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Abstract Background The dynamic and challenging work environment of the prehospital emergency care settings creates many challenges for paramedics. Previous studies have examined adverse events and patient safety activities, but studies focusing on paramedics’ perspectives of factors contributing to human error are lacking. In this study, we investigated paramedics’ opinions of the factors contributing to human errors. Method Data was collected through semi-structured individual interviews (n = 15) with paramedics and emergency medical field supervisors in Finland. The data was analyzed using inductive content analysis. Consolidated criteria for reporting qualitative research were used. Results Contributing factors to human errors were divided into three main categories. The first main category, Changing work environment, consisted of two generic categories: The nature of the work and Factors linked to missions. The second main category, Organization of work, was divided into three generic categories: Inadequate care guidelines, Interaction challenges and Challenges related to technological systems. The third main category, Paramedics themselves, consisted of four generic categories: Issues that complicate cognitive processing, Individual strains and needs, Attitude problems and Impact of work experience. Conclusion Various factors contributing to human errors in emergency medical services (EMS) settings were identified. Although many of them were related to individual factors or to the paramedics themselves, system-level factors were also found to affect paramedics’ work and may therefore negatively impact patient safety. The findings provide insights for organizations to use this knowledge proactively to develop their procedures and to improve patient safety.

Abstract Background The scope of emergency medical services (EMS) has expanded from the urgent care of emergency patients to on-call healthcare services provided in the field with a holistic view of the patient’s wellbeing. This challenges EMS to find solutions to cover all demands, while simultaneously setting high skill requirements for EMS personnel. Understanding personnel is a critical element in developing functional and resistant EMS. The aim of this study was to investigate how Finnish EMS personnel emphasize the Emergency Medical Services Role Identity Scale aspects of caregiving, thrill-seeking, duty, and capacity; and if these role identities are associated with intention to leave the profession. Methods We conducted a cross-sectional survey (N = 616, 52% women, mean age 32.9 years). Data were collected through social media platforms and analyzed with means, standard deviations, Mann-Whitney U-tests, Kruskal-Wallis H-tests, and binary logistic regression analyses. Results Our results indicate that capacity is the most emphasized aspect among EMS personnel, and at the same time, it increases intention to leave EMS. Capacity was followed by caregiving, with no association with intention to leave. Duty and thrill-seeking were the least emphasized and were negatively associated with intention to leave. Additionally, there were also other factors that were associated with emphasizing EMS-RIS aspect and intention to leave. Conclusion Capacity stands out most strongly in analysis being at the core of the role identity of EMS personnel and was associated with a higher likelihood of leaving intentions. Several other factors were also associated with the intention to leave. Future studies should examine the exact dimensions of capacity that are considered important among EMS personnel and why factors such as work experience are associated with intentions to leave.

Abstract Background The compounded effect of a migratory background and ageing increases the risk of unequal medical treatment opportunities. The aim of this article is to investigate the social determinants of barriers to health services. Methods The study uses population-based survey data of Russian-speaking migrants (50 + years) residing in Finland (n = 1082, 57% of men, mean age 63 years). Multiple correspondence analysis was performed as a dimension reduction procedure on six barriers to health services. Multiple ordinary least-squares linear regression was used for the predicted score of the barriers as an outcome variable. Results Most of the sociodemographic characteristics were not associated with barriers to health services, except gender, as women tended to face more disadvantages. Migration-related factors, such as the need for interpreters for health services and experienced discrimination, were associated with an increased likelihood of reporting barriers to health services. Using the internet as a primary source of health information was associated with more access barriers to health services. Conclusions Migrants 50 years of age or older face multiple barriers to health services. Given that the healthcare needs increase with age, addressing this issue becomes crucial, necessitating improved access to health services for older migrants.

This article examines the relationship between digital proficiency, trust in service providers, and the intention to use digital health care and social welfare services among prisoners and people with mental health conditions in Finland. Based on cross-sectional data, which includes responses from 225 prisoners and 120 people with mental health conditions between September 2020 and May 2021, a study utilizing latent profile analysis (LPA) reveals that although high digital skills were observed, trust in providers of digital services within the health care and social welfare sector remained low, particularly among younger participants. Despite trust issues, the intention to use digital services remained high, particularly among inmates. This suggests that trust is not the sole factor influencing digital service adoption; age and perceived digital competence also play significant roles. Prisoners demonstrated higher levels of advanced internet skills than individuals with mental health backgrounds, possibly due to overestimating their abilities. Alternative approaches, such as social support and hands-on learning, are vital for enhancing digital skills in socially marginalized groups. Understanding these determinants can guide policymakers and practitioners in developing targeted interventions to promote digital inclusion effectively by considering broadly the factors that promote the accessibility of digital health care and social welfare services. Future research combining objective proficiency testing and self-reported data can offer deeper insights for more successful strategies.

Abstract Aim To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession. Design A cross‐sectional survey. Methods Paramedics from eight purposively selected organizations participated in this study (n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self‐rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests. Results Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.

Abstract Background Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS). Methods The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding ‘Individual Placement and Support’ or ‘Evidence-Based Supported Employment’. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses. Results Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level. Discussion Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research. Trial registration Open Science Framework

Abstract Background Cardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement. We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants. Methods We used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000–2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution’s reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression. Results Six trajectories of CVD medication were distinguished: "constant low" (35%), “late increase” (6%), “early increase” (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing” (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the “early increase” trajectory. Conclusions Individuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.

ObjectivesAccording to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel, structural validity describes how well Patient-Reported Outcome Measures' (PROM) scores reflect the dimensions of the measured construct. The main purpose of this study was to examine the structural components of the Abilitator, a co-developed self-report questionnaire on work ability and functioning for the population in a weak labour market position.MethodsWe examined to what extent the Abilitator has reflective and formative elements in its five summary scales: "C. Inclusion", "D. Mind", "E. Everyday life", "F. Skills", and "G. Body". The Abilitator data sample (n = 4555, men 51%, mean age 37 years) was collected in 2017-2022 by the Finnish Institute of Occupational Health in cooperation with the European Social Fund Priority 5 projects in which the participants have multiple challenges to gain employment. For the structural components and validity analysis we implemented both Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA).ResultsBased on the COSMIN criteria for structural validity, the Abilitator reached approximate model fit with CFA when we analysed the different concepts of the questionnaire separately rather than in one unified model. An exception was "E. Everyday life" which was a formative summary scale, and it did not reach approximate fit. EFA showed that the items in the Abilitator's summary scales loaded on ten factors.ConclusionsThe Abilitator had both reflective and formative elements in its structure. It reached structural validity in those separate concepts that were based on a reflective model. This study revealed interesting connections between different aspects of the Abilitator and produced valuable information for further modification of the questionnaire.

Abstract Background The work environment in prehospital emergency medical care setting is dynamic and complex and includes many stressors. However, little is known about the perceived human factors from the perspective of paramedics. In this study, we investigated, from the perspective of paramedics, what are the human factors, and how are they linked to prehospital emergency medical care? Methods Data were collected through semi-structured interviews (n = 15) with Finnish paramedics. The material was analyzed using inductive content analysis. Results Three main categories of human factors were identified. The first main category consisted of factors related to work which were divided into two generic categories: “Challenging organizational work environment” and “Changing external work environment.” The second main category comprised factors related to paramedics themselves and were divided into three generic categories: “Issues linked to personality,” “Personal experiences”, and “Factors resulting from personal features.” The third main category described that paramedics have difficulties in understanding and describing human factors. Conclusion This study revealed numerous factors that can affect paramedics’ work in the EMS setting. Increased knowledge about human factors in the EMS setting provides organizations with the opportunity to develop procedures that can support paramedics’ cognitive and physical work. Human factors in different situations can be addressed to improve occupational and patient safety.

Abstract Background Disadvantaged socioeconomic circumstances are associated with certain unhealthy food habits such as inadequate consumption of fruit and vegetables. This study examined whether multiple socioeconomic measures are consistently associated with a variety of food habits. Methods We examined associations of 2 childhood and 6 adult socioeconomic measures with 8 recommended food habits among 19–39-year-old employees of the City of Helsinki, Finland. The data were collected in 2017 via online and mailed surveys. Our sample consisted of 4621 employees (80% women). The analyses included adjusted binary logistic regression models. Results More advantaged socioeconomic circumstances were positively associated with the recommended consumption of vegetables, fruit or berries, dark bread, skimmed milk products, fish, and cooking oil, but not consistently with red or processed meat and fat spread. All socioeconomic measures were positively associated with having several (6–8) recommended food habits after gender and age adjustments. The strongest associations were found for participant’s education, occupational class, and current financial difficulties. These associations remained after adjustments of childhood and adult socioeconomic measures, although especially participant’s education attenuated the associations for occupational class. Conclusions The consistent associations between multiple childhood and adult socioeconomic measures and food habits found among employees highlight the need for improving food habits among people with disadvantaged socioeconomic circumstances in particular. Financial barriers together with social aspects of adhering to healthy diets should be considered in future dietary interventions and policy actions.

Objectives Unhealthy behaviours are associated with increased sickness absence (SA), but few studies have considered person-oriented approach in these associations. Using latent class analysis, we examined clustering of unhealthy behaviours among Finnish municipal employees and their associations with subsequent SA.Design A prospective register-linkage study.Setting Unhealthy behaviours (low leisure-time physical activity, non-daily fruit and vegetable consumption, insufficient sleep, excessive alcohol use and tobacco use) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19- to 39-year-old employees of the City of Helsinki, Finland.Participants A total of 4002 employees (81% women) of the City of Helsinki, Finland.Primary outcome measures The questionnaire data were prospectively linked to employer’s SA register through March 2020. Associations between latent classes of unhealthy behaviours and subsequent SA (1–7 days/8+ days/all lengths) were examined using negative binomial regression.Results Among women, a three-class latent class model was selected: (1) few unhealthy behaviours (84%), (2) excessive alcohol and tobacco use (12%) and (3) several unhealthy behaviours (5%). Women belonging to classes 2 and 3 had increased SA rates compared with those in class 1, regardless of the length of SA spells. Among men, a 2-latent class model was selected: (1) few unhealthy behaviours (53%) and (2) several unhealthy behaviours (47%). Men belonging to class 2 had increased rates of 1–7 days’ SA compared with men in class 1.Conclusions This study suggests that preventive actions aiming to reduce employees’ SA should consider simultaneously several unhealthy behaviours. Targeted interventions may benefit of identifying the clustering of these behaviours among occupational groups.

Abstract Background Mass gathering (MG) events may cause delayed emergency responses via various mechanisms and strain the resources of local emergency services. Therefore, preparedness, including adequate pre-planning and sufficient resourcing during MG events, is vital. The aim of this retrospective register study was to investigate the impact of MG events on the workload of rescue and emergency medical service (EMS) personnel during events to enable more precise and sufficient deployment of these authorities’ operative resources. Methods The data from Finland covered of 25,124 EMS and rescue service missions during a three-year period (2015–2017), including data from nine MG events and reference material for the same weekdays two weeks before and after the event. The data were analysed through statistical and geospatial analyses. Results Our findings showed that missions increased in most events included in this study. Analysis of the missions’ reasons showed that the categories of violence, traffic accidents and other accidents and injuries increased during events, with violence-related missions showing the highest relative risk (RR 1.87, 95% CI 1.43–2.44). In the four-grade (A–D) urgency grading, the analysis showed an increase in category C missions and a decrease in non-urgent category D missions. The analysis indicated an increase in missions during the evening and night-time. The geospatial analysis revealed dense hotspots of missions in the vicinity of the event area. Conclusion The workload for EMS and rescue service personnel increases during MG events. Most of the increase is allocated to EMS staff, peaking in evening and night hours. The geospatial analysis showed hotspots of missions on the outskirts of the actual event area during events; thus, the workload can also increase for those authority resources that are not directly allocated to the event. Detailed information regarding workloads is valuable for the authorities that are responsible for resource planning and preparedness for MG events. Replicating the study internationally would improve the methodology for the future.

Abstract Background In older adults, including those with a migrant background, ill health is associated with less internet use. However, it is not known what are the specific self-perceived barriers to internet use among older migrants with different health conditions. The aim of this study was to investigate the associations between different health conditions and self-perceived barriers to internet use among older migrants. Methods We used the Care, Health and Ageing of Russian-speaking Minority in Finland (CHARM) study, which is a nationally representative survey of community-dwelling Russian-speaking adults aged ≥50 years living in Finland (N=1082, 57% men, mean age 63.2 years, standard deviation 8.4 years, response rate 36%). Postal survey data were collected in 2019. Health indicators were self-rated health (SRH), depressive symptoms, cognitive functioning, and doctor-diagnosed conditions. Linear regression analyses were used to investigate the associations between health indicators and a summary scale consisting of the following barriers of internet use: (1) internet use is too complicated and hard to learn; (2) having concerns about safety issues; (3) internet use is too expensive; (4) physical limitations hinder the internet use; (5) memory problems hinder the internet use. In addition, the two most commonly reported barriers (the first two) were examined separately using logistic regression analyses. The analyses were adjusted for age, sex, education, marital status, local language proficiency, and income support, and the health conditions, and were performed with weights accounting for the survey design and non-response. Results After adjustments, spine/back problems (b=0.13; p=0.049), depressive symptoms (b=0.40; p=0.007), and problems in learning new things (b=0.60; p

Abstract Background The COVID-19 pandemic has given an unprecedented boost to already increased digital health services, which can place many vulnerable groups at risk of digital exclusion. To improve the likelihood of achieving digital health equity, it is necessary to identify and address the elements that may prevent vulnerable groups from benefiting from digital health services. This study examined the challenges experienced by vulnerable groups in using digital health services during the COVID-19 pandemic. Methods Qualitative descriptive design was utilized. Semi-structured interviews were conducted between October 2020 and May 2021. The participants (N = 74) were older adults, migrants, mental health service users, high users of health services, and the unemployed. Qualitative content analysis with both inductive and deductive approach was used to analyze the data. Challenges related to the use of digital health services were interpreted through digital determinants of health from the Digital Health Equity Framework. Results For most of the participants the access to digital health services was hampered by insufficient digital, and / or local language skills. The lack of support and training, poor health, as well as the lack of strong e-identification or suitable devices also prevented the access. Digital services were not perceived to be applicable for all situations or capable of replacing face-to-face services due to the poor communication in the digital environment. Fears and the lack of trust regarding digital platforms were expressed as well as concerns related to the security of the services. Contact with a health care professional was also considered less personal and more prone to misunderstandings in the digital environment than in face-to-face services. Finally, digital alternatives were not always available as desired by participants, or participants were unaware of existing digital services and their value. Conclusion Several development needs in the implementation of digital health services were identified that could improve equal access to and benefits gained from digital services in the future. While digital health services are increasing, traditional face-to-face services will still need to be offered alongside the digital ones to ensure equal access to services.

Workplace social capital positively influences the quality but reduces the cost of healthcare services. Academic research suffers from limited and inadequate culturally sensitive nurses’ workplace social capital instruments. Here we report on the design and protocol of a culturally focused instrument development study in China. The overarching objective of our dual phase study is to develop and validate a questionnaire measuring nurses’ workplace social capital tailored toward Chinese cultural values and norms. In the first phase of INSTRUMENT DEVELOPMENT , the qualitative phase, we will conduct interviews with purposefully sampled nurses from five geographically diverse regions capturing 16 provinces in China to formulate the initial version of the Nurses’ Workplace Social Capital Questionnaire (NWSCQ). Data collection will be stopped at the saturation point and content analysis will be performed for interview data in parallel. The initial version of the NWSCQ will be evaluated and confirmed by two-rounds of expert consultation (target N = 20) and pre-tested among 70 nurses. During the second phase of INSTRUMENT VALIDATION or the quantitative phase, we will validate the psychometric properties of the NWSCQ. The validity and reliability of the questionnaire will be examined and validated through three cross-sectional surveys among nurses (target N = 1154) randomly selected from 12 tertiary hospitals. We have reported our study protocol with the intention of sharing our experience with researchers in other countries who are striving to advance the phenomenon of culturally sensitive and social normatively appropriate nurses’ workplace social capital. Findings from our study should advance the development of culturally appropriate and valid instrument of nurses’ workplace social capital, another important step toward recognition and incorporation of cultural diversity in the daily operation of healthcare industry.

Community paramedic (CP) units are becoming more popular in enhancing a person’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.

Abstract 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.

Abstract Purpose There is a recent and growing migrant population in Northern Ireland. However, rigorous research is absent regarding access to mental health care by different migrant groups. In order to address this knowledge gap, this study aimed to identify the relative use of psychotropic medication between the largest first generation migrant groups in Northern Ireland and the majority population. Methods Census (2011) data was linked to psychotropic prescriptions for the entire enumerated population of Northern Ireland using data linkage methodology through the Administrative Data Research Centre Northern Ireland (ADRC-NI). Results Lower prescription dispensation for all psychotropic medication types, particularly antidepressants (OR = 0.35, CI 95% 0.33–0.36) and anxiolytics (OR = 0.42, CI 95% 0.40–0.44), was observed for all migrant groups with the exception of migrants from Germany. Conclusions It is likely that the results reflect poorer access to services and indicate a need to improve access and the match between resources, services and the health and social care needs of migrants. Further research is required to identify barriers to accessing primary care and mental health services.

BackgroundMental 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. ObjectiveThis study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. MethodsAn 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. ResultsThe 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. ConclusionsThe 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.

BackgroundPrevious 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. ObjectiveThe 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. MethodsWe 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. ResultsAfter 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. ConclusionsPoor 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.

Abstract 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.

Abstract Background The two-way relationship between obesity and socioeconomic disadvantage is well established but previous studies on social and economic consequences of obesity have primarily focused on relatively young study populations. We examined whether obesity is associated with socioeconomic disadvantage through the 10–12-year follow-up, and how obesity-related socioeconomic inequalities develop during midlife among women. Methods Baseline data were derived from the female population of the Helsinki Health Study cohort, comprising 40–60 –year-old employees of the City of Helsinki, Finland in 2000–2002 (n = 6913, response rate 69%). The follow-up surveys were carried out in 2007 (n = 5810) and 2012 (n = 5400). Socioeconomic disadvantage was measured by five dichotomous measures. Repeated logistic regression analyses utilising generalized estimating equations (GEE) were used to test the association between baseline self-reported obesity and the likelihood of socioeconomic disadvantage through all phases. The effect of time on the development of inequalities was examined by time interaction terms in random effect logistic regression models. Results After adjustment for educational level, baseline obesity was associated with repeated poverty (OR = 1.23; 95% CI; 1.05–1.44), frequent economic difficulties (OR = 1.74; 95% CI; 1.52–1.99), low household net income (OR = 1.23; 95% CI; 1.07–1.41), low household wealth (OR = 1.90; 95% CI; 1.59–2.26) and low personal income (OR = 1.22; 95% CI; 1.03–1.44). The differences in poverty rate and low personal income between the participants with obesity and participants with normal weight widened during the follow-up. Living without a partner and early exit from paid employment explained the widening of inequalities. Conclusions Weight status inequalities in socioeconomic disadvantage persisted or widened during the late adulthood.

Abstract Background Previous studies investigating the mental health of migrants have shown mixed results. The increased availability of register data has led to a growing number of register-based studies in this research area. This is the first scoping review on the use of registry and record-linkage data to examine the mental health of migrant populations. The aim of this scoping review is to investigate the topics covered and to assess the results yielded from these studies. Methods We used a scoping review methodology to search MedLine, PubMed, PsychINFO, Web of Science, and SCOPUS for all register-based studies on the mental health of migrants. Two reviewers screened all papers, independently, using iteratively applied inclusion and exclusion criteria. Using gradually broadening inclusion and exclusion criteria for maximum “scope,” newly published criteria developed to appraise the methodological quality of record-linkage studies were applied to eligible papers and data were extracted in a charting exercise. Results A total of 1309 papers were screened and appraised, 51 of which met the eligibility and quality criteria and were included in the review. This review identified four major domains of register-based research within the topic of migrant mental health: rates and risks of psychiatric disorders, rates and risks of suicide mortality, the use of psychotropic drugs, and health service utilisation and mental health-related hospitalisation rates. We found that whilst migrants can be at an increased risk of developing psychotic disorders and suicide mortality, they are less likely to use psychotropic medication and mental health-related services. Conclusions This review systematically charts the register-based studies on migrants’ mental health for the first time. It shows the main topics and gaps in knowledge in this research domain, discusses the disadvantages of register-based studies, and suggests new directions for forthcoming studies.

Objectives To identify groups of municipal employees between the ages of 20 and 34 years with distinct utilisation trajectories of primary care services provided by occupational health service (OHS), measured as the annual number of OHS visits, and to identify demographic and socioeconomic risk factors that distinguish employees in the high utilisation trajectory group(s).Methods The present study is a retrospective register-based cohort study. All municipal employees of the City of Helsinki, Finland, aged 20–34 in the Helsinki Health Study, recruited from 2004 to 2013, with follow-up data for 4 years were included in the study (n=9762). The outcome measure was group-based trajectories of OHS utilisation, identified with a group-based trajectory analysis. The demographic and socioeconomic variables used to predict the outcome were age, first language, educational level and occupational class. The analyses were stratified by gender.Results A large proportion of the young employees do not use OHS. Trajectory groups of ‘No visits’ (50%), ‘Low/increasing’ (18%), ‘Low/decreasing’ (22%) and ‘High/recurrent’ (10%) use were identified. We found occupational class differences in OHS utilisation patterns showing that lower occupational classes had a higher propensity for ‘High/recurrent’ OHS utilisation for both genders.Conclusions Preventive measures should be targeted particularly to the trajectory groups of ‘Low/increasing’ and ‘High/recurrent’ in order to intervene early. In addition, OHS utilisation should be closely monitored among the two lowest occupational classes. More research with longitudinal OHS data is needed.

Background Research 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. Aim To 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. Methods Data 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. Results The 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. Conclusion Full 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.

OBJECTIVES: The aim of this study was to examine the association between pre-retirement physical working conditions and changes in physical health functioning during the retirement transition process. METHODS: Follow-up survey data were collected among ageing employees of the City of Helsinki, Finland, at three time points: wave 1 (2000–2002), wave 2 (2007) and wave 3 (2012). We focused on those who retired full time due to old age between waves 1 and 3 (N=1658). Exposure to physical workload, occupational environmental hazards, and computer work were divided into quartiles and used as measures of pre-retirement physical working conditions. Physical health functioning was measured by the physical component summary (PCS) of the Short-Form 36 questionnaire. Repeated-measures analysis was used to study the associations. RESULTS: Higher pre-retirement exposure to physical workload and environmental hazards was associated with lower physical health functioning before and after retirement. The differences in functioning narrowed somewhat during the retirement transition process, as physical health functioning in the higher exposure groups improved significantly compared to lower exposure groups. In addition, both high and low exposure to computer work were associated with lower functioning before retirement. However, functioning among those in the lowest exposure group improved during the follow-up whereas in all other exposure groups it declined slightly. This resulted into significantly lower post-retirement functioning among those in the highest as compared to the lower exposure groups. CONCLUSIONS: Retirees with higher exposure to adverse physical working conditions before retirement had lower pre- and post-retirement physical health functioning despite improvements in their functioning during the retirement transition process.

It was highlighted that the original article [1] contained an ambiguity in the citation of Reference 2 in the Results section.

Summary: Background: Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence. Methods: We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAFexternal). Findings: For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70·9 days per 10 person-years), depressive disorders (26·5 days per 10 person-years), and external causes (such as injuries and poisonings; 12·8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1·30, 95% CI 1·21–1·40; PAFexternal 8·9%) and low physical activity (1·23, 1·14–1·34; 7·8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1·90, 1·41–2·56; 15·2%), smoking (1·70, 1·42–2·03; 11·8%), low physical activity (1·67, 1·42–1·96; 19·8%), and obesity (1·38, 1·11–1·71; 5·6%) were associated with absences due to depressive disorders; heavy episodic drinking (1·64, 1·33–2·03; 11·3%), obesity (1·48, 1·27–1·72; 6·6%), smoking (1·35, 1·20–1·53; 6·3%), and being overweight (1·20, 1·08–1·33; 6·2%) were associated with absences due to external causes; obesity (1·82, 1·40–2·36; 11·0%) and smoking (1·60, 1·30–1·98; 10·3%) were associated with absences due to circulatory diseases; low physical activity (1·37, 1·25–1·49; 12·0%) and smoking (1·27, 1·16–1·40; 4·9%) were associated with absences due to respiratory diseases; and obesity (1·67, 1·34–2·07; 9·7%) was associated with absences due to digestive diseases. Interpretation: Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk. Funding: NordForsk, British Medical Research Council, Academy of Finland, Helsinki Institute of Life Sciences, and Economic and Social Research Council.

Background Research has shown that the health of migrants can vary dramatically from the health of the settled population of their countries. Whilst migrant health has been studied in other areas of the UK, it is especially important to research the mental health of migrants in Northern Ireland specifically, due to the country’s unique mental health situation. Objectives This study aims to assess the mental health of migrants in Northern Ireland as compared to the settled majority population, both by way of reported poor mental health, and psychotropic prescription medication uptake. Methods This study uses a cohort of 1,019,769 people in Northern Ireland, taken from the 2011 Census of Northern Ireland and the BSO Enhanced Prescribing Dataset (2011-2014). The migrant population of Northern Ireland is described in terms of demographic and socioeconomic factors, and logistic regression models are used to analyse the relative risks of reporting poor mental health and uptake of psychotropic medication within the migrant population as compared to the settled population. Findings The results show that migrants were significantly less likely to report poor mental health than the settled population of Northern Ireland, when adjusted for demographic characteristics, socioeconomic factors, and reported poor physical health. Migrants were also significantly less likely to use any form of psychotropic prescription medication than the settled population. Conclusions These findings are in concordance with most research conducted in other countries. The roles of the healthy migrant effect, the salmon bias, stigma, and lack of access to healthcare are discussed as possible reasons for the percieved migrant mental health advantage. However, such a dramatic difference between the health of migrants and the settled population of Northern Ireland may be due, in part, to certain limitations of the datasets used.

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.

OBJECTIVES: The aim of this study was to examine the co-occurrence of obesity and sleep problems among employees and workplaces. METHODS: We obtained data from 39 873 men and women working in 3040 workplaces in 2000–2002 (the Finnish Public Sector Study). Individual- and workplace-level characteristics were considered as correlates of obesity and sleep problems, which were modelled simultaneously using a multivariate, multilevel approach. RESULTS: Of the participants, 11% were obese and 23% reported sleep problems. We found a correlation between obesity and sleep problems at both the individual [correlation coefficient 0.048, covariance 0.047, standard error (SE) 0.005) and workplace (correlation coefficient 0.619, covariance 0.068, SE 0.011) level. The latter, but not the former, correlation remained after adjustment for individual- and workplace-level confounders, such as age, sex, socioeconomic status, shift work, alcohol consumption, job strain, and proportion of temporary employees and manual workers at the workplace. CONCLUSIONS: Obese employees and those with sleep problems tend to cluster in the same workplaces, suggesting that, in addition to targeting individuals at risk, interventions to reduce obesity and sleep problems might benefit from identifying “risky” workplaces.

Objective To investigate the effect of fast food consumption on mean population body mass index (BMI) and explore the possible influence of market deregulation on fast food consumption and BMI. Methods The within-country association between fast food consumption and BMI in 25 high-income member countries of the Organisation for Economic Co-operation and Development between 1999 and 2008 was explored through multivariate panel regression models, after adjustment for per capita gross domestic product, urbanization, trade openness, lifestyle indicators and other covariates. The possible mediating effect of annual per capita intake of soft drinks, animal fats and total calories on the association between fast food consumption and BMI was also analysed. Two-stage least squares regression models were conducted, using economic freedom as an instrumental variable, to study the causal effect of fast food consumption on BMI. Findings After adjustment for covariates, each 1-unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/m2 in age-standardized BMI (95% confidence interval, CI: 0.013–0.052). Only the intake of soft drinks – not animal fat or total calories – mediated the observed association (β: 0.030; 95% CI: 0.010–0.050). Economic freedom was an independent predictor of fast food consumption (β: 0.27; 95% CI: 0.16–0.37). When economic freedom was used as an instrumental variable, the association between fast food and BMI weakened but remained significant (β: 0.023; 95% CI: 0.001–0.045). Conclusion Fast food consumption is an independent predictor of mean BMI in high-income countries. Market deregulation policies may contribute to the obesity epidemic by facilitating the spread of fast food.

BACKGROUND:The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change. METHODOLOGY:National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years. PRINCIPAL FINDINGS:Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed. CONCLUSIONS/SIGNIFICANCE:A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010.

To examine which contextual features of the workplace are associated with social capital.This is a cohort study of 43,167 employees in 3090 Finnish public sector workplaces who responded to a survey of individual workplace social capital in 2000-02 (response rate 68%). We used ecometrics approach to estimate social capital of work units. Features of the workplace were work unit's demographic and employment patterns and size, obtained from employers' administrative records. We used multilevel-multinomial logistic regression models to examine cross-sectionally whether these features were associated with social capital between individuals and work units. Fixed effects models were used for longitudinal analyses in a subsample of 12,108 individuals to examine the effects of changes in workplace characteristics on changes in social capital between 2000 and 2004.After adjustment for individual characteristics, an increase in work unit size reduced the odds of high levels of individual workplace social capital (odds ratio 0.94, 95% confidence interval 0.91-0.98 per 30-person-year increase). A 20% increase in the proportion of manual and male employees reduced the odds of high levels of social capital by 8% and 23%, respectively. A 30% increase in temporary employees and a 20% increase in employee turnover were associated with 11% (95% confidence interval 1.04-1.17) and 24% (95% confidence interval 1.18-1.30) higher odds of having high levels of social capital respectively). Results from fixed effects models within individuals, adjusted for time-varying covariates, and from social capital of the work units yielded consistent results.These findings suggest that workplace social capital is contextually patterned. Workplace demographic and employment patterns as well as the size of the work unit are important in understanding variations in workplace social capital between individuals and workplaces.

Obesity and overweight are suggested to increase the risk of occupational injury but longitudinal evidence to confirm this is rare. We sought to evaluate obesity and overweight as risk factors for occupational injuries.A total of 69,515 public sector employees (80% women) responded to a survey in 2000-2002, 2004 or 2008. Body mass index (kg/m(2)) was derived from self-reported height and weight and was linked to records of subsequent occupational injuries obtained from national registers. Different injury types, locations and events or exposures (the manner in which the injury was produced or inflicted) were analyzed by body mass index category adjusting for baseline socio-demographic characteristics, work characteristics, health-risk behaviors, physical and mental health, insomnia symptoms, and sleep duration. During the mean follow-up of 7.8 years (SD = 3.2), 18% of the employees (N = 12,204) recorded at least one occupational injury. Obesity was associated with a higher overall risk of occupational injury; multivariable adjusted hazard ratio (HR) 1.21 (95% CI 1.14-1.27). A relationship was observed for bone fractures (HR = 1.37; 95% CI: 1.10-1.70), dislocations, sprains and strains (HR = 1.36; 95% CI: 1.25-1.49), concussions and internal injuries (HR = 1.26; 95% CI: 1.11-1.44), injuries to lower extremities (HR = 1.62; 95%: 1.46-1.79) and injuries to whole body or multiple sites (HR = 1.37; 95%: 1.10-1.70). Furthermore, obesity was associated with a higher risk of injuries caused by slipping, tripping, stumbling and falling (HR = 1.55; 95% CI: 1.40-1.73), sudden body movement with or without physical stress (HR = 1.24; 95% CI: 1.10-1.41) and shock, fright, violence, aggression, threat or unexpected presence (HR = 1.33; 95% CI: 1.03-1.72). The magnitude of the associations between overweight and injuries was smaller, but the associations were generally in the same direction as those of obesity.Obese employees record more occupational injuries than those with recommended healthy weight.

The relationship between work-related stress and alcohol intake is uncertain. In order to add to the thus far inconsistent evidence from relatively small studies, we conducted individual-participant meta-analyses of the association between work-related stress (operationalised as self-reported job strain) and alcohol intake.We analysed cross-sectional data from 12 European studies (n = 142 140) and longitudinal data from four studies (n = 48 646). Job strain and alcohol intake were self-reported. Job strain was analysed as a binary variable (strain vs. no strain). Alcohol intake was harmonised into the following categories: none, moderate (women: 1-14, men: 1-21 drinks/week), intermediate (women: 15-20, men: 22-27 drinks/week) and heavy (women: >20, men: >27 drinks/week). Cross-sectional associations were modelled using logistic regression and the results pooled in random effects meta-analyses. Longitudinal associations were examined using mixed effects logistic and modified Poisson regression. Compared to moderate drinkers, non-drinkers and (random effects odds ratio (OR): 1.10, 95% CI: 1.05, 1.14) and heavy drinkers (OR: 1.12, 95% CI: 1.00, 1.26) had higher odds of job strain. Intermediate drinkers, on the other hand, had lower odds of job strain (OR: 0.92, 95% CI: 0.86, 0.99). We found no clear evidence for longitudinal associations between job strain and alcohol intake.Our findings suggest that compared to moderate drinkers, non-drinkers and heavy drinkers are more likely and intermediate drinkers less likely to report work-related stress.

Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults.We analysed cross-sectional data from 15 European studies comprising 166,130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166,130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking.Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.

While hypertension is a common and treatable health problem, adherence to antihypertensive medication remains a challenge. This study examines the hypothesis that workplace social capital may influence adherence to antihypertensive medication among hypertensive employees.We linked survey responses to nationwide pharmacy records for a cohort of 3515 hypertensive employees (mean age 53.9 years, 76% women) who required continuous antihypertensive drug therapy (the Finnish Public Sector study). A standard scale was used to measure workplace social capital from co-workers' assessments and self-reports in 2000-2004. Non-adherence to antihypertensive medication was determined based on the number of days-not-treated at the year following the survey using comprehensive prescription records. Negative binomial regression models were conducted adjusting for socio-demographic characteristics, duration of hypertension, behaviour-related risk factors, and co-morbid conditions. The overall rate of days-not-treated was 20.7 per person-year (78% had no days-not-treated). Higher age, obesity, and presence of somatic co-morbidities were all associated with better adherence, but this was not the case for co-worker-assessed or self-reported workplace social capital. The rate of days-not-treated was 19.7 per person-year in the bottom fourth of co-worker-assessed workplace social capital, compared to 20.4 in the top fourth. The corresponding rate ratio from the fully-adjusted model was 0.95 (95% confidence interval (CI) 0.58-1.56). In a subgroup of 907 new users of antihypertensive medication this rate ratio was 0.98 (95% CI 0.42-2.29).We found no consistent evidence to support the hypothesized effect of workplace social capital on adherence to drug therapy among employees with chronic hypertension.