Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study.

The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44-58 years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30-70 % for having one more mobility limitation during the following 28 years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20-40 %) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.

Perceived stress symptoms in midlife predict disability in old age: a 28-year prospective cohort study.

BACKGROUND: Stress has damaging effects on individual's health. However, information about the long-term consequences of mental stress is scarce. METHODS: This 28-year prospective cohort study examined on the associations between midlife stress and old age disability among 2,994 Finnish municipal professionals aged 44-58 years at baseline. Self-reported stress symptoms were assessed at baseline in 1981 and 4 years later in 1985 and perceived disability in 2009. For the baseline data, principal component analysis was used for differentiation into stress symptom profiles. The regression coefficient estimates for self-care disability (activities of daily living) and instrumental activities of daily living disability were estimated using left-censored regression. The odds ratios for mobility limitation were estimated using logistic regression. RESULTS: Four midlife stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. We saw a clear gradient of increasing disability severity in old age for increasing intensity of midlife stress symptoms. In comparison with the participants with no stress symptoms, the extensively adjusted left-censored and logistic regression models showed that in old age, disability scores were almost 2-4 units higher and risk for mobility limitation was 2-3 times higher for those with constant stress symptoms in midlife. CONCLUSIONS: Among occupationally active 44- to 58-year-old men and women, perceived stress symptoms in midlife correlated with disability 28 years later. Stress symptoms may be the first signs of decompensation of individual functioning relative to environmental demands, which may later manifest in disabilities.

Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres.

OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264 health centres (91%) in Finland. The HT Guideline had been introduced into clinical practice in most health centres (89%). The style of implementation varied widely between health centres: at opposite ends of the implementation scale were 21 implementer health centres, which used multiple implementation channels, and 23 disseminator health centres, which used few or no implementation channels. The implementers had typically larger population bases and had organized services around the family doctor system, while the disseminators were smaller and had organized services according to a traditional model (appointments could be with any doctor in the surgery). CONCLUSION: The Finnish HT Guideline has become well known in most health centres since being introduced into clinical practice. However, the style of implementation varies markedly between health centres.

Effect of the shape of mica particles on the production of tumor necrosis factor alpha in mouse macrophages.

OBJECTIVES: Micas are thin, sheetlike minerals that are abundant in rocks and sand. They are common components of resuspended road dust in spring in Finland. The proinflammatory potential of mica particles was studied. METHODS: Respirable-size particles were prepared from phlogopite mica either by milling (milled phlogopite) or water elutriation (elutriated phlogopite). The cations were extracted with acids from one phlogopite sample (acid-treated phlogopite). Minusil (alpha-quartz) and titanium dioxide were used as positive and negative controls, respectively. Cultured mouse macrophage cells (RAW264.7) were exposed for 24 hours to the mineral particles at concentrations between 10 and 500 microg/ml. The mineral particle concentration of 100 microg/ml and the time range from 3 to 48 hours were used to study the time-dependency of the responses. Cell viability and the production of nitric oxide and proinflammatory cytokines [interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha)] were studied in the macrophages. RESULTS: Elutriated phlogopite particles were larger, and they had a smaller surface area and a more regular, plate-like shape than milled phlogopite. The mineral particles showed the following order of potency to induce TNF-alpha production in macrophages: elutriated phlogopite > Minusil > acid-treated phlogopite > milled phlogopite > titanium dioxide. Only elutriated phlogopite induced a small, dose-dependent IL-6 response. The mineral particle samples did not induce nitric oxide production in the macrophages. CONCLUSIONS: Phlogopite mica stimulates macrophages to produce proinflammatory cytokines. The platelike shape of mica particles rather than surface area seems to be important for cytokine production.

[Health and social insurance in Nordic countries]. / Trygdeordninger i Norden.

BACKGROUND: There is no previous comparative review available of Nordic social insurance schemes for sickness benefits, rehabilitation allowance and disability pensions. METHODS: Based on existing publications, a Nordic expert group in social insurance and insurance medicine has compared important aspects of the Nordic schemes. RESULTS: The Nordic sickness benefit schemes have many similarities, but differ considerably in degree of compensation, with 100% coverage of salary in Denmark and Norway and less coverage in the other three countries. The length of the self certification period varies from 1 to 14 days. Longer sickness absence have to be certified by a doctor, usually the family physician. To counteract the increasing costs for sickness benefits, the follow-up of sick-listed persons is being intensified. Efforts are also directed towards earlier and more extensive medical and vocational rehabilitation. So far these efforts have had only marginal effect on sickness absence and disability pensioning. INTERPRETATION: Basic needs for social security are still met by public insurance schemes in all Nordic countries. Private insurance schemes complement these to varying extent.