person&rsquo, s access to the need for care assessment and treatment in acute but non-life-threatening health issues. Simultaneously CP units can reduce the strain on emergency departments (EDs) by treating patients effectively at home. The efficacy of CP units is proven in previous studies, but the details of conditions patients seek retreatment at the ED after a CP unit visit are largely unknown. This study aimed to categorize CP unit patients (n = 229) seeking retreatment after a CP unit visit and investigate links between CP unit actions and patients seeking retreatment. The study was based on a data set from a six-month CP unit pilot program in Finland. The main results show that 82% of the patients assessed and treated by the CP unit did not seek retreatment. Low back symptoms and nausea were the main problems patients presented to the ED within 96 h after the CP visit. On-call physician consultation (p = 0.335) or CP unit treatment time (p = 0.629) were not associated with the frequency of ED presentation. Further studies are needed in order to investigate which types of emergency medical missions are the most suitable for CP units. The findings of this study support the effectiveness of community paramedicine programs.

Background Mental ill-health in young adults is a major public health and work-life problem. We examined in a quasi-experimental design whether occupational psychologist appointment can reduce subsequent sickness absence due to mental disorders among young Finnish employees. Methods The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We used Wald test to compare the differences in sickness absence days due to mental disorders (ICD-10, F-diagnosed) between those treated (occupational psychologist appointment for work ability support) and the non-treated (no psychologist appointment) during a one year follow-up. The full sample (n = 2156, 84% women) consisted of employees with mental disorder diagnosed sickness absence during 2009-2014. To account for the systematic differences between the treated and non-treated, the participants were matched according to their characteristics (age, sex, occupational class, education, previous sickness absence and psychotropic medication). The matched sample included 886 participants. We excluded those with treatment before the treatment screening time (± 3 months to the end of sickness absence period), non-treated with treatment during the follow-up and those that could not be matched (lack of common support). Results In the full sample, the mean of sickness absence days due to mental disorders was 17.7 (95% CI, 11.4, 24.1) days for those treated (n = 240) and 23.2 (95% CI, 20.5, 25.9) days for non-treated (n = 1916), difference being non-significant. The corresponding figures in the matched sample were (16.8, 95% CI, 9.5-24.1) for those treated (n = 195) and (27.8, 95% CI, 22.6-32.9) for non-treated (n = 691), difference being statistically significant (p = 0.02). Conclusions This quasi-experiment suggests that seeing an occupational psychologist to support work ability may be reduce mental health related sickness absence. Key messages We showed that supporting work ability at an early stage may prevent sickness absence due to mental disorders. More efforts to provide early stage support for maintaining work ability may prove useful in reducing sickness absence rates in younger employees.

Background: Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits. Objective: This study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. Methods: An umbrella review informed by the Joanna Briggs Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalized in terms of uptake of, dropping out from, or completion of cCBT treatment; factors that facilitated or impeded adherence; and reports about user, carer, and health care professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool and undertaken independently by 2 reviewers. Results: The systematic searches of databases identified 234 titles, and 9 reviews (covering 151 unique studies) met the criteria. Most studies were comprised of service users with depression, anxiety, or specifically, panic disorder or phobia. Operationalization of acceptability varied across reviews, thereby making it difficult to synthesize results. There was a similar number of guided and unguided cCBT programs; 34% of guided and 36% of unguided users dropped out; and guidance included email, telephone, face-to-face, and discussion forum support. Guided cCBT was completed in full by 8%-74% of the participants, while 94% completed one module and 67%-84% completed some modules. Unguided cCBT was completed in full by 16%-66% of participants, while 95% completed one module and 54%-93% completed some modules. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), internet or computerized delivery problems, negative perceptions about cCBT, low motivation, too busy or not having enough time, and personal circumstances were stated as reasons for dropping out. Yet, some users favored the anonymous nature of cCBT, and the capacity to undertake cCBT in one’s own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between sociodemographic variables, mental health status, and cCBT adherence or dropping out. Users tended to be satisfied with cCBT, reported improvements in mental health, and recommended cCBT. Overall, the results indicated that service users’ preferences were important considerations regarding the use of cCBT. Conclusions: The review indicated that “one size did not fit all” regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake, and adherence and therefore, deliver treatment benefits and improve mental health.

ObjectivesThe determinants of poor functioning and subsequent early exit from work are well established but very little is known about the positive determinants of maintaining good functioning among the ageing workforce. We investigated modifiable determinants of maintaining good mental and physical health functioning.MethodsWe used prospective survey data collected across four waves among the midlife employees of the City of Helsinki, Finland, 2000–2017 (n=3342). Health functioning was repeatedly measured using the Short Form 36 (SF-36) inventory. Trajectories of mental and physical health functioning were separately examined using group-based trajectory analysis. Multinomial logistic regression models were fitted to examine determinants of each trajectory.ResultsFour trajectory solutions for the developmental patterns in health functioning during the follow-up period were selected, with a slightly different shape of the first trajectory for mental and physical functioning: (1) continuously low (mental), low and decreasing (physical), (2) increasing, (3) decreasing and (4) continuously high functioning. After adjustments, the employees in the continuously high mental health functioning group were more likely to have optimal job demands, high job control, no sleep problems and no binge drinking behaviour. Employees in the continuously high physical functioning group had more likely low levels of physically strenuous work and hazardous working environment and no sleep problems and normal weight.ConclusionHigh job control, good sleep and avoiding binge drinking may help maintain good mental health functioning. Low levels of physical or environmental work exposures, good sleep and recommended healthy weight may support maintenance of good physical health functioning among ageing employees.

Background Previous studies have found that in general, poor health is associated with a lower likelihood of internet use in older adults, but it is not well known how different indicators of health are associated with different types of digital information technology (DIT) use. Moreover, little is known about the relationship between health and the types of DIT use in older ethnic minority and migrant populations. Objective The aim of this study is to examine the associations among depressive symptoms and self-rated health (SRH) with different dimensions of DIT use in older migrants. Methods We analyzed data from the Care, Health and Ageing of Russian-speaking Minority (CHARM) study, which is based on a nationally representative sample of community-dwelling, Russian-speaking adults aged 50 years or older residing permanently in Finland (men: 616/1082, 56.93%; age: mean 63.2 years, SD 8.4 years; response rate: 1082/3000, 36.07%). Data were collected in 2019 using a postal survey. Health was measured using depressive symptoms (measured using the Center for Epidemiologic Studies Depression Scale) and SRH. Binary logistic regression analyses were used to investigate the associations between the two health indicators and the following six outcomes: daily internet use, smartphone ownership, the use of the internet for messages and calls, social media use, the use of the internet for personal health data, and obtaining health information from the internet. A number of sociodemographic and socioeconomic factors were controlled for in the logistic regression regression analysis. Analyses were performed with weights accounting for the survey design and nonresponse. Results After adjusting for sociodemographic and socioeconomic factors, depressive symptoms (odds ratio [OR] 2.68, 95% CI 1.37-5.24; P=.004) and poor SRH (OR 7.90, 95% CI 1.88-33.11; P=.005) were associated with a higher likelihood of not using the internet daily. Depressive symptoms (OR 1.88, 95% CI 1.06-3.35; P=.03) and poor SRH (OR 5.05, 95% CI 1.58-16.19; P=.006) also increased the likelihood of smartphone nonuse. Depressive symptoms were additionally associated with a lower likelihood of social media use, and poor SRH was associated with a lower likelihood of using the internet for messaging and calling. Conclusions Poor SRH and depressive symptoms are associated with a lower likelihood of DIT use in older adults. Longitudinal studies are required to determine the directions of these relationships.

Occupational health service (OHS) is the main provider of primary care services for the working population in Finland. We investigated whether socioeconomic differences in the utilization of OHS predict sickness absence (SA) due to mental disorders. We used register linkage data covering the employees of the City of Helsinki aged 18&ndash, 34 years (N = 6545) and 35&ndash, 54 years (N = 15,296) from 2009 to 2014. The outcome was medically certified long-term (over 11 days) SA due to mental disorders. Cox regression analyses were performed to obtain hazard ratios (HR) and their 95% confidence intervals (CIs). Employees with low socioeconomic position (SEP) used OHS more frequently. The number of OHS visits independently predicted SA due to mental disorders. HRs were 1.59 (95% CI 1.35, 1.86) for those with frequent visits and 1.73 (95% CI 1.30, 2.29) for those with a clustered visit pattern among 18&ndash, 34 year old employees, and 1.46 (95% CI 1.18, 1.81) and 1.41 (95% CI 1.14, 1.74) among 35&ndash, 54 year old employees, respectively. In both age groups, lower education and routine non-manual worker position indicated the highest probability of SA. Low SEP predicts both high OHS utilization and subsequent SA due to mental disorders. Medical records may be used to accurately predict future SA, and the results indicate that preventive measures should be targeted particularly to younger employees with lower SEP.

Background The unemployed have lower work ability and poorer health than the employed. This situation deteriorates when unemployment continues. The long-term unemployed often have co-morbidities and face many other challenges. This increases the need for a multidimensional assessment of work ability and functioning in different service settings. In this study, we describe the development and analyse the content validity of the Abilitator, a self-report questionnaire on work ability and functioning for those in a weak labour market position. Methods The Abilitator was developed in 2014–2017. Its construct was assessed by members of academic expert panels (n = 30), practical expert panels of professionals (n = 700) and target group clients (n = 28). The structure and the content of the questionnaire was co-developed in 29 workshops and adjusted twice based on the expert panels’ feedback. The Abilitator was also implemented among target group clients (n = 3360) in different services and projects. During its development the Abilitator was linked to the International Classification of Functioning, Disability and Health (ICF). The content validation process followed the guidelines recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel. Results The construct of the Abilitator combines the multidimensional and biopsychosocial models of work ability and functioning. It also includes aspects of social inclusion and employability. It evaluates social, psychological, cognitive and physical functioning, and the ability to cope with everyday life. The content of these concepts was validated by the academic and practical expert panels. The Abilitator’s 79 ICF codes covered 57% of the Generic, 77% of the Brief Vocational Rehabilitation, and 8% of the Minimal Environmental ICF Core Sets. When compared with the Work Ability Index (WAI) and the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the direct equivalences of the ICF codes were 36 and 44%, respectively. Conclusion The Abilitator sufficiently comprehensively covers the relevant aspects to enable the assessment of the overall work ability and functioning of the population in a weak labour market position.

Background: Mass gatherings cause a need for multi-authority preparedness in order to ensure the safety of the event participants and to minimize delays in response for emergencies. Rescue authorities are key players in the pre-planning phase, however, their own point of view regarding all aspects of preparedness for mass gatherings is not well known. The aim of this study was to investigate what factors, according to the rescue authorities, need to be considered when preparing for mass gatherings. Method: Semi-structured thematic interviews were carried out with the rescue authorities involved in the mass gathering planning process (n = 15). The transcribed material was analyzed using inductive content analysis. Results: Three main categories emerged from the interviews: (1) co-operation in the pre-planning phase, (2) factors to be noted in the emergency plan, and (3) actions during the event. These categories were divided into 11 generic categories, which were further divided into 42 sub-categories. Conclusion: Rescue authorities recognized various factors considering preparedness for mass gatherings. Knowledge considering the dispersion of operative workload during the event needs further investigation in order to facilitate the effective use of limited operative resources.

Aims: Higher incidence of psychotic disorders in high-income countries for migrants compared with the settled majority has been well established. However, it is less clear to what extent different migrants groups have accessed and utilised mental health care. This study aimed to identify the hazard of antipsychotic medication use in the largest migrant groups in Finland, compared with a Finnish-born comparison group, using high quality datasets maintained by Statistics Finland and Social Insurance Institution Finland, and linking socio-demographic and -economic characteristics to antipsychotic prescription purchases. Methods: The study draws on a representative sample of 33% of the adult working-age population of Finland in 2005 ( n = 1,059,426, 50.2% male, 2.5% migrant). The use of antipsychotic drugs was followed-up from 2005 to 2014. Results: The results show that the hazard of antipsychotic medication purchases differed between migrant groups, with a higher hazard for migrants from North Africa and the Middle East before socio-economic adjustment (men HR 1.19, 95% CI 1.04–1.37; women HR 1.37, 95% CI 1.12–1.66), and a lower hazard for all migrant groups after adjustment for socio-economic characteristics compared with the Finland-born population. Conclusions: The findings suggest that attention should be paid to the lower use of medication for psychotic disorders in some migrant groups, as well as the potential role of social disadvantage for migrants from North Africa and Middle East.

Background We defined gender-specific profiles of mental ill-health for the main occupational groups using three outcomes; antidepressant use, sickness absence (SA) due to depression, and suicides. We also examined which occupational groups had the highest risk of the outcomes, and compared the importance of their predictors. Methods From a random register cohort of Finnish working age population, individuals in the six largest occupational groups in 2004 for men and women were included (N = 414 357). We used register data to define the first antidepressant purchase (i.e. use), the first long-term SA spell for depression, and suicide between Jan 1st 2005 and Dec 31st 2014. We assessed the risk of each outcome by occupational group with logistic regression models, and used dominance analysis to compare the relative importance of predictors. Results In all six occupational groups for women, the prevalence of antidepressant use and SA for depression was higher than in the men's occupational groups. The opposite was observed for suicides. The risk of antidepressant use was lower, but the risk of suicide was 2-times higher among men in low vs. high-skilled occupations. Among women, a lower skill-level was associated with a higher risk of SA due to depression. Gender was the most important predictor of all outcomes. Limitations We lacked information on history of medication use or health problems prior to follow-up. Conclusions Gendered occupational status was an underlying factor explaining distinctive mental health profiles in the working population. Occupational class-dependent behavioural patterns related to mental health existed among men.

Psychological distress and mental illness has been found to be elevated in migrant groups living in sovereign countries, as well as for indigenous people living under colonial or administrative rule. The north Pacific island of Guam is unusual in its ethnic composition as it has no majority ethnic group, has a large indigenous population and remains a territory of the U.S. This study aimed to identify ethnic differences in self-reported psychological distress between the main ethnic groups on Guam. The study uses a cross sectional design with data linkage methodology, drawing on the Guam Census and the Behavioral Risk Factor Surveillance System health survey for Guam. The results showed that the native Chamorro population had worse self-reported psychological distress (defined as a ‘mental health condition or emotional problem’) than White/Caucasians (OR 2.09, 95% CI 1.52–2.87), particularly for severe distress (OR 3.61, 95% CI 1.33–2.77). This relationship persisted even after adjusting for a wide range of socio-demographic and economic factors (OR 2.58, 95% CI 1.15–5.76). Other Pacific Islanders also had higher psychological distress compared to White/Caucasians, but this association was largely explained by the adjusted factors. The findings are discussed in terms of social and economic disadvantage for Pacific Island peoples on Guam, as well as the impact of colonial administration, disaffection, and lack of autonomy for the Chamorro of Guam. Recommendations are made to improve psychiatric treatment for these groups by considering wider socio-political factors in assessment and treatment, as well as broader implications for the national dialogue on self-determination.

Background Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders. Methods Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996–2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006–2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors. Results Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73–3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52–7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84–1.38, musculoskeletal SHR = 1.65, 95% CI 0.91–2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85–9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42–108%. Conclusion Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures.

Purpose There has been an increase in the use of registers and record linkages to study migrant mental health. However, the accuracy of these registers and the degree to which they are representative of the migrant population in Northern Ireland (NI) are unclear. The purpose of this paper is to explore: the coverage of the NI migrant population in general practitioner (GP) data and Census records; the issues faced by migrants in terms of registering and accessing the local health system; and the reporting of racial hate crimes against migrants to police. Design/methodology/approach Two focus groups of professionals (n=17) who worked with migrants were conducted. Group discussions were guided by a research-informed topic guide, and the data were analysed using thematic analysis. Findings Three main themes emerged: issues with the use of GP registration, Census and hate crime data for researching migrant mental health; barriers to health service use (e.g. low cultural awareness among health staff and access to interpreters); and risk factor exposure and mental health status in migrant communities (e.g. poverty, isolation and poor working conditions). Originality/value Record linkage and registry studies of migrant health and well-being using Census and health service sources need to be mindful of the likelihood that some migrants may be missed. The possible underrepresentation of migrants in health registers may be explained by reduced use of such services which may be caused my encountering staff with limited cultural competency and the inability to access an interpreter promptly.

Introduction Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. The randomised controlled trial component of the DAQI (Depression and sickness absence in young adults: a quasi-experimental trial and web-based treatment intervention) project aims to investigate if iCBT is effective in reducing sickness absence compared with care as usual (CAU) among young employees with depressive symptoms in primary care provided in an occupational health setting. Methods and analysis This study will use a randomised controlled single-centre service-based trial of an existing iCBT programme (Mental Hub iCBT for Depression) to evaluate whether or not this treatment can reduce the number of sickness absence days in public sector employees aged 18–34 years who present at the occupational health service with mild depressive symptoms (score ≥9 on the Beck Depression Inventory-IA). Control participants will be offered CAU, with no constraints regarding the range of treatments. The active condition will consist of seven weekly modules of iCBT, with support from a web therapist. Primary outcome will be participants’ all-cause sickness absence as indicated in employer’s and national administrative records up to 6 months from study entry. Secondary outcomes relating to long-term sickness absence (over 11 calendar days) for mental and musculoskeletal disorders and psychotropic medication use will be obtained from the Finnish Social Insurance Institution’s administrative records; and short sickness absence spells (up to 11 calendar days) will be extracted from employer’s records. Analyses will be conducted on an intention-to-treat basis. Ethics and dissemination The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa has approved the study (HUS/974/2019). The results will be published in peer-reviewed scientific journals and in publications for lay audience. Trial registration number NCT10877837

BackgroundResearch has highlighted the poor mental health of looked after children compared to those never in care. However, little is known on what becomes of these children and their mental health trajectories after they leave the care of social services. In addition, previous studies are limited in their ability to differentiate between type of social care intervention received; kinship care, foster care or residential care. AimTo utilise nationwide social services data from two countries (Northern Ireland (NI) and Finland), with similar populations but different intervention policies, linked to a range of demographic and health datasets to examine the mental health outcomes of young adults in the years following leaving care. MethodsData from both countries on children born 1991-2000 were linked to social services data, hospital admissions, prescribed medication data and death records. Mental health outcomes were defined after the age of 18years (when statutory care provision ends) examined by care intervention and included admissions to psychiatric hospital, for self-harm and death by suicide. ResultsThe gender split in care in Finland is reflective of the population but more males are in care in NI. Initial results from Finnish data suggest those exposed to care in childhood have an increased risk of self-harm, psychiatric hospital admission and suicide after the age of 18years compared to those never in care. After adjusting for gender, age of entry to care and deprivation at birth those exposed to any care intervention had 3 times the risk of suicide (HR=3.06, 95% CI 1.18,7.98). Risk increased with duration in care but was equivalent across care intervention types. Analysis on the NI data is underway. ConclusionFull results will be available December 2019 and will explore which care pathways are most associated with poor mental health outcomes informing discussion around intervention opportunities and policy.

Background: Migrant populations are particularly at risk of not receiving the care for mental ill-health that they require for a range of reasons, including language and other barriers to health service access. This record linkage study compares, for migrant and settled communities, the likelihood that a person in Northern Ireland with poor mental health will receive psychotropic medication. Methods: A cohort of 78,267 people aged 16-64 (including 1,736 migrants) who reported chronic poor mental health in the 2011 Census records was followed for 15 months by linkage to a centralised prescribing dataset to determine rates of pharmacological treatment. Logistic regression analyses quantified the relationship between psychotropic medication uptake and migrant status, while accounting for relevant demographic and socio-economic factors. Results: Overall, 67% of migrants with chronic poor mental health received at least one psychotropic medication during the study period, compared to 86% for the settled population; this equates to an odds ratio of OR 0.32 (95% CI 0.29 – 0.36) in the fully adjusted models. Adjustment for English proficiency did not significantly alter these models. There was also considerable variation between individual migrant groups. Conclusion: Although this study suggests substantial unmet need for treatment of poor mental health amongst the migrant population of Northern Ireland, further qualitative studies are required to better understand how different migrant groups respond to mental ill-health. The study was funded as part of an Administrative Data Research Centre Northern Ireland (ADRC-NI) research programme, funded by the Economic and Social Research Council (ESRC) (grants ES/L007509/1 and ES/S00744X/1). DƠR, MD and AK were also supported by the Medical Research Council (MRC) (grant MR/K023241/1). AK was additionally supported by the Academy of Finland (grant 312310 for the Centre of Excellence for Research on Ageing and Care, RG 3 Migration, Care and Ageing).

Background A higher risk of common mental health disorders has been found for first-generation migrants in high income countries, but few studies have examined the use of mental health care. This study aimed to identify the level of antidepressant use amongst the largest first generation migrant groups resident in Finland. Methods This cohort study used record-based data linkage methodology to examine the hazard of antidepressant use between migrant groups in Finland using Cox proportional hazard models. Data was derived using socio-demographic and prescription data from Statistics Finland and the Finnish Population Registry. The cohort included a random sample of 33% of the working age population in 2007 (N = 1,059,426, 49.8% women, 2.5% migrants) and dispensed antidepressant prescriptions from 2008 to 2014. Results After adjustment for socio-demographic characteristics, results show higher antidepressant use for female migrants from North Africa and the Middle East compared to the Finland-born majority, a similar level of use for migrants from Western countries, and lower use for migrants from other non-Western countries. Conclusions The gender and country of origin dependent use of antidepressant medication is discussed in terms of socio-political and cultural between-group differences. Recommendations are made to address inequalities in accessing services, particularly for migrants from non-Western countries.

Purpose We developed a job exposure matrix (JEM) to study the association between long-term exposure to heavy physical effort or heavy lifting and carrying at work with disability pension due to musculoskeletal disorders and premature all-cause mortality. Methods Exposure to heavy physical effort at work during 1996–2005 was estimated with JEM developed for this study population, where the exposure was based on occupational titles of the participants. We included all employees of the City of Helsinki, Finland, who had annual data of exposure for 8–10 years (1996–2005, n = 18387). The outcome variables were register-based, and the follow-up was from 2006 until 2015. The risk estimates were evaluated using competing risk survival analysis. Results There were 530 (3%) disability pension events due to musculoskeletal disorders during the 10-year follow-up. After adjustment for sex, age, education and chronic diseases, employees in the second (SHR = 1.46, 95% CI 1.05–2.05), third (SHR = 2.73, 95% CI 2.00–2.29), and the highest exposure quartile (SHR = 2.56, 95% CI 1.88–3.50) had a higher risk of musculoskeletal disability pension than employees in the lowest quartile. A total of 110 (4%) men and 266 (2%) women died during the follow-up. Men in the third quartile (SHR = 2.29, 95% CI 1.23–4.24), and women in the highest exposure quartile (SHR = 1.54, 95% CI 0.99–2.41) had a higher risk of premature mortality than those in the lowest quartile. Conclusions Eight to ten years of exposure to heavy physical effort at work is strongly associated with disability pension due to musculoskeletal disorders. This exposure also increases the risk of premature mortality, particularly among men. Electronic supplementary material The online version of this article (10.1007/s00420-018-1393-5) contains supplementary material, which is available to authorized users.

ObjectivesPain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics.MethodsThe Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models.ResultsAcute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19–1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10–1.50] for acute/subacute and 1.43 [1.23–1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08–1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations).ConclusionsThese results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.

Objective We examined trajectories of work disability, indicated by sickness absence and disability retirement, among midlife public sector employees with and without common mental disorders (CMD) at baseline. We also examined adverse childhood events, occupational class, long-standing illness and health behaviour as determinants of the trajectories. Methods A sample from the Helsinki Health Study was extracted comprising 2350 employees. Baseline characteristics were obtained from mail surveys conducted in 2000–2 and 2007. CMD were measured by the General Health Questionnaire. Participants were followed between the ages of 50–59. Work disability trajectories were modelled by the annual number of work disability months in group-based trajectory analysis. Multinomial regression was used to predict trajectory group memberships. Results Three trajectories were identified: no work disability (consisting 59% of the all employees), stable/low (31%) and high/increasing disability (10%). Employees with CMD were more likely to belong to the stable/low (odds ratio 1.73 [95% confidence interval 1.37–2.18]), and the high/increasing (2.55 [1.81–3.59]) trajectories. Stratified models showed that the determinants of the trajectories were largely similar for those with CMD compared to those without CMD except that obesity was a somewhat stronger predictor of the high/increasing trajectory among employees with CMD. Limitations The focus on midlife public sector employees limits the generalisability to other employment sectors and younger employees. Conclusions CMD were strongly associated with a trajectory leading to early exit from employment and a stable/low work disability trajectory. These findings have implications for interventions promoting work ability of employees with mental ill-health.

Objective: The aim of this study is to examine the prevalence of coronary heart disease (CHD)–related disability (hereafter also “disability”) and the impact of CHD risk factors on disability in older adults in the Republic of Ireland (ROI) and Northern Ireland (NI). Method: Population attributable fractions were calculated using risk factor relative risks and disability prevalence derived from The Irish Longitudinal Study on Ageing and the Northern Ireland Health Survey. Results: Disability was significantly lower in ROI (4.1% vs. 8.8%). Smoking and diabetes prevalence rates, and the fraction of disability that could be attributed to smoking (ROI: 6.6%; NI: 6.1%), obesity (ROI: 13.8%; NI: 11.3%), and diabetes (ROI: 6.2%; NI: 7.2%), were comparable in both countries. Physical inactivity (31.3% vs. 54.8%) and depression (10.2% vs. 17.6%) were lower in ROI. Disability attributable to depression (ROI: 16.3%; NI: 25.2%) and physical inactivity (ROI: 27.5%; NI: 39.9%) was lower in ROI. Discussion: Country-specific similarities and differences in the prevalence of disability and associated risk factors will inform public health and social care policy in both countries.

It is not well known how the timing of entry into paid employment and physical work exposures contribute to different health outcomes in young employees. Thus, we determined the associations of age at entry into paid employment and physical work exposures with general and mental health in young employees and determined whether associations differ by behavior-related risk factors. Data were collected via online and mailed surveys in autumn 2017 from employees of the City of Helsinki aged 18–39 years (n = 5897, 4630 women and 1267 men, response rate 51.5%). Surveys comprised measures of age at entry into paid employment, seven working conditions, behavior-related risk factors and health outcomes (self-rated health [SRH] and common mental disorders [CMD] as generic indicators of physical and mental health). Logistic regression analysis was used. After full adjustment, age at entry was not associated with the health outcomes, however, in additional analyses, younger age at first employment was associated with smoking and obesity (OR 3.00, 95% CI 2.34–3.85 and 1.67, 95% CI 1.32–2.11 for those started working at age of ≤18 years, respectively). Of the working conditions, sitting and standing were positively associated with poor SRH and CMD and uncomfortable working postures with CMD. Working conditions were broadly similarly associated with health outcomes among those with and without behavior-related risk factors. Although we found little support for modification by behavior-related risk factors, overweight, obesity and smoking were associated with poor SRH and binge drinking and smoking with CMD. Additionally, moderate and high levels of leisure-time physical activity were inversely associated with poor SRH. In conclusion, early entry into paid employment appears not to associate to immediate poorer health in young employees, although it was associated with smoking and obesity even after full adjustment. Exposure to physically heavy work and uncomfortable working postures may increase the risk of adverse health outcomes.

BACKGROUND Most studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, and whether own education moderates these associations. METHODS The Northern Finland Birth Cohort 1986 was followed from birth until the end of 2015. We included 8542 participants (52% male) who had had a minimum of 6-month employment that was defined by registered earning periods. As socioeconomic predictors, we examined low parental education at age 7 and low household income at age 16. Behaviour- and health-related factors at age 16 included smoking, alcohol use, physical inactivity, overweight, length of sleep and not having breakfast, while mental health problems included symptoms of anxiety and depression, attention problems and social problems. The analyses for significant predictors were further stratified by register-based level of completed own education by age 28-29 (low/high). RESULTS After adjustments, low parental education, smoking and having been drunk were significant predictors of early entry into paid employment (≤18 vs. ≥24 years), especially among those who later obtained high education. Low parental education and smoking were predictors of low or non-specified (vs. high) occupational class in the first job. Mental health problems were not associated with either outcome. CONCLUSIONS Socioeconomic background and unhealthy lifestyle contribute to early entry into the labour market and low occupational status in the first job.

Background The impact of retirement on health-related functioning, an important indicator of individual´s ability to function in everyday life, is poorly understood. Thus the aim of this study was to examine the association between transition to retirement, and changes in physical and mental health functioning among Finnish municipal employees. Methods Follow-upsurvey data were collected among ageing employees of the City of Helsinki, Finland, at three Phases: 1 (2000–2002), 2 (2007) and 3 (2012). Physical and mental health functioning were measured using the Short-Form 36 questionnaire at each Phase. Retirees between Phases 1 and 3 were identified from the national registers of the Finnish Centre for Pensions: Full-time statutory retirement (n=1464), part-time retirement not due to health reasons (n=404) and disability retirement due to health reasons (n=462). Generalised estimating equations were used to study the associations between transition to retirement and changes in health functioning. We also examined whether changes in functioning vary by gender, occupational status, or different health- and life-style factors. Results Statutory and part-time retirement were not associated with changes in physical health functioning during retirement transition process when adjusting for gender and age (β 0.1, 95% CI −0.3 to 0.5 and −1.0,–1.8 to 0.1, respectively), whereas clear decline was observed among disability retirees (−4.3,–5.4 to −3.2). Higher occupational class before retirement and sedentary lifestyle were associated with greater decline in physical health functioning. Mental health functioning improved during the retirement transition process among statutory and part-time retirees (1.9, 1.4 to 2.4 and 2.0, 1.0 to 3.0, respectively) while no association was observed among disability retirees (−0.3,–1.7 to 1.0). Conclusion Disability retirement was associated with decrease in physical health functioning, and statutory retirement with a slight improvement in mental health functioning. Evidence on changes in physical and mental functioning during retirement transition process may provide useful information for interventions to promote healthy ageing.

ObjectivesTo examine antidepressant use among male and female human service professionals.MethodsA random sample of individuals between 25 years and 54 years of age (n=752 683; 49.2% women; mean age 39.5 years). Information about each individual’s filled antidepressant prescriptions from 1995 to 2014 was provided by the Social Insurance Institution. First, antidepressant use in five broad human service categories was compared with that in all other occupations grouped together, separately for men and women. Then, each of the 15 human service professions were compared with all other occupations from the same skill/education level (excluding other human services professions). Cox models were applied and the results are presented as HRs for antidepressant use with 95% CIs.ResultsThe hazard of antidepressant use was higher among men working in human service versus all other occupations with the same skill/occupational level (1.22, 95% CI 1.18 to 1.27), but this was not the case for women (0.99, 95% CI 0.98 to 1.01). The risks differed between professions: male health and social care professionals (including medical doctors, nurses, practical nurses and home care assistants), social workers, childcare workers, teachers and psychologists had a higher risk of antidepressant use than men in non-human service occupations, whereas customer clerks had a lower risk.ConclusionsMale human service professionals had a higher risk of antidepressant use than men working in non-human service occupations. Gendered sociocultural norms and values related to specific occupations as well as occupational selection may be the cause of the elevated risk.

Introduction Pain is a risk factor for work disability, however, routes of exit out of paid employment among those with chronic pain have not been examined in detail. We aimed to examine the contribution of chronic back pain to subsequent transitions out of paid employment, accounting for covariates. Methods We included participants of the Whitehall II study cohort (n=8445, 69% men, aged 35–55 at baseline), with measurements of back pain between phases 1 and 3 (1985–1994). Exit from paid employment (health-related, retirement not related to health, unemployment, other) was observed between 1995–2013 (phases 4–11). Those remaining in paid employment served as the reference group. Sex, age, parental and own socioeconomic position, job demands, job control, and body mass index were controlled for. Repeated measures logistic regression models were fitted. Result Altogether 10% of the participants exited paid employment due to health-related reasons, 2% due to unemployment and further 6.5% due to other reasons. After full adjustments, reporting back pain at one time point (26%) was unassociated with exit due to health reasons, whereas reporting repeated pain (18%) was associated with such exit (OR 1.53, 95% CI: 1.17 to 2.00), when compared to those who did not report pain during phases 1–3 (56%). Associations were somewhat stronger among middle or lower class employees, and non-existent among high class employees. Otherwise differences e.g. by age, working conditions or obesity were small. The risk of exit due to other routes than health-related did not vary between participants with or without pain. Discussion These results highlight the need for early detection of chronic pain to prevent the risk of health-related early exit out of paid employment. The results further emphasise the importance of identification of high risk groups and their modifiable risk factors, such as adverse working conditions

Purpose: The aim of the study was to investigate sickness absence due to mental disorders in human service occupations. Methods: Participants (n = 1,466,100) were randomly selected from two consecutive national 9-year cohorts from the Statistics Finland population database; each cohort represented a 33% sample of the Finnish population aged 25-54 years. These data were linked to diagnosis-specific records on receipt of sickness allowance, drawn from a national register maintained by the Social Insurance Institution of Finland, using personal identification numbers. Results: Sociodemographic-adjusted hazard ratios (HRs) for sickness absence due to mental disorders in all human service occupations combined were 1.76 for men (95% confidence interval [CI], 1.70-1.84) and 1.36 for women (95% CI, 1.34-1.38) compared with men and women in all other occupations, respectively. Of the 15 specific human service occupations, compared with occupations from the same skill/education level without a significant human service component, medical doctors, psychologists, and service clerks were the only occupations with no increased hazard for either sex, and the HRs were highest for male social care workers (HR 3.02: 95% CI, 2.67-3.41). Conclusions: Most human service occupations had an increased risk of sickness absence due to mental disorders, and the increases in risks were especially high for men. (C) 2018 Elsevier Inc. All rights reserved.

Background Unemployment in early adulthood is associated with higher rate of disability due to common mental disorders (CMDs). We investigated to what extent the association between unemployment and sub-sequent long-term sickness absence due to CMDs is direct or whether it is dependent on accumulation of mental health problems and socioeconomic disadvantage. Methods In this longitudinal study, a population-based 60% sample of Finnish young adults born between 1983 and 1985 (N = 116 878) was followed up for the incidence of CMDs from 2006 to 2010. Sociodemographic and health-related covariates were identified using several nationwide registers. Hazard ratios (HRs) with 95% confidence intervals (CIs), and survival and cumulative hazard functions for CMD were calculated. A matching procedure was applied to account for the systematic differences in the distribution of the baseline characteristics. Results A total of 1416 (2.4%) of men and 2539 (4.4%) of women were granted a long-term sickness allowance for CMD during the follow-up. After matching, HR (95% CI) of CMD for men decreased from 2.38 (2.12-2.68) to 1.31 (1.03-1.67) and for women from 1.97 (1.79-2.18) to 1.39 (1.18-1.65). Approximately half of the effect of the unemployment on CMDs was explained by the background variables. Conclusion Using a causal approach, our study suggests that unemployment is consistently associated with an increased risk of work disability due to CMDs. Considering the young unemployed as a risk group may help in targeting interventions promoting mental health and improving educational and employment opportunities.

Objectives The aim this study was to examine the effect of changes in physical and psychosocial working conditions on physical health functioning among ageing municipal employees. Methods Follow-up survey data were collected from midlife employees of the City of Helsinki, Finland, at three time points: wave 1 (2000–2002), wave 2 (2007), and wave 3 (2012). Changes in physical and psychosocial working conditions were assessed between waves 1 and 2. Physical health functioning was measured by the physical component summary (PCS) of the Short-Form 36 questionnaire at each of the three waves. In total, 2784 respondents (83% women) who remained employed over the follow-up were available for the analyses. Linear mixed-effect models were used to assess the associations and adjust for key covariates (age, gender, obesity, chronic diseases, and health behaviors). Results Repeated and increased exposure to adverse physical working conditions was associated with greater decline in physical health functioning over time. In contrast, decrease in exposures reduced the decline. Of the psychosocial working conditions, changes in job demands had no effects on physical health functioning. However, decreased job control was associated with greater decline and repeated high or increased job control reduced the decline in physical health functioning over time. Conclusions Adverse changes in physical working conditions and job control were associated with greater decline in physical health functioning over time, whereas favorable changes in these exposures reduced the decline. Preventing deterioration and promoting improvement of working conditions are likely to help maintain better physical health functioning among ageing employees.

Background: We examined whether higher effort-reward imbalance (ERI) and lower job control are associated with exit from the labour market. Methods: There were 1263 participants aged 50-74 years from the English Longitudinal Study on Ageing with data on working status and work-related psychosocial factors at baseline (wave 2; 2004-2005), and working status at follow-up (wave 5; 2010-2011). Psychosocial factors at work were assessed using a short validated version of ERI and job control. An allostatic load index was formed using 13 biological parameters. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Exit from the labour market was defined as not working in the labour market when 61 years old or younger in 2010-2011. Results: Higher ERI OR=1.62 (95% CI 1.01 to 2.61, p=0.048) predicted exit from the labour market independent of age, sex, education, occupational class, allostatic load and depression. Job control OR=0.60 (95% CI 0.42 to 0.85, p=0.004) was associated with exit from the labour market independent of age, sex, education, occupation and depression. The association of higher effort OR=1.32 (95% CI 1.01 to 1.73, p=0.045) with exit from the labour market was independent of age, sex and depression but attenuated to non-significance when additionally controlling for socioeconomic measures. Reward was not related to exit from the labour market. Conclusions: Stressful work conditions can be a risk for exiting the labour market before the age of 61 years. Neither socioeconomic position nor allostatic load and depressive symptoms seem to explain this association.

Background: Environmental factors may affect adolescents’ eating habits and thereby body weight. However, the contribution of school neighbourhood environment is poorly understood. This study examined the association between proximity of a fast-food outlet or grocery store to school and adolescents’ eating habits and overweight. Methods: Participants were 23 182 adolescents (mean age 15 years) who responded to a classroom survey in 181 lower secondary schools in Finland (2008–09). School location was linked to data on distance from school to the nearest fast-food outlet or grocery store (≤100 m, 101−500 m, >500 m) using global positioning system-coordinate databases. Outcomes were irregular eating habits (skipping breakfast, skipping free school lunch, skipping free school-provided snacks and not having family dinners), the accumulation of these habits and overweight, including obesity (body mass index ≥ 25 kg/m2). Results: Thirteen percentage of the participants were overweight. Having a fast-food outlet or grocery store near school was associated with skipping often breakfast and free school lunch, and the accumulation of irregular eating habits. The proximity of a fast-food outlet or grocery store was associated with a 1.25-fold (95% confidence interval 1.03–1.52) risk of overweight among adolescent with a low socioeconomic status but not among those with higher socioeconomic status. This association was partly (12%) explained by the accumulation of irregular eating habits. Conclusions: Among adolescents from low socioeconomic background, the presence of fast-food retailers near schools is associated with accumulation of irregular eating habits and greater overweight. These findings suggest that obesogenic school neighbourhoods may contribute to social inequalities in overweight.

Aims To investigate if diabetes is associated with a higher risk of occupational (workplace or commuting) injury. Methods Medication data from the Finnish Prescription Register were used to identify diabetes cases in 2004 in a large employee cohort (the Finnish Public Sector study). These data were linked to injury records obtained from the Federation of Accident Insurance Institutions. A total of 1020 diabetes cases (median age 52 years, range 20 to 65 years; 66% women) and their 5234 age- and sex-matched controls were followed up until 2011. Sex-stratified Cox proportional hazards models, adjusting for age, occupational status, obesity and health behaviours, were applied. Because of the small number of men in the cohort, injury types and locations were only examined among women. Results During the median follow-up of 6.7 years, 25% of the participants with diabetes (n=252) and 20% of those without (n=1051) experienced an occupational injury. The association between diabetes and injury was stronger in women than men (P=0.048). Diabetes was associated with a higher risk of workplace (hazard ratio 1.37, 95% CI 1.11 to 1.69) and commuting (hazard ratio 1.36, 95% CI 1.03 to 1.79) injury in women. With regard to different injury types and locations, diabetes was associated with bone fractures, dislocations, sprains and strains, and injuries to upper and lower extremities. In men, there was an association between insulin-treated diabetes and commuting injury (hazard ratio 3.14, 95% CI 1.52 to 6.49). Conclusions Diabetes was associated with workplace and commuting injuries in women. Men with insulin-treated diabetes had a higher risk of commuting injuries. This article is protected by copyright. All rights reserved.