Documents Rahkonen, Ossi 9 results

"Objective The main aims of this longitudinal study were to (i) examine associations between changes in economic difficulties and health functioning among middle-aged employees and (ii) assess whether the associations remained after considering conventional domains of socioeconomic position. The associations were tested in two European welfare state occupational cohorts to strengthen the evidence base and improve generalizability. Methods Data came from two cohorts: the Finnish Helsinki Health Study (baseline 2000–2002, follow-up 2007, N=6328) and the British Whitehall II Study (baseline 1997–1999, follow-up 2003–2004, N=4350). Responses to the survey item “finding it hard to afford adequate food and clothes and pay bills” repeated at baseline and follow-up were used to examine persistent, increasing, and decreasing economic difficulties. Poor physical and mental health functioning were denoted as being in the lowest quartile of the Short Form 36 physical and mental component summary. Logistic regression analyses were adjusted for sex, age, childhood economic difficulties, household income at baseline and follow-up, employment status at follow-up, and baseline health functioning. Results We observed strong sex- and age-adjusted associations between increasing [odds ratio (OR) range 1.69–2.96] and persistent (OR range 2.54–3.21) economic difficulties and poorer physical and mental health functioning in both British and Finnish occupational cohorts. These associations remained after full adjustments. Those reporting decreasing difficulties over follow-up also had poorer functioning (OR range 1.30–1.61) compared to those who did not have difficulties at baseline, possibly reflecting residual effects of economic difficulties at baseline. Conclusion Changes in economic difficulties are associated with poorer physical and mental health functioning independent of income, employment status, and baseline health functioning.'

"Objective The associations between workplace bullying and subsequent sleep problems are poorly understood. This study aims to address this evidence gap.Methods We used the Helsinki Health Study questionnaire survey data at baseline in 2000–2002 and follow-up in 2007 (N=7332). The 4-item Jenkins sleep questionnaire was used in both surveys. Two measures of workplace bullying asked whether the respondent had (i) reported being bullied and (ii) observed bullying. Logistic regression models were fitted, adjusting for age, childhood bullying, education, working conditions, obesity, common mental disorders, limiting long-standing illness, and baseline sleep problems.Results At baseline, 5% of women and men reported being currently bullied. Additionally, 9% of women and 7% of men had frequently observed bullying at their workplace. Adjusted for age, reporting bullying was associated with sleep problems at follow-up among women [odds ratio (OR) 1.69, 95% confidence interval (95% CI) 1.30–2.20) and men (OR 3.17, 95% CI 1.85–5.43). Also, reporting earlier bullying was associated with sleep problems among both women (OR 1.47, 95% CI 1.26–1.72) and men (OR 1.58, 95% CI 1.06–2.36). Separate adjustments for covariates had some effects on the associations. After full adjustment for childhood bullying and baseline sociodemographic factors, working conditions, health, and sleep problems, the associations reduced. Similarly, adjusted for age, observing bullying was associated with sleep problems among women (OR 2.00, 95% CI 1.61–2.48) and men (OR 2.04, 95% CI 1.23–3.39).Conclusions Workplace bullying is associated with sleep problems, but associations attenuate after factors related to the social environment, work, and health are simultaneously taken into account."

"OBJECTIVES:
The aim of this study was to examine whether differences in male and female occupations and workplaces explain gender differences in self-certified (1-3 days) and medically confirmed sickness absence episodes of various lengths (> or = 4 days, >2 weeks, >60 days). Analyses in the main ICD-10 diagnostic groups were conducted for absence episodes of >2 weeks. Furthermore, we examined whether the contribution of occupation is related to different distributions of female and male jobs across the social class hierarchy.
METHODS:
All municipal employees of the City of Helsinki at the beginning of 2004 (N=36 395) were followed-up until the end of 2007. Conditional fixed-effects Poisson regression was used to control for differences between occupations and workplaces.
RESULTS:
Controlling for occupation accounted for half of the female excess in self-certified and medically confirmed episodes lasting >60 days. In the intermediate categories, this explained about one third of the female excess. The effect of workplace was similar but weaker. Occupational and workplace differences explained the female excess in sickness absence due to mental and behavioral disorders, musculoskeletal diseases, and respiratory diseases. The effect of occupation was clearly stronger than that of social class in self-certified absence episodes, whereas in medically confirmed sickness absence episodes gender differences were to a large extent related to social class differences between occupations.
CONCLUSIONS:
Differences between occupations held by women and men explain a substantial part of the female excess in sickness absence. Mental and behavioral disorders and musculoskeletal diseases substantially contribute to this explanation."

"Objectives The aim of the study was to examine the associations of changes in exposure to physical and psychosocial working conditions on subsequent sickness absence among ageing municipal employees of the City of Helsinki, Finland. Methods Changes in exposure to working conditions were assessed between baseline (2000–2002) and follow-up (2007) surveys. Register-based sickness absence information was linked to the survey data (N=3739) and followed-up from the return of the questionnaire in 2007 to the end of 2010. The study included six measures of physical and two measures of psychosocial working conditions. Negative binomial regression analysis was used to assess the associations and adjust for covariates.Results Favorable changes in physical working conditions lowered the risk for sickness absence whereas adverse changes increased the risk. Adverse changes in psychosocial working conditions only slightly increased the risk for sickness absence whereas favorable changes were unassociated with sickness absence. Conclusions Changes in exposure to physical working conditions in particular are associated with subsequent sickness absence. Preventing an increase in exposure to both psychosocial and physical working conditions and promoting a decrease in exposure to physical working conditions likely helps reduce the risk of sickness absence."

"Background Panel studies on changes of occupational class differences in health have given varying results. The aim of this study was to examine changes of occupational class differences in physical functioning and the factors that explain these changes.Methods A cohort of middle-aged employees of the City of Helsinki was followed up for an average of 6 years in two surveys from 2000–2002 and 2007. Hierarchical linear random effects models were fitted to analyse the changes of occupational class differences in SF-36 physical functioning, as well as the contribution of physical and psychosocial working conditions, material conditions, health behaviours and employment status to these changes.Results Lower occupational classes had worse physical functioning at baseline: among women, the SF-36 scores ranged from 50.5 in the highest class to 47.1 in the lowest one, and among men from 52.2 to 48.9, with higher scores indicating better health. Occupational class differences widened during the follow-up due to stronger decline of physical functioning in the lower occupational classes than in the higher occupational classes. The largest difference in the decline of functioning between classes was 1.2 scores among women and 1.5 scores among men. Among women the widening of the class differences could be explained partly by health behaviours and employment status and among men by material conditions.Conclusion Occupational class differences in physical functioning widened due to a faster decline of physical functioning in the lower occupational classes. Health behaviours, employment status and material conditions explained the widening class differences in physical functioning."

"This paper analyses the social patterning and change of health status among the Finnish population from the mid-1980s until the mid-1990s. A broad structural transformation has been going on in Finland including demographic, social structural and, in the early 1990s, particularly sudden and deep labour market changes. We first examine the patterning of health status and its change among the Finnish adult population by age; secondly by regional structure; thirdly by socioeconomic status, that is educational level; and fourthly by employment status, that is between the employed and the unemployed. Analyses were made separately for men and women. The data derive from two pooled nationwide "Surveys on Living Conditions" which were conducted in 1986 (N = 12,057) and in 1994 (N = 8650). Health status was measured by limiting long-standing illness (LLI) and self-assessed health (SAH) as below good. The overall trend shows that health status has remained stable or improved slightly among the Finnish adult population from 1986 to 1994. Age differences show levelling off as particularly men above age 45 in 1994 reported better health status than eight years before; those below age 45 tend to report somewhat poorer health. Also regional differences have declined; health in the East/North regions is approaching the level of the rest of the country, except the Helsinki Metropolitan region. Educational differences in health status continue to be clear; however, for men, differences in LLI between the two lower educational groups have levelled off by 1994. Also for men, employment status differences in LLI have declined by 1994; no corresponding levelling off was apparent for women. The health status and its social patterning among the Finnish adult population have remained rather stable during the recession and related social structural changes in the early 1990s. Certain levelling off has taken place among men. As a result men's and women's health inequalities now resemble each other more than eight years before. Adverse health consequences of the recession are supposed to take a longer time to show up."

"Background: In addition to conventional indicators of socioeconomic position, material conditions such as economic difficulties are associated with mental health. However, there has been little investigation of these associations. This study aims to examine the association of current economic difficulties with common mental disorders (CMD) and the contribution of social and behavioural factors to this association in two cohorts of Finnish and British white-collar employees. Methods: Comparable survey data from the Finnish Helsinki Health Study and the British Whitehall II Study were used. CMD were measured with the GHQ-12. Inequality indices from logistic regression analysis were used to examine the association between current economic difficulties and CMD, and the contribution of other past and present socioeconomic circumstances, health behaviours, living arrangements and work-family conflicts to this association. Inequality indices show the average change in ill health for each step up in the level of economic difficulties. Analyses were conducted separately for men and women.Results: Clear associations between current economic difficulties and CMD were found. Adjusting for work-family conflicts attenuated the associations. Adjusting for indicators of past and present socioeconomic circumstances, health behaviours and living arrangements had generally negligible effects. The results were very similar among both sexes in the two cohorts. Conclusions: Conflicts between work and family contribute to the association between economic difficulties and CMD in both Finland and Britain. Supporting people to cope not only with everyday economic difficulties but also with work-family conflicts may be important for reducing inequalities in mental health."

"OBJECTIVES: Low socioeconomic position is consistently associated with higher rates of sickness absence. We aimed to examine whether working conditions, health-related behaviours and family-related factors explain occupational class differences in medically certified sickness absence.METHODS: The study included 5470 women and 1464 men employees of the City of Helsinki, surveyed in 2000-2002. These data were prospectively linked to sickness absence records until the end of 2005, providing a mean follow-up time of 3.9 years. Poisson regression was used to examine the occurrence of medically certified sickness absence episodes lasting 4 days or more.RESULTS: Medically certified sickness absence was roughly three times more common among manual workers than among managers and professionals in both women and men. Physical working conditions were the strongest explanatory factors for occupational class differences in sickness absence, followed by smoking and relative weight. Work arrangements and family-related factors had very small effects only. The effects of psychosocial working conditions were heterogeneous: job control narrowed occupational class differences in sickness absence while mental strain and job demands tended to widened them. Overall, the findings were quite similar in women and men.CONCLUSIONS: Physical working conditions provided strongest explanations for occupational class differences in sickness absence. Smoking and relative weight, which are well-known determinants of health, also explained part of the excess sickness absence in lower occupational classes. Applying tailored work arrangements to employees on sick leave, reducing physically heavy working conditions and promoting healthy behaviours provide potential routes to narrow occupational class differences in sickness absence."

"Background: High job strain has been linked with cardiovascular outcomes. This study aimed to examine whether job strain is associated with angina pectoris symptoms among British and Finnish non-manual employees. Methods: Postal questionnaire survey data among 40–60-year-old employees of the British Whitehall II Study (n?=?4551, 27% women) and the Finnish Helsinki Health Study (n?=?7605, 83% women) cohort were analysed. Angina pectoris symptoms were the outcome in logistic regression analysis. Karasek's job strain was examined. Models were adjusted first for age, second for occupational class and finally for smoking, heavy drinking, physical inactivity, unhealthy food habits and obesity. Results: Angina pectoris symptoms were reported by 5% of women and 3% of men in Britain, and by 6% of women and 4% of men in Finland. High job strain was associated with angina pectoris symptoms among men in Britain (OR 2.08; CI 95% 1.07 to 4.02) and women in Finland (OR 1.90; CI 95% 1.36 to 2.63) independent of age, occupational class, and behavioural risk factors. However, similar associations between job strain and angina pectoris symptoms were not observed among men in Finland or women in Britain. Conclusion: The results yielded partial support for the association between job strain and angina pectoris symptoms across national contexts."