Musculoskeletal pain among Finnish orchestra musicians versus core workforce.

BACKGROUND: Professional musicians show a high prevalence of musculoskeletal pain, but information is limited about prevalence of pain compared to the general populations. AIMS: Our cross-sectional epidemiological study compared the prevalence of musculoskeletal pain between professional orchestra musicians and the working population in Finland. METHODS: Musicians with a permanent contract with all domestic professional symphony and philharmonic orchestras and a population sample of the workforce in Finland completed questionnaires including the same questions on musculoskeletal pain and on various other issues. Cross-sectional data from two population-based and two orchestra-musician studies were analysed by logistic regression model adjusting for confounding factors. RESULTS: In 2002, 345 musicians completed questionnaires (40% response rate), and in 2010, 195 (23%). The Health 2000 study sample comprised 5956 employed participants and in 2011, 5942. Musicians reported, in 2002 and in 2010, back pain during the past 30 days more often than did controls, 39% versus 27%, adjusted odds ratio (95% confidence interval, CI) 1.5 (1.2-1.9); shoulder pain, 21% versus 9%, 2.6 (1.9-2.5); elbow pain, 14% versus 5%, 2.9 (2.0-4.2); wrist pain 14% versus 7%, 2.2 (1.5-3.1); and finger pain 13% versus 9%, 2.8 (2.0-3.9). Prevalence of musculoskeletal pain increased with age in controls but not in musicians. CONCLUSIONS: Professional orchestra musicians reported more pain in the back and upper extremity than other working people. Future research should focus on explaining differences in the occurrence of musculoskeletal disorders between musicians and the general population.

Self-report dieting and long-term changes in body mass index and waist circumference.

OBJECTIVE: This prospective study explores whether dieting attempts and previous changes in weight predict changes in body mass index (BMI) and waist circumference (WC). METHODS: The study was based on the representative Finnish Health 2000 Survey and on its follow-up examination 11 years later. The sample included 2,785 participants, aged 30-69. BMI and WC were determined at health examinations. Information on dieting attempts and previous changes in weight was collected using a questionnaire including questions on whether participant had tried to lose weight (no/yes), gained weight (no/yes) or lost weight (no/yes) during the previous year. RESULTS: At baseline, 32.8% were dieters. Of these, 28.4% had lost weight during the previous year. Dieters had higher BMI and WC than non-dieters. During the follow-up, the measures increased more in dieters and in persons with previous weight loss. The mean BMI changes in non-dieters versus dieters were 0.74 (standard deviation [SD] 2.13) kg/m2 and 1.06 (SD 2.77) kg/m2 (P = 0.002), respectively. The corresponding numbers for those with no previous weight change versus those who had lost weight were 0.65 (SD 2.07) kg/m2 and 1.52 (SD 2.61) kg/m2. The increases in BMI and WC were most notable in dieters with initially normal weight. CONCLUSIONS: The increases in BMI and WC were greater in dieters than in non-dieters, suggesting dieting attempts to be non-functional in the long term in the general population.

Risk factors for sciatica leading to hospitalization.

PURPOSE: To study the known or suspected risk factors for sciatica: Tallness, overweight, smoking, leisure-time physical exercise, self-reported health and occupation, and how they predict hospitalizations due to sciatica. Only a few cohort studies have previously focused on the risk factors for sciatica. METHODS: The 13,095 subjects, free from low back disorders at the baseline in 1973-1976 were followed up to the end of 2011 via the Care Register for Health Care. Along with an invitation to the health examination, a basic questionnaire concerning lifestyle factors was sent to participants. The outcome measure was incident sciatica leading to hospitalization. RESULTS: Altogether 702 incident sciatica cases occurred. Among men, the adjusted hazard ratio (HR) with 95% confidence interval (CI) was 2.57 (95% CI 1.47-4.50) in metal or machine work, and 1.44 (1.06-1.95) in other industrial work, compared to that in white-collar occupations. Among women, the corresponding risk estimates were 1.81 (1.18-2.78) for nurses and related occupations, 1.56 (1.05-2.31) for sales workers, and 1.46 (1.03-2.08) for industrial workers. Among men, physical exercise during leisure predicted a decrease in the risk of sciatica (0.74; 0.55-1.00); this association was significantly pronounced in white-collar occupations (0.38; 0.18-0.88). Among women, the association between body mass index and the risk of sciatica was only modest, but varied greatly between different occupations. CONCLUSIONS: Physically demanding work is a strong risk factor for sciatica. Leisure-time physical activity seems to protect men against sciatica, while overweight is a risk factor among women. However, occupation substantially modifies these associations.

Associations of tissue transglutaminase antibody seropositivity with coronary heart disease: Findings from a prospective cohort study.

BACKGROUND AND AIMS: Clinical experience and observational studies suggest that individuals with coeliac disease are at increased risk of coronary heart disease (CHD), but the precise mechanism for this is unclear. Laboratory studies suggest that it may relate to tissue transglutaminase antibodies (tTGAs). Our aim was to examine whether seropositivity for tTGA and endomysial antibodies (EMAs) are associated with incident CHD in humans. METHODS AND RESULTS: We used data from Mini-Finland Health Survey, a prospective cohort study of Finnish men and women aged 35-80 at study baseline 1978-80. TTGA and EMA seropositivities were ascertained from baseline blood samples and incident CHD events were identified from national hospitalisation and death registers. Cox regression was used to examine the associations between antibody seropositivity and incident CHD. Of 6887 men and women, 562 were seropositive for tTGAs and 72 for EMAs. During a median follow-up of 26 years, 2367 individuals experienced a CHD event. We found no clear evidence for an association between tTGA positivity (hazard ratio, HR: 1.04, 95% confidence interval, CI: 0.83, 1.30) or EMA positivity (HR: 1.16, 95% CI: 0.77, 1.74) and incident CHD, once pre-existing CVD and known CHD risk factors had been adjusted for. CONCLUSION: We found no clear evidence for an association of tTGA or EMA seropositivity with incident CHD outcomes, suggesting that tTG autoimmunity is unlikely to be the biological link between coeliac disease and CHD.

Obesity in early adulthood predicts knee pain and walking difficulties among men: A life course study.

BACKGROUND: Few studies have addressed the role of obesity in young adulthood in knee problems later in life. We assessed the associations of overweight/obesity with knee pain and functional limitations of the knee across the life course. METHODS: Military health records from 1967 to 2000 (baseline) were searched for 18- to 50-year-old Finnish men (n = 1913) who participated in the Health 2000 Study (follow-up). Visits to health care were followed during service. Height and weight were measured at baseline and follow-up and waist circumference at follow-up. Weight was inquired at follow-up for ages of 20, 30, 40 and 50 years, if applicable. Life course body mass index (BMI) was calculated. One-month knee pain and functional limitations (walking difficulties and limping) due to knee problems were enquired with interview at follow-up. Cox regression model, logistic regression and trajectory analysis were applied. RESULTS: Body mass index at the age of 20 increased the risk of unilateral knee pain by 38% and functional limitations by 27% for one standard deviation increment of BMI, respectively. One-unit increment of Z-score of life course BMI increased knee pain by 32%. Development of severe obesity during the follow-up increased the risk of knee pain by 80% and functional limitations by 93%. The effect of obesity on functional limitations was partly mediated by traumatic knee problems during military service. CONCLUSIONS: Reducing overweight already in adolescence and avoiding further weight gain during life course may prevent knee pain and associated disability. WHAT DOES THIS STUDY ADD?: BMI at the age of 20 increases the likelihood of knee pain and functional limitations of the knee later in life. Development of severe obesity in adulthood increases the risk of knee pain by 80% and functional limitations by more than 90%. Both general and abdominal obesity are associated with knee pain, associations being stronger for general obesity.

Multisite musculoskeletal pain predicts medically certified disability retirement among Finns.

BACKGROUND: Musculoskeletal pain at several sites (multisite pain) is more common than single-site pain. Little is known on its effects on disability pension (DP) retirement. METHODS: A nationally representative sample comprised 4071 Finns in the workforce aged 30 to 63. Data (questionnaire, interview, clinical examination) were gathered in 2000-2001 and linked with national DP registers for 2000-2011. Pain during the preceding month in 18 locations was combined into four sites (neck, upper limbs, low back, lower limbs). Hazard ratios (HR) of DP were estimated by Cox regression. RESULTS: The HR of any DP (n = 477) was 1.6 (95% confidence interval 1.2-2.1) for one, 2.5 (1.9-3.3) for two, 3.1 (2.3-4.3) for three and 5.6 (4.0-7.8) for four pain sites, when adjusted for age and gender. When additionally adjusted for clinically assessed chronic diseases, the HRs varied from 1.4 (1.0-1.8) to 3.5 (2.5-4.9), respectively. When further adjusted for physical and psychosocial workload, education, body mass index, smoking, exercise and sleep disorders, the HRs were 1.3 (0.9-1.7), 1.6 (1.2-2.2), 1.8 (1.3-2.5) and 2.5 (1.8-3.6). The number of pain sites was especially strong in predicting DPs due to musculoskeletal diseases (HRs in the full model; 3.1 to 4.3), but it also predicted DPs due to other somatic diseases (respective HRs 1.3 to 2.3); pain in all four sites was also predictive of DPs due to mental disorders (full model HR 2.2). CONCLUSIONS: The number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability.

Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample.

UNLABELLED: Maximal walking speed and quantitative ultrasound index (QUI) were significant and independent predictors of hip fracture among subjects aged ≥ 55 years. A model including readily available variables along with simple fall-related factors may be clinically useful in the assessment of hip fracture risk even without a QUI measurement. INTRODUCTION: This study assessed fall-related risk factors along with heel bone quantitative ultrasound (QUS) measurements for the prediction of hip fracture during a mean follow-up of 9.8 years in a nationally representative population sample. METHODS: The study population consisted of 2,300 subjects (1,331 women and 969 men) aged 55 years or over, who had participated in a comprehensive health survey in 2000-2001. Information on the subjects' health and fall-related risk factors was obtained with interviews, questionnaires and tests carried out by specially trained professionals. QUS measurements were made by means of the Hologic Sahara device. First emerging cases of hip fracture were identified from the National Hospital Discharge Register. RESULTS: During the follow-up, 96 subjects sustained a hip fracture. Slow maximal walking speed, low quantitative ultrasound index (QUI), high age, tallness, short waist circumference, Parkinson's disease and the number of central nervous system active medication were significant and independent predictors of hip fracture. The model including all of these risk factors explained 68 % of the variation in hip fracture risk. Excluding QUI from this model reduced the percentage to 66%. CONCLUSIONS: Maximal walking speed and QUI were significant and independent predictors of hip fracture. A model including readily available variables such as age, gender, height and waist circumference along with simple fall-related factors may be of clinical use in the assessment of hip fracture risk even without a QUS measurement.

Obesity and muscle strength as long-term determinants of all-cause mortality--a 33-year follow-up of the Mini-Finland Health Examination Survey.

OBJECTIVE: To examine the independent and combined associations of obesity and muscle strength with mortality in adult men and women. DESIGN: Follow-up study with 33 years of mortality follow-up. SUBJECTS: A total of 3594 men and women aged 50-91 years at baseline with 3043 deaths during the follow-up. MEASUREMENT: Body mass index (BMI) and handgrip strength were measured at baseline. RESULTS: Based on Cox models adjusted for age, sex, education, smoking, alcohol use, physical activity and chronic conditions, baseline obesity (BMI ≥30 kg m(-2)) was associated with mortality among participants aged 50-69 years (hazard ratio (HR) 1.14, 95% confidence interval (CI), 1.01-1.28). Among participants aged 70 years and older, overweight and obesity were protective (HR 0.77, 95% CI, 0.66-0.89 and HR 0.76, 95% CI, 0.62-0.92). High handgrip strength was inversely associated with mortality among participants aged 50-69 (HR 0.89, 95% CI, 0.80-1.00) and 70 years and older (HR 0.78, 95% CI, 0.66-0.93). Compared to normal-weight participants with high handgrip strength, the highest mortality risk was observed among obese participants with low handgrip strength (HR 1.23, 95% CI, 1.04-1.46) in the 50-69 age group and among normal-weight participants with low handgrip strength (HR 1.30, 95% CI, 1.09-1.54) among participants aged 70+ years. In addition, in the old age group, overweight and obese participants with high handgrip strength had significantly lower mortality than normal-weight participants with high handgrip strength (HR 0.79, 95% CI, 0.67-0.92 and HR 0.77, 95% CI, 0.63-0.94). CONCLUSION: Both obesity and low handgrip strength, independent of each other, predict the risk of death in adult men and women with additive pattern. The predictive value of obesity varies by age, whereas low muscle strength predicts mortality in all age groups aged>50 years and across all BMI categories. When promoting health among older adults, more attention should be paid to physical fitness in addition to body weight and adiposity.

Quantitative ultrasound measurements and vitamin D status in the assessment of hip fracture risk in a nationally representative population sample.

SUMMARY: Adjusted for age, gender, height and weight, calcaneal quantitative ultrasound (QUS) and serum 25-hydroxyvitamin D (S-25(OH)D) proved to be significant predictors of hip fracture among subjects aged ≥50 years. Even if their contribution to the predictive power was modest, they may be useful in the assessment of hip fracture risk in the elderly. INTRODUCTION: This study assessed calcaneal QUS measurements, S-25(OH)D and several other factors for the prediction of hip fracture risk in a nationally representative population sample. METHODS: The study population consisted of 3,305 subjects (1,872 women), aged 50 years or over, who had participated in a comprehensive health survey. QUS measurements were made by means of the Hologic Sahara device. S-25(OH)D was measured by radioimmunoassay. Emerging cases of hip fracture were identified from the National Hospital Discharge Register. RESULTS: During a mean follow-up of 8.4 years, 95 subjects sustained a hip fracture. After adjusting for age, gender, height, weight and each other, a 1 standard deviation increment in the quantitative ultrasound index (QUI) (21.7) and in S-25(OH)D (17.5 nmol/L) reduced the risk of hip fracture by 40 % (hazard ratio [HR] = 0.60, 95 % confidence interval [CI] = 0.42-0.86) and by 31 % (HR = 0.69, 95 % CI = 0.55-0.87), respectively. The predictive power of a model including age, gender, height and weight was improved by about 8 % after the addition of QUI and S-25(OH)D. Among subjects aged 75 years or over, the corresponding improvement was about 130 %. CONCLUSIONS: QUI and S-25(OH)D were significant and independent predictors of hip fracture. However, their ability to increase the predictive power of a statistical model including readily available simple variables such as age, gender, height and weight was rather modest. Still, our findings suggest that QUI and S-25(OH)D may be of clinical use in the assessment of hip fracture risk particularly in the elderly.

A cohort study on diet and the risk of Parkinson's disease: the role of food groups and diet quality.

Previous studies on individual foods and nutrients and Parkinson's disease (PD) risk have been inconsistent. Furthermore, only one study has examined the association between the quality of diet and PD. We investigated the prediction of food groups and diet quality on PD in the Finnish Mobile Clinic Survey (1966-72). The population comprised 4524 individuals, aged 40-79 years and free from PD at baseline. Data collection included health examinations, a questionnaire and a 1-year dietary history interview. A modified Alternate Healthy Eating Index was formed to assess diet quality. Statistical analyses were based on Cox's model. During a 41-year follow-up, eighty-five incident cases of PD occurred. No statistically significant associations were found between PD incidence and most of the food groups examined. A few exceptions were fruits and berries in men and milk in women, which showed positive associations. An inverse association between the intake of meat products and PD was found in women. The diet quality index did not predict PD, the adjusted relative risk between the highest and lowest quartiles being 1.83 (95 % CI 0.65, 5.18) in men and 0.97 (95 % CI 0.38, 2.48) in women. The present study suggests that since most of the single food groups or the quality of diet did not predict PD occurrence, the role of diet is apparently rather modest.

Untreated Scheuermann's disease: a 37-year follow-up study.

INTRODUCTION: There are only a few follow-up studies of untreated Scheuermann's disease. The aim of this study was to investigate the relationship between vertebral changes, back pain, and disability in patients with untreated Scheuermann's disease after a 37-year follow-up. MATERIALS AND METHODS: Eighty patients responded to a postal questionnaire concerning back pain and disability and 49 of them had classic Scheuermann's disease. Degree of kyphosis, lordosis, scoliosis, the number of affected vertebrae, and mean and maximum wedge angles were measured from radiographs. Back pain and disability scores were compared to a sample of the general Finnish population (n = 3,835). RESULTS: At follow-up, the patients were on average 59 (SD 8) years old (range 44-79 years), and the mean follow-up time was 37 (SD 7) years (26-54 years). The patients comprised more males than females (3.1:1). At follow-up, male patients were on average 3 cm taller than controls (p = 0.007). At age 20, female patients compared to controls were on average 6 kg heavier (p = 0.016) and had higher body mass index (BMI) (mean 23.9 kg/m(2) vs. 20.8 kg/m(2), p = 0.001). Scheuermann's patients had 2.5-fold [odds ratio (OR); 95% confidence interval (CI); 1.4-4.5, p = 0.003] increased risk for constant back pain compared to controls. The risk for disability because of back pain during the past 5 years (OR 2.6; 95% CI 1.4-4.7, p = 0.002), risk for back pain during the past 30 days (OR 3.7; 95% CI 1.9-7.0, p < 0.001) and risk for sciatic pain (OR 2.3; 95% CI 1.3-4.3, p = 0.005) were higher compared to controls. Scheuermann's patients had higher risk for difficulties in mounting stairs (OR 5.4; 95% CI 2.8-10.3, p < 0.001) and in carrying a 5 kg load for at least 100 m (OR 7.2; 95% CI 3.9-13.3, p < 0.001). CONCLUSION: Scheuermann's patients had a higher risk for back pain and disabilities during activities of daily living than controls. However, the degree of thoracic kyphosis among Scheuermann's patients was not related to back pain, quality of life, or general health.

Association of 25-hydroxyvitamin D with the incidence of knee and hip osteoarthritis: a 22-year follow-up study.

OBJECTIVE: In the light of conflicting results from previous studies on the role of vitamin D, we studied serum 25-hydroxyvitamin D [25(OH)D] with regard to its prediction of incident knee and hip osteoarthritis (OA). METHODS: The study population (n = 805) consisted of participants of a national health examination survey who had undergone baseline and follow-up clinical examinations at intervals of 20-23 years. Knee and hip OA were diagnosed on the basis of a standardized clinical examination by physicians with the same diagnostic criteria at baseline and follow-up. Information on covariates, including age, sex, season of blood draw, education, body mass index (BMI), physical workload, leisure time physical activity, smoking history, and previous injuries, was collected at baseline. Serum 25(OH)D concentrations were determined from baseline serum samples kept frozen at -20°C. RESULTS: We found no significant association between serum 25(OH)D level and the risk of incident knee or hip OA. However, a statistically significant interaction between season of blood draw and serum 25(OH)D emerged when predicting the development of definite knee OA (p = 0.004). After adjusting for all the covariates, the relative odds (95% confidence interval) of developing definite knee OA per increment of 1 SD (20.7 ng/mL) in winter season 25(OH)D was 1.57 (1.10-2.27), whereas for summer season sera the corresponding rate was 0.53 (0.28-1.00). CONCLUSION: The results do not support the hypothesis that a low level of serum 25(OH)D contributes to the development of OA. Instead, our study suggests that season is a potent effect modifier of 25(OH)D, which merits attention in future research.

Parity and risk of hip fracture in postmenopausal women.

UNLABELLED: Hip fracture risk was assessed according to parity among postmenopausal women. Compared with nulliparous women, the fracture risk was lower in women with three or more births. INTRODUCTION: Parity was assessed for long-term prediction of hip fracture in postmenopausal women. METHODS: Postmenopausal women (n= 2,028) aged 45 or over with no history of hip fracture were studied. From 1978 to 1980, all of them had participated in a comprehensive health survey based on a nationally representative population sample. Emerging cases of hip fracture were identified from the National Hospital Discharge Register during a follow-up period extending up to 17 years. RESULTS: The risk of hip fracture was lower among parous women compared with nulliparous women. The model adjusted for age showed a significant inverse association between parity as a continuous variable and the risk of hip fracture [RR = 0.74; 95% confidence interval (CI), 0.61-0.90] per an increment of one standard deviation (2.4 births). Adjusted for age, menopausal age, level of education, body mass index, vitamin D status, alcohol consumption, smoking history, leisure time physical activity, and self-rated health, the relative risk was 0.50 (95% CI, 0.32-0.79) for women with three or more births and 0.85 (95% CI, 0.55-1.32) for women with one to two births as compared with nulliparous women. CONCLUSION: Parity, three or more births in particular, predicts a lowered risk of hip fracture in the long run.

Severity of vertebral fracture and risk of hip fracture: a nested case-control study.

UNLABELLED: Severe vertebral fractures strongly predicted subsequent hip fracture in this population-based study. Such high-risk patients should be provided with clinical evaluation and care for osteoporosis. INTRODUCTION: Vertebral fractures are commonly osteoporotic and known to predict hip fracture. The aim of this study was to evaluate associations between the severity of vertebral fractures and the risk of subsequent hip fracture. METHODS: Chest radiographs were obtained of 7,095 Finnish men and women aged 30 years or over in the Mini-Finland Health Survey in 1978-1980. Record linkage to the National Hospital Discharge Register identified 182 subjects from the survey who had subsequently been hospitalized for primary treatment of hip fracture by the end of 1994. A nested case-control setting was adopted, where three controls individually matched for age, gender, and place of residence were drawn for 169 subjects with hip fracture from the same cohort. Baseline vertebral fractures were identified at levels T3 to T12, and their morphology was categorized to mild, moderate, or severe according to Genant's classification. RESULTS: Severe vertebral fracture (>40% reduction in vertebral body height) strongly predicted hip fracture. After controlling for education, physical activity, smoking, alcohol consumption, and self-rated general health, the adjusted relative odds was 12.06 (95% confidence interval, 3.80-38.26). Mild to moderate fracture grades and the number of compressed vertebral bodies showed no prediction for hip fracture. CONCLUSIONS: The presence of a severe vertebral fracture in the thoracic spine strongly predicts subsequent hip fracture. Such high-risk patients should be clinically evaluated and provided with care for osteoporosis and measures to reduce the risk of falling as required.

Recommendations for standardization and phenotype definitions in genetic studies of osteoarthritis: the TREAT-OA consortium.

OBJECTIVE: To address the need for standardization of osteoarthritis (OA) phenotypes by examining the effect of heterogeneity among symptomatic (SOA) and radiographic osteoarthritis (ROA) phenotypes. METHODS: Descriptions of OA phenotypes of the 28 studies involved in the TREAT-OA consortium were collected. We investigated whether different OA definitions result in different association results by creating various hip OA definitions in one large population based cohort (the Rotterdam Study I (RSI)) and testing those for association with gender, age and body mass index using one-way ANOVA. For ROA, we standardized the hip-, knee- and hand ROA definitions and calculated prevalence's of ROA before and after standardization in nine cohort studies. This procedure could only be performed in cohort studies and standardization of SOA definitions was not feasible at this moment. RESULTS: In this consortium, all studies with SOA phenotypes (knee, hip and hand) used a different definition and/or assessment of OA status. For knee-, hip- and hand ROA five, four and seven different definitions were used, respectively. Different hip ROA definitions do lead to different association results. For example, we showed in the RSI that hip OA defined as "at least definite joint space narrowing (JSN) and one definite osteophyte" was not associated with gender (P =0.22), but defined as "at least one definite osteophyte" was significantly associated with gender (P=3×10(-9)). Therefore, a standardization process was undertaken for ROA definitions. Before standardization a wide range of ROA prevalence's was observed in the nine cohorts studied. After standardization the range in prevalence of knee- and hip ROA was small. CONCLUSION: Phenotype definitions influence the prevalence of OA and association with clinical variables. ROA phenotypes within the TREAT-OA consortium were standardized to reduce heterogeneity and improve power in future genetics studies.

No increase in the prevalence of COPD in two decades.

Relevant information on the prevalence of chronic obstructive pulmonary disease (COPD) and its trends is scarce. In the present study, we compare the prevalence rates and potential determinants of COPD in two national population samples that were surveyed 20 yrs apart. In 1978-1980, a sample of 8,000 people was surveyed; subjects were representative of the Finnish population and were aged ≥30 yrs. Among those aged 30-74 yrs, acceptable spirometry was obtained from 6,364 (87%) subjects. In a similar survey conducted in 2000-2001, comparable spirometry was obtained from 5,495 (80%) participants. Airway obstruction was defined as forced expiratory volume in 1 s (FEV(1))/forced vital capacity below the lower limit of normal and staged for severity on the basis of FEV(1) % predicted. The age-adjusted prevalence rates of obstruction (stages I-IV) were rather similar in both surveys in males (4.7 versus 4.3%; p = 0.25), but were almost significantly higher in females in the later survey (2.2 versus 3.1%; p = 0.06). The rates of COPD stage II or higher were 3.9% in 1978-1980, and 3.6% in 2000-2001 (p = 0.36) for males, and 1.4 and 1.5% (p = 0.93), respectively, for females. In conclusion, no significant difference was found in the prevalence of COPD stages II-IV between similar population based surveys performed 20 yrs apart. Since COPD is mostly mild or moderate there is a strong case for early prevention.

Twenty-year changes in the prevalence of obesity among Finnish adults.

We investigated changes in the prevalence of obesity among Finnish adults (aged > or = 30 years) during a 20-year period. Data were derived from two cross-sectional nationally representative surveys (n = 13 844) in 1978-1980 and 2000-2001. Weight and height were measured using a standardized protocol. Obesity was defined as body mass index (BMI) > or = 30 kg m(-2). Cut-offs of BMI > or = 35 kg m(-2) and BMI > or = 40 kg m(-2) were also used. A 20-year difference in the prevalence of obesity was from 11.3% to 20.7% in men and from 17.9% to 24.1% in women. In 1978-1980, 1.1% of men and 3.8% of women had a BMI at least 35 kg m(-2). The corresponding prevalence was 3.9% in men and 6.8% in women 20 years later. The educational gradient in obesity diminished in 20 years because of the most prominent increase among highly educated men. Yet, 25% of men and 28% of women with low education are obese. Obesity increased in all age and educational groups over the 20-year period. It was highest among women and individuals with the lowest education, but the increase was most striking among well-educated men. A comprehensive public health strategy targeting the whole population and especially those with low education is urgently needed to halt the obesity epidemic.

Physical work load factors and carpal tunnel syndrome: a population-based study.

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. Studies on selected occupational populations suggest an association of CTS with forceful repetitive work and vibration. Only few population-based studies have addressed the role of physical load factors in CTS. The aim of this study was to investigate the relations between exposures to a single or a combination of physical work load factors and CTS. METHODS: The target population consisted of people aged 30 years or older residing in Finland during 2000-2001. Of the 7977 eligible subjects, 6254 (78.4%) were included in the study. Occupational physical load factors were assessed by interview and CTS by physical examination. RESULTS: The prevalence of possible or probable CTS was 2.1% in men and 5.3% in women. Work tasks with vibrating tools (adjusted odds ratio (OR) 1.9, 95% CI 1.2 to 2.9) and handgrip with high forces (OR 1.7, 95% CI 1.2 to 2.5) were related to an increased prevalence of CTS. There were joint effects between work tasks requiring handgrip with high forces and the use of vibrating tools (adjusted OR 3.3, 95% CI 2.0 to 5.4), between forceful activities (handgrip with high forces or handling of loads) and repetitive movements of the hands (OR 2.1, 95% CI 1.5 to 2.9), and between repetitive movements of the hands and the use of vibrating tools (OR 2.8, 95% CI 1.6 to 4.8). Only exposure in the most recent job was associated with CTS. CONCLUSIONS: Work tasks demanding handgrip with high forces or the use of vibrating tools are associated with CTS. The association is stronger if these work tasks are accompanied by repetitive movements of the hand or wrist.