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Background Raised C-reactive protein (CRP) is a risk factor for type 2 diabetes. According to the Mendelian randomization method, the association is likely to be causal if genetic variants that affect CRP level are associated with markers of diabetes development and diabetes. Our objective was to examine the nature of the association between CRP phenotype and diabetes development using CRP haplotypes as instrumental variables. Methods and Findings We genotyped three tagging SNPs (CRP+2302G > A; CRP+1444T > C; CRP+4899T > G) in the CRP gene and measured serum CRP in 5,274 men and women at mean ages 49 and 61 y (Whitehall II Study). Homeostasis model assessment-insulin resistance (HOMA-IR) and hemoglobin A1c (HbA1c) were measured at age 61 y. Diabetes was ascertained by glucose tolerance test and self-report. Common major haplotypes were strongly associated with serum CRP levels, but unrelated to obesity, blood pressure, and socioeconomic position, which may confound the association between CRP and diabetes risk. Serum CRP was associated with these potential confounding factors. After adjustment for age and sex, baseline serum CRP was associated with incident diabetes (hazard ratio = 1.39 [95% confidence interval 1.29-1.51], HOMA-IR, and HbA1c, but the associations were considerably attenuated on adjustment for potential confounding factors. In contrast, CRP haplotypes were not associated with HOMA-IR or HbA1c (p=0.52-0.92). The associations of CRP with HOMA-IR and HbA1c were all null when examined using instrumental variables analysis, with genetic variants as the instrument for serum CRP. Instrumental variables estimates differed from the directly observed associations (p = 0.007-0.11). Pooled analysis of CRP haplotypes and diabetes in Whitehall II and Northwick Park Heart Study II produced null findings (p = 0.25-0.88). Analyses based on the Wellcome Trust Case Control Consortium (1,923 diabetes cases, 2,932 controls) using three SNPs in tight linkage disequilibrium with our tagging SNPs also demonstrated null associations. Conclusions Observed associations between serum CRP and insulin resistance, glycemia, and diabetes are likely to be noncausal. Inflammation may play a causal role via upstream effectors rather than the downstream marker CRP. The Editors' Summary of this article follows the references., Introduction C-reactive protein (CRP) is a nonspecific marker of systemic inflammation that predicts incident type 2 diabetes. Chronic low-grade inflammation may induce insulin resistance and is a candidate pathway leading [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2007.10.013 Byline: Tuula Oksanen (a), Anne Kouvonen (b), Mika Kivimaki (a)(c), Jaana Pentti (a), Marianna Virtanen (a), Anne Linna (a), Jussi Vahtera (a) Keywords: Finland; Social capital; Self-rated health; Work; Multilevel analysis Abstract: The majority of previous research on social capital and health is limited to social capital in residential neighborhoods and communities. Using data from the Finnish 10-Town study we examined social capital at work as a predictor of health in a cohort of 9524 initially healthy local government employees in 1522 work units, who did not change their work unit between 2000 and 2004 and responded to surveys measuring social capital at work and health at both time-points. We used a validated tool to measure social capital with perceptions at the individual level and with co-workers' responses at the work unit level. According to multilevel modeling, a contextual effect of work unit social capital on self-rated health was not accounted for by the individual's socio-demographic characteristics or lifestyle. The odds for health impairment were 1.27 times higher for employees who constantly worked in units with low social capital than for those with constantly high work unit social capital. Corresponding odds ratios for low and declining individual-level social capital varied between 1.56 and 1.78. Increasing levels of individual social capital were associated with sustained good health. In conclusion, this longitudinal multilevel study provides support for the hypothesis that exposure to low social capital at work may be detrimental to the health of employees. Author Affiliation: (a) Finnish Institute of Occupational Health, Turku, Finland (b) Institute of Work, Health & Organisations, University of Nottingham, UK (c) Department of Epidemiology and Public Health, University College London Medical School, UK

Background Glycated hemoglobin (HbA1c) is used to diagnose type 2 diabetes (T2D) and assess glycemic control in patients with diabetes. Previous genome-wide association studies (GWAS) have identified 18 HbA1c-associated genetic variants. These variants proved to be classifiable by their likely biological action as erythrocytic (also associated with erythrocyte traits) or glycemic (associated with other glucose-related traits). In this study, we tested the hypotheses that, in a very large scale GWAS, we would identify more genetic variants associated with HbA1c and that HbA1c variants implicated in erythrocytic biology would affect the diagnostic accuracy of HbA1c. We therefore expanded the number of HbA1c-associated loci and tested the effect of genetic risk-scores comprised of erythrocytic or glycemic variants on incident diabetes prediction and on prevalent diabetes screening performance. Throughout this multiancestry study, we kept a focus on interancestry differences in HbA1c genetics performance that might influence race-ancestry differences in health outcomes. Methods & findings Using genome-wide association meta-analyses in up to 159,940 individuals from 82 cohorts of European, African, East Asian, and South Asian ancestry, we identified 60 common genetic variants associated with HbA1c. We classified variants as implicated in glycemic, erythrocytic, or unclassified biology and tested whether additive genetic scores of erythrocytic variants (GS-E) or glycemic variants (GS-G) were associated with higher T2D incidence in multiethnic longitudinal cohorts (N = 33,241). Nineteen glycemic and 22 erythrocytic variants were associated with HbA1c at genome-wide significance. GS-G was associated with higher T2D risk (incidence OR = 1.05, 95% CI 1.04-1.06, per HbA1c-raising allele, p = 3 x 10.sup.-29 ); whereas GS-E was not (OR = 1.00, 95% CI 0.99-1.01, p = 0.60). In Europeans and Asians, erythrocytic variants in aggregate had only modest effects on the diagnostic accuracy of HbA1c. Yet, in African Americans, the X-linked G6PD G202A variant (T-allele frequency 11%) was associated with an absolute decrease in HbA1c of 0.81%-units (95% CI 0.66-0.96) per allele in hemizygous men, and 0.68%-units (95% CI 0.38-0.97) in homozygous women. The G6PD variant may cause approximately 2% (N = 0.65 million, 95% CI 0.55-0.74) of African American adults with T2D to remain undiagnosed when screened with HbA1c. Limitations include the smaller sample sizes for non-European ancestries and the inability to classify approximately one-third of the variants. Further studies in large multiethnic cohorts with HbA1c, glycemic, and erythrocytic traits are required to better determine the biological action of the unclassified variants. Conclusions As G6PD deficiency can be clinically silent until illness strikes, we recommend investigation of the possible benefits of screening for the G6PD genotype along with using HbA1c to diagnose T2D in populations of African ancestry or groups where G6PD deficiency is common. Screening with direct glucose measurements, or genetically-informed HbA1c diagnostic thresholds in people with G6PD deficiency, may be required to avoid missed or delayed diagnoses., Author(s): Eleanor Wheeler 1, Aaron Leong 2,3, Ching-Ti Liu 4, Marie-France Hivert 5,6, Rona J. Strawbridge 7,8, Clara Podmore 9,10, Man Li 11,12,13, Jie Yao 14, Xueling Sim 15, Jaeyoung [...]

Background Socioeconomic disadvantage is a risk factor for dementia, but longitudinal studies suggest that it does not affect the rate of cognitive decline. Our objective is to understand the manner in which socioeconomic disadvantage shapes dementia risk by examining its associations with midlife cognitive performance and cognitive decline from midlife to old age, including cognitive decline trajectories in those with dementia. Methods and findings Data are drawn from the Whitehall II study (N = 10,308 at study recruitment in 1985), with cognitive function assessed at 4 waves (1997, 2002, 2007, and 2012). Sociodemographic, behavioural, and cardiometabolic risk factors from 1985 and chronic conditions until the end of follow-up in 2015 (N dementia/total = 320/9,938) allowed the use of inverse probability weighting to take into account data missing because of loss to follow-up between the study recruitment in 1985 and the introduction of cognitive tests to the study in 1997. Generalized estimating equations and Cox regression were used to assess associations of socioeconomic markers (height, education, and midlife occupation categorized as low, intermediate, and high to represent hierarchy in the socioeconomic marker) with cognitive performance, cognitive decline, and dementia (N dementia/total = 195/7,499). In those with dementia, we examined whether retrospective trajectories of cognitive decline (backward timescale) over 18 years prior to diagnosis differed as a function of socioeconomic markers. Socioeconomic disadvantage was associated with poorer cognitive performance (all p < 0.001). Using point estimates for the effect of age, the differences between the high and low socioeconomic groups corresponded to an age effect of 4, 15, and 26 years, for height, education, and midlife occupation, respectively. There was no evidence of faster cognitive decline in socioeconomically disadvantaged groups. Low occupation, but not height or education, was associated with risk of dementia (hazard ratio [HR] = 2.03 [95% confidence interval (CI) 1.23-3.36]) in an analysis adjusted for sociodemographic factors; the excess risk was unchanged after adjustment for cognitive decline but was completely attenuated after adjustment for cognitive performance. In further analyses restricted to those with dementia, retrospective cognitive trajectories over 18 years prior to dementia diagnosis showed faster cognitive decline in the high education (p = 0.006) and occupation (p = 0.001) groups such that large differences in cognitive performance in midlife were attenuated at dementia diagnosis. A major limitation of our study is the use of electronic health records rather than comprehensive dementia ascertainment. Conclusions Our results support the passive or threshold cognitive reserve hypothesis, in that high cognitive reserve is associated with lower risk for dementia because of its association with cognitive performance, which provides a buffer against clinical expression of dementia., Author(s): Jennifer Rusmaully 1, Aline Dugravot 1, Jean-Paul Moatti 2, Michael G. Marmot 3, Alexis Elbaz 1, Mika Kivimaki 3, Séverine Sabia 1,3, Archana Singh-Manoux 1,3,* Introduction Cognitive reserve refers [...]

This study examined the role of pre-employment factors, such as maternal antenatal depression, low birth weight, childhood socioeconomic position, early adolescence health risk behaviours and academic performance, in the relationship between work characteristics (low job control and high job demands, or job strain) and psychological distress at age 31. The data of 2062 women and 2231 men was derived from the prospective unselected population-based Northern Finland 1966 Birth Cohort study. Results of linear regression models showed that being female, father's low socioeconomic position, and poor academic achievement in adolescence were linked to low control and high job strain jobs at age 31, and that low control and high job strain were associated with psychological distress at age 31. Although having lower school grades, high absence rate from school, and moderate alcohol consumption at age 14 were significant predictors of psychological distress at age 31, the associations between job control, job strain and psychological distress remained after controlling for these and other pre-employment effects. As such, pre-employment factors do seem to link people to risky work environments, which in turn seem to relate strongly to psychological distress. However, the relationship between pre-employment factors and later psychological distress in adulthood is not completely explained by job environment. Keywords: Mental health; Life course; Job strain; Job control; Birth weight; Finland; Psychological distress

Social environments, like neighbourhoods, are increasingly recognised as determinants of health. While several studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour, little is known of the health effects of neighbourhood crime rates. Using the ongoing 10-Town study in Finland, we examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behaviour in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behaviour among women was substantially explained by the area-level crime rate. This study extends our knowledge of potential pathways through which social environmental factors may affect health. Keywords: Crime rates; Neighbourhoods; Socio-economic status; Health behaviours; Multilevel modelling; Social disorganisation; Finland

Objectives. We examined the associations between socioeconomic position, co-occurrence of behavior-related risk factors, and the effect of these factors on the relative and absolute socioeconomic gradients in coronary heart disease. Methods. We obtained the socioeconomic position of 9337 men and 39255 women who were local government employees aged 17-65 years from employers' records (the Public Sector Study, Finland). A questionnaire survey in 2000-2002 was used to collect data about smoking, heavy alcohol consumption, physical inactivity, obesity, and prevalence of coronary heart disease (myocardial infarction or angina diagnosed by a doctor). Results. The age-adjusted odds of coronary heart disease were 2.1-2.2 times higher for low-income groups than high-income groups for both men and women, and adjustment for risk factors attenuated these associations by 13%-29%. There was no further attenuation with additional adjustment for the number of co-occurring risk factors, although socioeconomic disadvantage was associated with the co-occurrence of multiple risk factors. The absolute difference in coronary heart disease risk between socioeconomic groups could not be attributed to the measured risk factors. Conclusions. Interventions to reduce adult behavior-related risk factors may not completely remove socioeconomic differences in relative or absolute coronary heart disease risk, although they would lessen these effects.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.03.036 Byline: Tarja Heponiemi (a), Marko Elovainio (a), Mika Kivimaki (b), Laura Pulkki (b), Sampsa Puttonen (b), Liisa Keltikangas-Jarvinen (b) Keywords: Social support; Hostility; Depression; Finland; Anger Abstract: This 14-year longitudinal study examined the independent association between perceived social support and the 5-year progression of depressive tendencies while taking into account the potential effects of childhood/adolescent anger and later hostility. From the on-going population based study of 'Cardiovascular Risk in Young Finns', 553 male and 860 female participants responded to a revised version of Beck's Depression Inventory in 1992 and 1997. Hostility and perceived social support were assessed by self-rated questionnaires in 1992. Childhood/adolescent anger was assessed by parent-reports in 1983. Our results showed that higher levels of perceived social support were associated with the decrease of depressive tendencies after 5 years and lower levels of depressive tendencies prospectively and after 5 years. This association persisted after adjusting for childhood/adolescent anger and later hostility. In addition, hostility was strongly related to the 5-year increase of depressive tendencies and higher levels of depressive tendencies. Social support may therefore be a long-term protective factor from depression irrespective of personality characteristics, such as hostility and anger. Author Affiliation: (a) National Research and Development Centre for Welfare and Health, Finland (b) University of Helsinki, Helsinki, Finland

We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires designed to assess organizational justice, workload and other factors. Hierarchical regression showed that after adjustment for age, income, and health behaviors low procedural and interactional justice were related to long sickness absence spells. In accordance with the uncertainty management model, these associations were dependent on experienced work-time control and perceived changes at work. Keywords: Organizational justice; Uncertainty; Psychosocial factors; Health care personnel; Sickness absence; Finland

We used two studies to examine whether mental health and hostility predicted temporary employment. Study 1 involved a cohort of 970 Finnish hospital employees (102 men, 868 women) who had temporary job contracts at baseline. After adjustment for demographics, organisational tenure and part-time work status, doctor-diagnosed psychiatric disorder predicted continuing in temporary employment instead of receiving a permanent job by the end of the 2-year follow-up. A higher level of hostility was also associated with temporary employment, but only among employees in low socioeconomic positions. In Study 2, anxiety and aggressive behaviour were measured in a cohort of 226 Finnish school children (116 boys, 110 girls) at 8 years of age. Anxiety in childhood predicted temporary employment at age 42. Aggressive behaviour in childhood was related to ongoing temporary employment status in adulthood among individuals in low socioeconomic positions. Our findings suggest that selection by individual characteristics operates between the temporary and permanent workforces. Mental health problems, a part of which are already seen in childhood, seem to restrict individuals' possibilities to gain secure labour market positions. Hostility and aggressiveness seem to be related to labour market prospects only among individuals in low socioeconomic positions. Keywords: Employment; Depression; Hostility; Mental health; Health-related selection; Inequality; Finland

The authors examined esteem enhancement theory and equity theory in explaining the long-term health status of men (n = 178) and women (n = 575). Baseline characteristics were measured in 1990-1993, intimate reciprocity in 1993. and recorded sickness absences for a 9-year period during 1993 2001. Among women, giving more support than receiving in intimate relations, hips positively affected subsequent health status, as indicated by fewer sickness absences. Among men. receiving more support than giving predicted fewer absences. These effects remained even after significant covariates were included in the model. Thus, women seem to benefit from giving support in intimate relationships, and men seem to benefit from receiving support in intimate relationships. The findings on women are in line with the esteem enhancement theory. No support was obtained for the equity theory. Keywords: reciprocity, intimate relationships, sickness absence, health gender

This study explored the association between psychosocial work characteristics and incidence of depression as indicated in three complementary models (the Job Strain Model, the Team Climate Model, and the Procedural Justice Model). Participants were 4815 Finnish hospital personnel (4278 women and 537 men) free from diagnosed depression at entry into the study. A baseline survey in 1998 measured psychosocial work characteristics, health-related behaviours, psychological distress, and doctor-diagnosed depression. The factor analysis of pooled questionnaire items on psychosocial work characteristics supported a five-factor solution with the following distinct dimensions: team climate, relational justice, procedural justice, job control, and job demands. Items in these dimensions were used as scales and job strain was modelled as a combination of job demands and job control. A follow-up survey in 2000 identified 225 incident cases of depression. After adjustment for age, sex and income, poor team climate, low procedural justice, and low relational justice were associated with a higher risk of new depression, the odds ratios (ORs) 1.58 (95% confidence interval (CI) 1.11-2.24), 1.45 (95% CI 1.03-2.04), and 1.39 (95% CI 1.00-1.96), respectively. After additional adjustment for lifestyle factors and exclusion of those with psychological distress at baseline, there was still an association between poor team climate and risk of depression (ORs 1.55 and 1.75, respectively). Job control, work demands, and job strain did not predict the 2-year incidence of depression, and the effects of all psychosocial work characteristics were attenuated when entered simultaneously in the model. In conclusion, work unit social factors seem to be predictive of subsequent doctor-diagnosed depression, but other aspects of psychosocial work environment may also be important. Keywords: Depression; Psychosocial work characteristics; Team climate; Organizational justice; Hospital staff; Finland

Objectives. Although sick, some people take no time off work, a phenomenon called 'sickness presenteeism.' This study examined the association between sickness presenteeism and incidence of serious coronary events. Methods. The analyses were based on a cohort of 5071 male British civil servants without previous myocardial infarction. Baseline screening included measurements of health status and coronary risk factors. Absence records were assessed for the 3 years subsequent to baseline screening. The outcome of interest was incident nonfatal myocardial infarction or fatal coronary heart disease (mean length of follow-up = 9.1 years). Results. Seventeen percent of unhealthy employees took no absence during the 3-year follow-up. Their incidence of serious coronary events was twice as high as that of the unhealthy employees with moderate levels of sickness absenteeism (after adjustment for conventional risk factors, hazard ratio 1.97, 95% confidence interval = 1.02, 3.83). Conclusions. Employers and employees should be aware of the potential harmful effects caused by sickness presenteeism.

It is commonly assumed that social capital influences health, but only few studies have examined this hypothesis in the context of the workplace. The present prospective cohort study of 6028 public sector employees in Finland investigated social capital as a workplace characteristic which potentially affects employee health. The two indicators of social capital were trust in the labour market, measured by security of the employment contract, and trust in co-worker support. Self-rated health status and psychological distress were used as indicators of health. The combination of subsidised job contract and low co-worker support (i.e. the lowest category of social capital) was associated with poorer health prospects than the combination of permanent employment and high support (the highest social capital category) in an age-adjusted model, but this association disappeared in logistic regression analysis adjusted by sociodemographic background factors and baseline health. Fixed-term employment predicted better self-rated health and less psychological distress when compared with permanent employment. Co-worker support was most common in permanent and least common in subsidised employees and it was associated with better self-rated health in women. Our findings suggest only partial support for the hypothesis of work-related social capital as a health resource. Keywords: Social capital; Public sector employees; Non-permanent employment; Co-worker support; Self-rated health; Finland

This study investigated the dominance of predictive relationships between Sense of Coherence (SOC) and work characteristics (organizational climate and job control) in cross-lagged longitudinal data with two measurement points and a time lag of 3 years. The sample consisted of 615 (587 men and 28 women) managers, aged between 27 and 64 years. The cross-lagged longitudinal analysis was done by the use of Structural Equation Modelling (SEM) within the framework by LISREL. The results of the chi-square difference rests indicated that the model where SOC at Time I predicted work characteristics at Time 2 better accounted for the data than the competitive models. However, the only significant path in addition to test-retest stabilities was the path from SOC at Time I to organizational climate at Time 2 indicating that high SOC predicts good organizational climate over a 3-year follow-up period. The path from SOC at Time I to job control at Time 2 was not significant. Thus, it seems that SOC, as a relatively stable disposition, influences the ability to mobilize and generate social resources in the workplace but not the ability to produce job control., Antonovsky's concept of 'Sense of Coherence' (SOC; Antonovsky, 1979, 1987a), referring to a generalized orientation toward the environment, has recently attracted growing interest among researchers. In accordance with Antonovsky's theory, [...]

The objective of the study was to determine whether the double burden of and negative spillover between domestic and full-time paid work are associated with an increase in health problems. Survey responses were linked with sickness absence records in a cross-sectional study of 6442 full-time municipal employees. Women and men experiencing severe work-family spillover had a 1.5-1.6 (95% confidence intervals 1.1 to 2.0) times higher rate of sickness absence than those with no such experience. The corresponding odds ratios for psychological distress and suboptimal self-assessed health varied between 3.6 and 6.5 (2.3 to 11.0). Among the women, severe family-work spillover increased the risk of psychological distress and suboptimal health [odds ratios 2.0 (1.4 to 2.9) and 1.6 (1.1 to 2.3), respectively], and accumulated sole responsibilities were associated with a 1.5 (1.1 to 2.1) times higher odds ratio for psychological distress. Long domestic work hours (> 50/week) were associated with a 1.5 (1.1 to 2.0) times higher rate of sickness absence among the men, but there was no such increase among the women. We conclude that negative work-family spillover especially is associated with health problems among both women and men, and negative family-work spillover is related to a poorer health status among women. KEYWORDS. Double burden, work hours, spillover, work-family conflict, self-rated health, psychological distress, sickness absence, health, gender

750 employees from 40 small and middle sized industrial enterprises participated in a study of the extent to which perceived utilization of knowledge, skills, and abilities among personnel is associated with innovative performance. Multiple hierarchical regression analyses, based on structured questionnaire survey and data from organizational and national registers, showed that perceived underutilization of knowledge, skills, and abilities was statistically significantly associated with low innovative performance across all innovation indicators and even after the effects of other major barriers to innovation and a large set of other potential confounding factors had been control]ed for. These findings underline the importance of efficient identification, utilization, and allocation of expertise in innovative activities.

A total of 2969 hospital employees from 162 wards participated in a 2-year follow-up study that examined the relationship between job decision latitude, organizational justice and employee health in Finland. We used medically certified sickness absence records as indicators of health problems. Multilevel covariance structure analysis was applied to take into account the hierarchical nature of the data. Responses from individuals within work units seem not always to be independent, and any models that ignore this lack of independence may incorrectly estimate the between individual relationships. Our results suggest that both job decision latitude and organizational justice varied considerably between work units in addition to individual level variation. Furthermore job decision latitude was associated with organizational justice both at individual and work unit level. Justice evaluations predicted sickness absence only at the individual level. Keywords: Psychosocial factors; Multilevel analysis; Health care: Organizational justice: Finland

We studied health-related selection and consequences of an organizational downsizing among 886 municipal employees. Measurements of health indicators were conducted before any rumor of the downsizing and immediately after the downsizing 3 years later. Results of pre-downsizing health showed that those who did not find employment after the staff reductions were older employees with high preexisting morbidity. Those getting a new job elsewhere were younger and had better health already before the downsizing than the stayers. After the downsizing, deterioration of health was most likely in the stayers working in groups of major staff reductions and among the nonemployed leavers. In the reemployed leavers, the risk of increased health problems was lower than in others including employees working in no or minor downsizing groups. KEY WORDS: personnel downsizing; organizational change; socioeconomic determinants of health; employment; occupational diseases; longitudinal studies.

This study examined three theoretical models of hostility, health and life context. According to the psychosocial vulnerability hypothesis, there is an interaction between hostility and adverse conditions. The increased health risk in hostile individuals is assumed to stem from their lower ability to benefit from existing psychosocial resources. The second hypothesis, called here the social context model, considers adverse conditions as an antecedent of both hostility and health problems. The third model states that hostility is a predictor of being selected to adverse conditions involving risk to health (the selection hypothesis). The results from a survey of a population-based random sample (2153 non-institutionalized citizens aged 18-64 years) in Finland, showed that hostile men had a high prevalence of non-optimal health, irrespective of employment status. In non-hostile men, employment was associated with better health than unemployment. This association between hostility and unemployment was not found in women. Corresponding findings were obtained from a 1959-born cohort of 311 individuals followed up for 27 years. The combination of high hostility at school age and unemployment in adulthood had an additive effect on poor health in adult men but not in adult women. Hostility in childhood was not significantly associated with unemployment in adulthood. Thus, this study supported the psychosocial vulnerability model in men. Keywords: Finland; Hostility; Unemployment; Psychosocial factors; Health status; Men

Background Cognitive dysfunction is common in haemodialysis patients but whether poor kidney function in the general population is also associated with higher risk of dementia remains unclear. Objective To examine the association of kidney function with incident dementia in community dwelling older adults. Design Whitehall II prospective study. Setting Population-based study on 6,050 adults, mean age 65.8 in 2007–2009. Methods Poor kidney function, defined as estimated Glomerular Filtration Rate (eGFR) <60 ml/min/1.73 m2 in 2007–2009, and adverse change in eGFR was defined as decrease ≥4 ml/min/1.73 m2 between 2007–2009 and 2012–2013. Incident dementia was ascertained through linkage to electronic health records, and Cox regression was used to examine associations with dementia. Results A total of 306 cases of dementia were recorded over a mean follow-up of 10 years. Baseline eGFR <60 was associated with a hazard ratio (HR) for dementia of 1.37 (95% CI 1.02, 1.85) in analysis adjusted for sociodemographic factors, hypertension, obesity, stroke, diabetes and cardiovascular disease/medication. Removing stroke cases at baseline and censoring them over the follow-up yielded an HR of 1.42 (95% CI 1.00, 2.00) for the association between CKD and dementia. Decline of eGFR ≥4 between 2007–2009 and 2012–2013 was associated with incidence of dementia over a 6.3 year mean follow-up (HR: 1.37; 95% CI 1.02, 1.85), with somewhat stronger associations when analyses were restricted to those with eGFR ≥60 in 2007–2009 (1.56; 95% CI: 1.12, 2.19). Conclusion Poor and declining kidney function in older adults is associated with a higher risk of dementia that is not attributable to stroke and persists after accounting for major cardiometabolic conditions. [ABSTRACT FROM AUTHOR]

The aim of this study was to test the role of procedural justice (PJ) in the relationship between team climate (TC; i.e., accepted and clear goals, participation safety, perceived support for development, and commitment to good performance) and strain. The study population consisted of all the workers at 6 health centers in Finland (n = 688). PJ evaluations were found to have a strong mediating effect on the relationship between TC and occupational strain. This finding was interpreted as supporting the relational model of PJ, which states that people use quality of social relationships as an important indicator of fair treatment and that, in mm, is related to occupational strain.

Objectives. This study examined the justice of decision-making procedures and interpersonal relations as a psychosocial predictor of health. Methods. Regression analyses were used to examine the relationship between levels of perceived justice and self-rated health, minor psychiatric disorders, and recorded absences due to sickness in a cohort of 506 male and 3570 female hospital employees aged 19 to 63 years. Results. The odds ratios of poor self-rated health and minor psychiatric disorders associated with low vs high levels of perceived justice ranged from 1.7 to 2.4. The rates of absence due to sickness among those perceiving low justice were 1.2 to 1.9 times higher than among those perceiving high justice. These associations remained significant after adjustment for behavioral risks, workload, job control, and social support. Conclusions. Low organizational justice is a risk to the health of employees.