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Analyzes the socioeconomic and demographic determinants of inpatient hospital care for lumbar intervertebral disc disorders (LIDD) in Finland. Coverage of the study; Statistical methods used in the study, including the Poisson regression analyses; Details on the patients admitted for LIDD; Factors that affected the results of the study.

Abstract: We have slightly refined, evaluated and tested a mathematical model for predicting the vehicular suspension emissions of PM10. The model describes particulate matter generated by the wear of road pavement, traction sand, and the processes that control the suspension of road dust particles into the air. However, the model does not address the emissions from the wear of vehicle components. The performance of this suspension emission model has been evaluated in combination with the street canyon dispersion model OSPM. We used data from a measurement campaign that was conducted in the street canyon Runeberg Street in Helsinki from 8 January to 2 May, 2004. The model reproduced fairly well the seasonal variation of the PM10 concentrations, also during the time periods, when studded tyres and anti-skid treatments were commonly in use. For instance, the index of agreement (IA) was 0.83 for the time series of the hourly predicted and observed concentrations of PM10. The predictions of the model were found to be sensitive to precipitation and street traction sanding. The main uncertainties in the predictions are probably caused by (i) the cleaning processes of the streets, which are currently not included in the model, (ii) the uncertainties in the estimation of the sanding days, and (iii) the uncertainties in the evaluation of precipitation. This study provides more confidence that this model could potentially be a valuable tool of assessment to evaluate and forecast the suspension PM10 emissions worldwide. However, a further evaluation of the model is needed against other datasets in various vehicle fleet, speed and climatic conditions. [Copyright &y& Elsevier]

Abstract: The emission-exposure and exposure-response (toxicity) relationships are different for different emission source categories of anthropogenic primary fine particulate matter (PM2.5). These variations have a potentially crucial importance in the integrated assessment, when determining cost-effective abatement strategies. We studied the importance of these variations by conducting a sensitivity analysis for an integrated assessment model. The model was developed to estimate the adverse health effects to the Finnish population attributable to primary PM2.5 emissions from the whole of Europe. The primary PM2.5 emissions in the whole of Europe and in more detail in Finland were evaluated using the inventory of the European Monitoring and Evaluation Programme (EMEP) and the Finnish Regional Emission Scenario model (FRES), respectively. The emission-exposure relationships for different primary PM2.5 emission source categories in Finland have been previously evaluated and these values incorporated as intake fractions into the integrated assessment model. The primary PM2.5 exposure-response functions and toxicity differences for the pollution originating from different source categories were estimated in an expert elicitation study performed by six European experts on air pollution health effects. The primary PM2.5 emissions from Finnish and other European sources were estimated for the population of Finland in 2000 to be responsible for 209 (mean, 95% confidence interval 6–739) and 357 (mean, 95% CI 8–1482) premature deaths, respectively. The inclusion of emission-exposure and toxicity variation into the model increased the predicted relative importance of traffic related primary PM2.5 emissions and correspondingly, decreased the predicted relative importance of other emission source categories. We conclude that the variations of emission-exposure relationship and toxicity between various source categories had significant impacts for the assessment on premature deaths caused by primary PM2.5. [Copyright &y& Elsevier]

Objectives: Air pollution and traffic noise are detrimental to cardiovascular health. However, the effects of different sources of these exposures on cardiovascular biomarkers remain unclear. We explored the associations of long-term exposure to source-specific air pollution (vehicular exhausts and residential woodsmoke) at low concentrations and road-traffic noise with systemic inflammation and cardiovascular disease biomarkers., Material and Methods: Modeled outdoor exposure to fine particulate matter (aerodynamic diameter ≤2.5 μm; PM 2.5 ) from vehicular exhausts and residential woodsmoke, nitrogen dioxide (NO 2 ) from road traffic, and road-traffic noise were linked to the home addresses of the participants (Finnish residents aged 25-74) in the FINRISK study 1997-2012. The participants were located in the cities of Helsinki, Vantaa, and the region of Turku, Finland. The outcomes were high-sensitivity C-reactive protein (CRP), a biomarker for systemic inflammation, and cardiovascular disease biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin I. We performed cross-sectional analyses with linear and additive models and adjusted for potential confounders., Results: We found no association between PM 2.5 from vehicular exhausts (% CRP difference for 1 μg/m 3 increase in PM 2.5 : -0.9, 95% confidence interval, CI: -7.2, 5.8), or from residential woodsmoke (% difference: -8.1, 95% CI: -21.7, 7.9) and CRP (N = 4147). Road-traffic noise >70 dB tended to be positively associated with CRP (% CRP difference versus noise reference category of ≤45 dB: 18.3, 95% CI: -0.5, 40.6), but the association lacked significance and robustness (N = 7142). Otherwise, we found no association between road-traffic noise and CRP, nor between NO 2 from road traffic and NT-proBNP (N = 1907) or troponin I (N = 1951)., Conclusion: Long-term exposures to source-specific, fairly low-level air pollution from vehicular exhausts and residential woodsmoke, or road-traffic noise were not associated with systemic inflammation and cardiovascular disease biomarkers in this urban area., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Tanja Zeller has patent #397 WO2022043229A1 licensed to a computing device to estimate the probability of myocardial infarction. Tanja Zeller is shareholder of the ART.EMIS GmbH Hamburg. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose Employers increasingly use 'return to work' (RTW) coordinators to support work ability and extend working careers, particularly among employees with reduced work ability. We examined whether applying this model was associated with changes in employee sickness absence and disability retirements. Methods We used data from the Finnish Public Sector study from 2009 until 2015. Employees where the model was introduced in 2012 constituted the cases (n = 4120, one municipality) and employees where the model was not in use during the follow-up, represented the controls (n = 5600, two municipalities). We analysed risk of disability retirement in 2013-2015 and risk of sickness absence after (2013-2015) vs. before (2009-2011) intervention by case-control status. Results The incidence of disability retirement after the intervention was lower in cases compared to controls both in the total population (hazard ratio HR = 0.49, 95% CI 0.30-0.79) and in the subgroup of participants with reduced work ability (HR = 0.34, 95% CI 0.12-0.99). The risk of sickness absence increased from pre-intervention to post-intervention period both among cases and controls although the relative increase was greater among cases (RR post- vs. pre-intervention  = 1.26, 95% CI 1.14-1.40) than controls (RR post- vs. pre-intervention  = 1.03, 95% CI 0.97-1.08). In the group of employees with reduced work ability, no difference in sickness absence trends between cases and controls was observed. Conclusions These findings suggest that RTW-coordinator model may increase employee sickness absence, but decrease the risk of disability retirement, i.e., permanent exclusion from the labour market., (© 2021. The Author(s).)

Objective: This study aimed to examine duration of sickness absence due to knee osteoarthritis (OA) and sustained return to work (RTW) among municipal employees, who had at least one compensated sickness absence period due to knee OA. The contribution of sociodemographic characteristics, diabetes and previous sickness absence were assessed. We differentiated between participants with and without total knee arthroplasty (TKA)., Methods: Data from 123 506 employees in the Finnish Public Sector Study were linked with national health and mortality register information. There were 3 231 sickness absence periods (2372 participants) due to knee OA in 2005-2011. Kaplan-Meier curves for sustained RTW were obtained and median time with inter-quartile range (IQR) calculated for those with and without TKA. Cox regression analyses were carried out in multivariable analyses., Results: The median time to RTW from the beginning of sickness absence was 21-28 days when TKA was not related to sickness absence and 92-145 days when it was. Among participants with no TKA, age 60-64, non-sedentary work, diabetes, and previous sickness absences predicted longer time to RTW, while pain medication predicted a shorter time. Among participants with TKA, non-sedentary work and previous sickness absences predicted a longer time to RTW., Conclusions: The clinical relevance of the difference in time to RTW between employees with or without TKA was substantial. Employees with knee OA working in physically demanding jobs need work modifications after TKA, and this calls for a dialog between occupational health care professionals and workplaces.

Purpose: Alternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector., Methods: Two city administrations (A and D) that implemented an alternative duty work policy to their employees (n = 5341 and n = 7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (n = 6976 and n = 6720). The outcomes were the number of annual days, all episodes, and short-term (< 10 days) episodes during the 2 years before versus the 2 years after the intervention year. We applied repeated measures negative binomial regression analyses, using the generalized estimating equations method and the difference-in-difference analysis to compare the intervention and control cities (adjusted for sex, age, type of job contract, occupational class)., Results: During the five-year study period, the number of sickness absence days and episodes increased in both the intervention and control cities. Covariate-adjusted analysis of relative risk showed that the overall increase in post- versus pre-intervention sickness absence days was smaller in intervention City A, RR = 1.14 (95% CI = 1.09-1.21) than in control cities B and C, RR = 1.19 (95% CI =1.14-1.24), group × time interaction p < 0.02. In intervention City D, we found a corresponding result regarding all sickness absence episodes and short-term sickness absence episodes but not days., Conclusions: This follow-up suggests that implementing an alternative duty work policy may marginally decrease employees' sickness absences.

Urban dwellers are simultaneously exposed to several environmental health risk factors. This study aimed to examine the relationship between long-term exposure to fine particulate matter (PM 2.5 , diameter < 2.5 µm) of residential-wood-burning and road-traffic origin, road-traffic noise, green space around participants' homes, and hypertension. In 2015 and 2016, we conducted a survey of residents of the Helsinki Capital Region to determine their perceptions of environmental quality and safety, lifestyles, and health statuses. Recent antihypertensive medication was used as an indicator of current hypertensive illness. Individual-level exposure was estimated by linking residential coordinates with modelled outdoor levels of wood-smoke- and traffic-related PM 2.5 , road-traffic noise, and coverage of natural spaces. Relationships between exposure and hypertension were modelled using multi-exposure and single-exposure binary logistic regression while taking smooth functions into account. Twenty-eight percent of the participants were current users of antihypertensive medication. The odds ratios (95% confidence interval) for antihypertensive use were 1.12 (0.78-1.57); 0.97 (0.76-1.26); 0.98 (0.93-1.04) and 0.99 (0.94-1.04) for wood-smoke PM 2.5 , road-traffic PM 2.5 , road-traffic noise, and coverage of green space, respectively. We found no evidence of an effect of the investigated urban exposures on prevalent hypertension in the Helsinki Capital Region.

Exposure to fine particles in ambient air has been estimated to be one of the leading environmental health risks in Finland. Residential wood combustion is the largest domestic source of fine particles, and there is increasing political interest in finding feasible measures to reduce those emissions. In this paper, we present the PM 2.5 emissions from residential wood combustion in Finland, as well as the resulting concentrations. We used population-weighed concentrations in a 250 x 250 m grid as population exposure estimates, with which we calculated the disease burden of the emissions. Compared to a projected baseline scenario, we studied the effect of chosen reduction measures in several abatement scenarios. In 2015, the resulting annual average concentrations were between 0.5 and 2 µg/m 3 in the proximity of most cities, and disease burden attributable to residential wood combustion was estimated to be 3400 disability-adjusted life years (DALY) and 200 deaths. Disease burden decreased by 8% in the 2030 baseline scenario and by an additional 63% in the maximum feasible reduction scenario. Informational campaigns and improvement of the sauna stove stock were assessed to be the most feasible abatement measures to be implemented in national air quality policies., Competing Interests: The authors declare no conflict of interest.

The contribution of physically demanding work to the developmental trajectories of sickness absence (SA) has seldom been examined. We analyzed the associations of 12 physical work exposures, individually and in combination, with SA trajectories among the occupationally active in the Finnish nationally representative Health 2000 survey. We included 3814 participants aged 30-59 years at baseline, when exposure history to work-related factors was reported. The survey and interview responses were linked with the annual number of medically confirmed SA spells through 2002-2008 from national registries. Trajectory analyses identified three SA subgroups: 1 = low (54.6%), 2 = slowly increasing (33.7%), and 3 = high (11.7%). After adjustments, sitting or use of keyboard >1 year was inversely associated with the high SA trajectory (odds ratio, OR, 0.57; 95% 95% confidence interval, CI, 0.43-0.77). The odds of belonging to the trajectory of high SA increased with an increasing number of risk factors, and was highest for those with ≥4 physical workload factors (OR 2.71; 95% CI 1.99-3.69). In conclusion, these findings highlight the need to find ways to better maintain the work ability of those in physically loading work, particularly when there occurs exposure to several workload factors.

Aim: Although multisite pain (MSP) often threatens work ability (WA), some of those with MSP retain good WA. Our aim was to identify factors associated with good WA among subjects with MSP., Methods: A nationally representative sample (the Health 2000-Study, response rate 87%) comprising 3884 occupationally active Finns aged 30-64 years. Data on WA, musculoskeletal pain, physical and psychosocial working conditions, chronic diseases, lifestyle and domestic situation were gathered by questionnaire, interview and clinical examination. Good current WA compared with the lifetime best was defined as ⩾9 on a 0-10 scale. Musculoskeletal pain in 18 body locations was combined into four sites, and thereafter pain in two or more sites was defined as MSP (N=1351). Poisson regression analysis was used to obtain prevalence rate ratios (PRR)., Results: Good WA was reported by 48% of the women and 37% of the men with MSP. In a multivariable model good WA was associated with younger age, female gender, physically non-strenuous work (PRR 1.3, 95% CI 1.1-1.5), low job strain (1.2, 1.0-1.4), high supervisor support (1.2, 1.0-1.4), and not having musculoskeletal diseases (1.3, 1.1-1.5), mental disorders (1.4, 1.1-1.9), daytime tiredness (1.4, 1.2-1.7) or economic troubles (1.5, 1.1-1.9). Age-stratified analyses revealed also associations with high coworker support (1.2, 1.0-1.4) and strenuous leisure-time physical exercise (1.2, 1.0-1.4) in those aged 30-44 and low alcohol consumption (1.8, 1.2-2.6) in the age-group 45-64., Conclusions: Several potentially modifiable factors related to health, work, and lifestyle were associated with good WA among occupationally active subjects with MSP., (© 2015 the Nordic Societies of Public Health.)

Objective: To examine the associations between occupational psychosocial factors and obesity among 31-year-olds, adjusting for adolescent body mass index, physical strenuousness of work, and adverse health behaviors (ie, stress-related eating/drinking, leisure-time physical inactivity, smoking, and high alcohol consumption)., Methods: The study population comprised 2083 men and 1770 women from the Northern Finland Birth Cohort 1966. Obesity was defined as a body mass index of 30.0 kg/m or more. Psychosocial exposures were defined in terms of demands, control, and social support at work., Results: Among men, high job demands and low worksite social support were independently associated with obesity. Among women, stress-related eating/drinking and physical inactivity seemed to promote obesity. Body mass index at age 14 was an important predictor of obesity for both sexes., Conclusions: In workplace obesity prevention programs, it might be beneficial to improve the psychosocial work environment and promote healthy behaviors simultaneously.

We studied the number of musculoskeletal pain sites as a predictor of sickness absence during a 7-year follow-up among a nationally representative sample (the Health 2000 survey) of occupationally active Finns 30 to 55years of age (3420 subjects who did not retire or die during the follow-up). Baseline data (questionnaire, interview, clinical examination by a physician) were gathered in 2000 to 2001 and linked with information from national registers on annual compensated sickness absence periods (⩾10workdays) covering the years 2002 to 2008. Pain during the preceding month in 18 body locations was inquired and combined into 4 sites (neck, upper limbs, low back, lower limbs). Demographic factors, BMI, smoking, leisure-time physical activity, sleep disorders, physical and psychosocial workload, and chronic diseases were assessed. Four distinct sickness absence trajectories emerged, labeled as Low (59% of the subjects), Ascending (21%), Mixed (11%), and High (9%). In multinomial logistic regression, the odds ratios (ORs) for belonging to the High vs. the Low trajectory increased with the number of pain sites, being 2.1 for single-site pain, 2.6 for 2 pain sites, 2.9 for 3 pain sites, and 4.1 for 4 pain sites, after adjustment for chronic diseases, demographic and lifestyle factors, and workload. The confidence intervals of the ORs did not include unity. The adjusted ORs for belonging to the Ascending trajectory were 1.1, 1.3, 1.7, and 1.7, respectively. As the number of pain sites was a strong independent predictor of work absenteeism, early screening of workers with multisite pain and interventions to support work ability seem warranted., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Objectives: We reviewed work histories of manual handling of loads >20 kg in relation to hip osteoarthritis by age, exposure and work participation., Methods: A nationally representative sample of 3110 Finnish men and 3446 women aged 30-97 was recruited. Diagnosis of hip osteoarthritis was based on standardised clinical examination by trained physicians. Previous exposure to physically loading work was evaluated through interviews. Logistic regression was used to estimate associations between work factors and hip osteoarthritis., Results: 1.9% of men and 2.1% of women had hip osteoarthritis. Almost half the men and a quarter of the women had recurrently handled heavy loads at work. Subjects who had manually handled loads >20 kg had a 1.8-fold increased risk of hip osteoarthritis compared to non-exposed references, when age, body mass index, traumatic fractures and smoking were accounted for. Results were similar for men (OR 2.0; 95% CI 1.0 to 4.0) and women (1.8; 1.1 to 2.8). In a sub-analysis of subjects with hip replacement, the OR was 1.7 (1.0 to 2.9). Risk increased first after 12 years' exposure: among men it was 2.2 (0.8 to 5.9) for 13-24 years' exposure, and 2.3 (1.2 to 4.3) for >24 years' exposure. Among women it was 3.8 (1.7 to 8.1) for 13-24 years' exposure. Work participation among men aged <60 years with hip osteoarthritis was 20% lower compared with subjects without osteoarthritis., Conclusions: A work history of manual handling of loads >20 kg showed a strong association with hip osteoarthritis in all age groups except the youngest.

Objectives: Musculoskeletal pain often occurs at multiple sites concurrently. The aim of this study was to examine the associations between multi-site pain and self-rated work ability and retirement plans among actively working people., Methods: The Health 2000 Survey was carried among a representative sample of Finnish adults. Musculoskeletal pain during the preceding month in the lower back, neck or shoulders, upper extremities, hips and lower extremities, and work ability and intentions to retire early were assessed. Subjects were also clinically examined. Analyses were restricted to 30-64-year-old subjects actively working during the preceding 12 months who provided information on work ability outcomes (population-weighted number of subjects=4087). Log-binomial regression was used to estimate prevalence ratios of reduced work ability., Results: Single-site pain was reported by 33% of subjects, 20%, 9% and 4% reported pain in two, three and four sites, respectively, and 8%-15% reported poor work ability. Every fifth person had thought about retiring early. Age- and gender-adjusted risks of poor physical work ability and own prognosis of poor future work ability increased from 2 for single-site pain to 8 for pain at four sites. Risks remained considerably elevated after adjustment for various covariates, including clinical musculoskeletal disorders and functional capacity. Poor current work ability was most affected by multi-site pain at older age (50-64 years) and intentions to retire early at age 40-49 years., Conclusions: Co-occurring pain is a considerable threat to work ability. Workers with multi-site pain may benefit from targeted preventive measures to sustain their work ability. Future studies should also consider multi-site pain as an important risk factor for reduced work ability.

Study Design: Cross-sectional study with retrospectively assessed work determinants., Objective: To study the association between the history of physically demanding work and sciatica, among the occupationally active, and among persons of working age who are not occupationally active., Summary of Background Data: Few studies have examined the association of physically loading work with sciatica, and studies concerning women are scarce., Methods: A nationally representative sample of The Health 2000 survey comprised 4811 Finns aged 30 to 64, which we further stratified into 2 groups based on working status during the preceding 12 months. The diagnosis of sciatica was based on characteristic symptoms and a standardized clinical examination by physicians trained for the purpose. Life-long exposure to physically demanding work tasks was assessed retrospectively by interview., Results: A total of 3.8% of working subjects and 7.9% of nonworking subjects had sciatica; men more often than women. In the multivariable logistic regression models, a history of physically demanding work in general was associated with sciatica among men. The risk increased with the length of exposure for the first 20 years (OR: 1.85; 95% CI: 1.17-2.91 for 1-10 years and 2.67; 1.61-4.43 for 11-20 years of exposure), but decreased thereafter. When analyzing manual handling of heavy objects, bending, and kneeling separately, odds ratios for these factors were high for both working and nonworking men. However, they remained at the borderline of statistical significance among working men. None of the physical work exposures were associated with sciatica among working women, whereas a long history of handling heavy objects and bending were related to sciatica among nonworking women., Conclusion: Physically demanding work in general is a risk factor for sciatica among men. Sciatica may be a significant cause of premature health-related selection out of the heavy work among both genders.

Objectives: Atherosclerosis of arteries supplying the lumbar region has been suggested as a mechanism leading to intervertebral disc degeneration and sciatica. The study described here examined whether serum lipid levels or pharmacologically treated hyperlipidemia were associated with sciatica., Methods: A nationally representative sample (n=8028) of Finns aged 30 years or over was interviewed and examined. Sciatica was assessed by a physician according to preset criteria. Information for the present purpose was available for 74.8% of the sample., Results: The prevalence of sciatica was 3.3% for men and 2.2% for women. In men without hyperlipidemia treatment, sciatica was associated with total cholesterol (high vs. low tertile: OR 2.28, 95% CI 1.14-4.55), LDL cholesterol (2.12; 1.11-4.05), and triglycerides (1.92; 1.04-3.55), adjusted for age, BMI, exercise, smoking, heavy physical work, and education. HDL was not associated with sciatica. For men in the highest tertile of both total cholesterol and triglycerides, the OR of sciatica was 3.89 (1.68-8.99) in comparison to men with cholesterol in the lowest tertile and triglycerides in the lowest or the middle tertile. In similar analyses among women no associations were seen. Pharmacologically treated hyperlipidemia was associated with sciatica in women (2.02; 1.01-4.04), but not in men (1.71; 0.83-3.55)., Conclusions: Independent of BMI and other possible confounders, clinically assessed sciatica in men was associated with levels of atherogenic serum lipids. Pharmacologically treated hyperlipidemia was associated with sciatica in women. The findings are in accordance with the atherosclerosis-sciatica hypothesis.

Background: Little is known about the effect of fibromyalgia on absence due to sickness in working populations., Objective: To examine the risk of absence due to sickness among employees with fibromyalgia., Methods: A prospective cohort study with 1-year follow-up of recorded and certified absence due to sickness after a survey of chronic diseases among 34 100 Finnish public sector employees (27 360 women and 6740 men) aged 17-65 years at baseline in 2000-2., Results: 20 224 days of absence due to sickness for the 644 employees with fibromyalgia and 454 816 days for others were documented. Of those with fibromyalgia, 67% had co-occurring chronic conditions such as osteoarthritis, rheumatoid arthritis, depression or other psychiatric disorders. Compared with employees with none of these chronic conditions, the hazard ratio (HR) adjusted for age, sex and occupational status was 1.85-fold (95% confidence interval (CI) 1.53 to 2.18) for people with fibromyalgia alone and 2.63-fold (95% CI 2.34 to 2.96) for employees with fibromyalgia with coexisting conditions. The excess rate of absence due to sickness was 61 episodes/100 person-years among people with fibromyalgia alone. Among employees with musculoskeletal and psychiatric disorders, secondary fibromyalgia was associated with a 1.4-1.5-fold increase in risk of absence., Conclusion: Fibromyalgia is associated with a substantially increased risk of medically certified absence due to sickness that is not accounted for by coexisting osteoarthritis, rheumatoid arthritis or psychiatric disorders.

The aim of the study was to examine the stability of voluntary and household physical activity (PA) and to compare it with that of the use of the most common stimulants. The prospective cohort study comprised of follow-ups at 5, 10, and 28 years at baseline in 1973 in four plants of an industrial corporation in Finland. A systematic, non-proportional sample (n=902, age range 18-64 years) stratified for age, gender, and occupational status was drawn from the employees. Scores of PA were based on a questionnaire and interviews. Logistic regression models with proportional odds assumptions were counted. The 5-year stability (Spearman's rho) of PA time was 0.44 (PA intensity 0.44), the respective 10-year coefficient was 0.26 (0.32), and that in the 28-year follow-up was 0.18 (0.20). The stability of PA decreased rapidly from 1973 to 1983 and more slowly thereafter. Changes along the follow-up reflect a polarization of the distributions of PA within the sample. Age and an initially low level of activity were the strongest predictors of inactivity. The stability coefficient of smoking and alcohol consumption was twice as high as that of PA. Stimulant use was a greater factor in the individual's lifestyle than PA.

Study Design: Cohort study with 5-, 10-, and 28-year follow-up., Objectives: To examine associations between baseline serum lipid concentrations and later low back pain (LBP)., Summary of Background Data: Atherosclerosis of the lumbar vessels has been suggested as a mechanism leading to disc degeneration and LBP. Cholesterol is considered essential for atherosclerosis development., Methods: A sample (n = 902) of employees in an engineering company was examined for serum total cholesterol and triglycerides, body mass index (BMI), smoking, exercise, work history, and LBP in 1973. By November 2000, 232 subjects had died. In 1978, 748 (84% of the survivors), in 1983, 654 (76%), and in 2000, 546 (81%) responded to a follow-up questionnaire., Results: In men, baseline serum total cholesterol predicted new cases of radiating LBP in the 5-year follow-up (highest tertile vs. lowest: odds ratio [OR], 2.5; 95% confidence interval [CI], 1.1-5.9) and in the 10-year follow-up (OR, 2.8; 95% CI, 1.3-6.1), adjusted for age, occupational class, work history, BMI, smoking and exercise. Also, serum triglycerides predicted new cases in the latter examination (OR, 2.6; 95% CI, 1.2-5.8). In women, no associations were seen until the 10-year follow-up, when their results were similar to those in men. In the total material, serum total cholesterol predicted radiating LBP reported both at the 10- and the 28-year follow-up., Conclusions: High serum lipids predicted incident radiating LBP, consistent with the atherosclerosis-LBP hypothesis.

Aims: To study the socioeconomic distribution of severe back morbidity by age and gender, and to examine to what extent the differences in back morbidity between socioeconomic groups are particularly related to manual work in different age groups., Methods: Hospital admissions in 1996 for back disorders of 25-64 year old men (3123 of a total 743,961) and women (3043 of 773,936) from the Finnish Hospital Discharge Register were linked with demographic and socioeconomic data from the 1995 population census. Poisson regression analysis was used to calculate the rate ratios for back related hospitalisation by occupational class and education. The distribution of cases according to occupational status and education was presented in relation to the whole occupationally active workforce by age and gender., Results: Blue-collar (manual) workers had a higher risk of being hospitalised because of back disorders compared with white-collar employees (non-manual) in all age groups among both genders. Manual work versus non-manual work was associated with a 1.3 to 1.4-fold risk (95% CI 1.0 to 1.8) among women and a 1.3 to 1.6-fold risk (95% CI 1.1 to 2.2) among men. The risk of hospitalisation was further inversely associated with educational level within manual and non-manual work in all other age groups except in those aged 55-64 years. Gender related differences were much smaller compared with the socioeconomic ones., Conclusions: Socioeconomic differences in back morbidity leading to hospitalisation were consistent by age and gender. The results suggest that not only the physical strenuousness of work, but also other causes of severe back disorders are clustered around a subject's socioeconomic status, indicated by formal education. This may have implications for prevention and the planning of rehabilitation.

Study Design: A prospective cohort study., Objective: To study the relationship of sleep disturbances with severe back disorders leading to hospitalization., Summary of Background Data: Sleep disturbances are associated with persistent pain syndromes, but little is known about their relationship with back disorders., Methods: The first hospital admission for back disorders from 1973 to 2000 was studied in a cohort of metal industry workers (n = 902). The occurrence of sleep disturbances at baseline was categorized as: none; 1 type (either difficulties in falling asleep/waking up at night or nightmares); or both types. Cox proportional hazards regression was used to estimate the time between the assessment of risk factors and first hospital admission for back disorders., Results: Those individuals who had 1 type of sleep disturbance had a 2.1-fold (95% confidence interval 1.1-3.8) risk of back-related hospitalization, and those with both types of disturbance a 2.4-fold (1.2-4.6) risk, compared with those with no sleep disturbances. The hazard ratios were 2.1; 1.0-4.6 and 2.9; 1.2-7.1, respectively, when patients with chronic back disease or recurrent back symptoms at baseline were excluded from the analyses., Conclusion: These findings suggest that sleep disturbances are predictive of hospitalization for back disorders. The mechanism underlying this association warrants further study.

Background: Low back disorders are among the most common health problems in industrialized societies. We examined the relationship between occupational exposures and severe lumbar intervertebral disc disorders (LIDD)., Methods: Information on inpatient care for LIDD (ICD-10: M51.1-51.9) in Finnish hospitals during 1996 was linked with the 1995 Population Census, and based on occupational title with the Finnish Job Exposure Matrix and the Occupational Lifestyle Matrix. There were 3,863 individuals hospitalized due to LIDD among occupationally active Finns. Poisson regression analyses were made with the total occupationally active population as reference., Results: In a multivariate analysis in women, accident risk, job control, and three-shift work were associated with hospitalization, together with age, education, personal income, and average body mass index (BMI) by occupation. In men, accident risk and job control were associated with hospital admissions, allowing for age, education, and income., Conclusions: Accident risk and job control increased the risk of hospitalization for LIDD in both sexes. Three-shift work and BMI were also predictive of hospital admission among women., (Copyright 2004 Wiley-Liss, Inc.)

Objectives: The variation in hospital admission rates was studied for back disorders by industry and occupational title among gainfully employed Finns., Methods: Admissions to Finnish hospitals in 1996 among 25- to 64-year-olds, based on the Hospital Discharge Register, were linked with sociodemographic data from the 1995 population census for the following primary diagnoses [International Classification of Diseases, 10th revision (ICD-10)]: all back disorders (M40.0-54.9; N (individual patients) 7,253), lumbar intevertebral disc disorders (M51.0-M51.9, N = 3,863), and other common back disorders (ICD-10: M47.1-47.2, M47.8-47.9, M48.0, M54.1, M54.3-54.5, M54.8-54.9; N = 2,433), with the total occupationally active workforce (same age range and gender) as reference. Age-standardized hospitalization rate ratios (SRR) were calculated., Results: The highest SRR values for hospitalization for any back disorder were found for fishing (SRR 195), "other" mining and carrying (SRR 168), and sewage and refuse disposal (SRR 152) among the men and water transport (SRR 158), wood product (SRR 149) and pulp, paper and paper product (SRR 145) manufacturing among the women. Computer activities (SRR 44) among the men and insurance and pension funding (SRR49) among the women had the lowest SRR values. The occupations reindeer breeders and herders (SRR 495), agricultural workers (SRR 232), and paper product workers (SRR 205) among the men and plastic product (SRR 233), laundry (SRR 224), and agricultural (SRR 219) workers among the women had the highest SRR values. The lowest SRR values were observed for upper white-collar employees in public administration [men (SRR 40) and women (SRR 61)]., Conclusions: Hospitalization rates for back disorders were high for several physically strenuous industries and occupations.