Microalbuminuria, defined as urine albumin-to-creatinine ratio (UACR)>3.0?mg/mmol and = 30?mg/mmol, is an early marker of endothelial damage of the renal glomeruli. Recent research suggests an association among microalbuminuria, albuminuria (UACR?>?3.0?mg/mmol), and cognitive impairment. Previous studies on microalbuminuria, albuminuria, and cognition in the middle-aged have not provided repeated cognitive testing at different time-points. We hypothesized that albuminuria (micro- plus macroalbuminuria) and microalbuminuria would predict cognitive decline independently of previously reported risk factors for cognitive decline, including cardiovascular risk factors. In addition, we hypothesized that UACR levels even below the cut-off for microalbuminuria might be associated with cognitive functioning. These hypotheses were tested in the Finnish nationwide, population-based Health 2000 Survey (n?=?5,921, mean age 52.6, 55.0% women), and its follow-up, Health 2011 (n?=?3,687, mean age at baseline 49.3, 55.6% women). Linear regression analysis was used to determine the associations between measures of albuminuria and cognitive performance. Cognitive functions were assessed with verbal fluency, word-list learning, word-list delayed recall (at baseline and at follow-up), and with simple and visual choice reaction time tests (at baseline only). Here, we show that micro- plus macroalbuminuria associated with poorer word-list learning and a slower reaction time at baseline, with poorer word-list learning at follow-up, and with a steeper decline in word-list learning during 11 years after multivariate adjustments. Also, higher continuous UACR consistently associated with poorer verbal fluency at levels below microalbuminuria. These results suggest that UACR might have value in evaluating the risk for cognitive decline.
Research has demonstrated a bidirectional relationship between physical function and depression, but studies on their association in migrant populations are scarce. We examined the association between mental health symptoms and mobility limitation in Russian, Somali and Kurdish migrants in Finland.
We used data from the Finnish Migrant Health and Wellbeing Study (Maamu). The participants comprised 1357 persons of Russian, Somali or Kurdish origin aged 18-64 years. Mobility limitation included self-reported difficulties in walking 500?m or stair climbing. Depressive and anxiety symptoms were measured using the Hopkins Symptom Checklist-25 (HSCL-25) and symptoms of somatization using the somatization subscale of the Symptom Checklist-90 Revised (SCL-90-R). A comparison group of the general Finnish population was selected from the Health 2011 study.
Anxiety symptoms were positively associated with mobility limitation in women (Russians odds ratio [OR] 2.98; 95% confidence interval [CI] 1.28-6.94, Somalis OR 6.41; 95% CI 2.02-20.29 and Kurds OR 2.67; 95% CI 1.41-5.04), after adjustment for socio-demographic factors, obesity and chronic diseases. Also somatization increased the odds for mobility limitation in women (Russians OR 4.29; 95% CI 1.76-10.44, Somalis OR 18.83; 95% CI 6.15-57.61 and Kurds OR 3.53; 95% CI 1.91-6.52). Depressive symptoms were associated with mobility limitation in Russian and Kurdish women (Russians OR 3.03; 95% CI 1.27-7.19 and Kurds OR 2.64; 95% CI 1.39-4.99). Anxiety symptoms and somatization were associated with mobility limitation in Kurdish men when adjusted for socio-demographic factors, but not after adjusting for obesity and chronic diseases. Finnish women had similar associations as the migrant women, but Finnish men and Kurdish men showed varying associations.
Mental health symptoms are significantly associated with mobility limitation both in the studied migrant populations and in the general Finnish population. The joint nature of mental health symptoms and mobility limitation should be recognized by health professionals, also when working with migrants. This association should be addressed when developing health services and health promotion.
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Department of Sociology, Universitat de Barcelona, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. Electronic address: email@example.com.
Socioeconomic status, as measured by education, occupation or income, is associated with depression. However, data are lacking on the psychosocial, material and behavioral mediators of these associations. We have examined the association of education, occupation and income with depression and the potential mediations using community-based data.
A total of 7,966 older adults were interviewed in Finland, Poland and Spain. The differential associations between depression and SES, mediator variables, country of residence and cofounder variables, such as chronic physical conditions, were assessed through logistic regression models. Meditation analyses were carried out using khb method for Stata 13.1.
Education, followed by household income, were the SES indicators most frequently significantly associated with depression. These SES markers, but not occupation, showed an independent effect in this association. Psychosocial factors and loneliness in particular showed the strongest associations with depression among mediator variables. However, material factors and, especially, financial strain had a higher mediating function in the association between SES and depression. Overall, SES markers, chronic conditions and mediation factors were more positive in Finland than in Poland and Spain.
Improving psychosocial and material dimensions as well as access to the educational system for older adults might result in a reduction in the prevalence of depression in the general population and particularly among individuals with low SES.
To determine the independent effect of visual acuity on individual activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility.
Cross-sectional survey on a sample representing the Finnish population aged 55 years and above. Of the 3392 eligible people, 3185 (93.9%) were interviewed, 2870 (84.6%) attended a comprehensive health examination, and 2781 (82.0%) had distance visual acuity (VA) assessed. A home interview included assessment of ADL, IADL and mobility, demographic variables and chronic conditions. Mobility measurements and binocular VA were assessed during the examination.
Prevalence of ADL, IADL, and mobility limitations increased with decreasing VA (p or =0.8) after adjustment for socio-demographic and behavioral factors, and chronic conditions (OR 4.36, 95%CI 2.44-7.78). Limitations in IADL and measured mobility were five times as likely (OR 4.82, 95%CI 2.38-9.76 and OR 5.37, 95%CI 2.44-7.78, respectively), and self-reported mobility limitations were three times as likely (OR 3.07, 95%CI 1.67-9.63) as in persons with good VA.
Decreased VA is strongly associated with functional limitations, and even a slight decrease in VA was found to be associated with limitations in functioning.
Social support is assumed to protect mental health, but it is not known whether low social support at work increases the risk of common mental disorders or antidepressant medication. This study, carried out in Finland 2000-2003, examined the associations of low social support at work and in private life with DSM-IV depressive and anxiety disorders and subsequent antidepressant medication.
Social support was measured with self-assessment scales in a cohort of 3429 employees from a population-based health survey. A 12-month prevalence of depressive or anxiety disorders was examined with the Composite International Diagnostic Interview (CIDI), which encompasses operationalized criteria for DSM-IV diagnoses and allows the estimation of DSM-IV diagnoses for major mental disorders. Purchases of antidepressants in a 3-year follow-up were collected from the nationwide pharmaceutical register of the Social Insurance Institution.
Low social support at work and in private life was associated with a 12-month prevalence of depressive or anxiety disorders (adjusted odds ratio 2.02, 95% CI 1.48-2.82 for supervisory support, 1.65, 95% CI 1.05-2.59 for colleague support, and 1.62, 95% CI 1.12-2.36 for private life support). Work-related social support was also associated with subsequent antidepressant use.
This study used a cross-sectional analysis of DSM-IV mental disorders. The use of purchases of antidepressant as an indicator of depressive and anxiety disorders can result in an underestimation of the actual mental disorders.
Low social support, both at work and in private life, is associated with DSM-IV mental disorders, and low social support at work is also a risk factor for mental disorders treated with antidepressant medication.
The contribution of travel-related urban zones, cycling and pedestrian networks and green space to commuting physical activity among adults - a cross-sectional population-based study using geographical information systems.
The current political agenda aims to promote active environments and physical activity while commuting to work, but research on it has provided mixed results. This study examines whether the proximity of green space and people's residence in different travel-related urban zones contributes to commuting physical activity.
Population-based cross-sectional health examination survey, Health 2011 study, and geographical information system (GIS) data were utilized. The GIS data on green space and travel-related urban zones were linked to the individuals of the Health 2011 study, based on their home geocoordinates. Commuting physical activity was self-reported. Logistic regression models were applied, and age, gender, education, leisure-time and occupational physical activity were adjusted. Analyses were limited to those of working age, living in the core-urban areas of Finland and having completed information on commuting physical activity (n?=?2 098).
Home location in a pedestrian zone of a main centre (odds ratio?=?1.63; 95 % confidence interval?=?1.06-2.51) or a pedestrian zone of a sub-centre (2.03; 1.09-3.80) and higher proportion of cycling and pedestrian networks (3.28; 1.71-6.31) contributed to higher levels of commuting physical activity. The contribution remained after adjusting for all the environmental attributes and individuals. Based on interaction analyses, women living in a public transport zone were almost two times more likely to be physically active while commuting compared to men. A high proportion of recreational green space contributed negatively to the levels of commuting physical activity (0.73; 0.57-0.94) after adjusting for several background factors. Based on interaction analyses, individuals aged from 44 to 54 years and living in sub-centres, men living in pedestrian zones of sub-centres, and those individuals who are physically inactive during leisure-time were less likely to be physically active while commuting.
Good pedestrian and cycling infrastructure may play an important role in promoting commuting physical activity among the employed population, regardless of educational background, leisure-time and occupational physical activity. Close proximity to green space and a high proportion of green space near the home may not be sufficient to initiate commuting physical activity in Finland, where homes surrounded by green areas are often situated in car-oriented zones far from work places.
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BACKGROUND: The aim of the study was to compare elderly persons' self-reported use of physician services and associated sociodemographic factors and self-rated health in two Nordic countries with different health care systems, Finland and Norway. METHODS: Population based, cross-sectional surveys conducted in Norway (1995-97) and in Finland (1997) were employed. In the Norwegian data a total of 7,919 individuals, and in the Finnish data 1, 500 individuals, aged 65-74 years old were included in the samples. The outcome variables were having visited a general practitioner, a specialist or both during the past 12 months. Associations between utilization of physician's services and sociodemographic factors and self-rated health were analysed by multiple logistic regression. RESULTS: Approximately the same proportion of elderly in Norway and Finland reported having visited a physician during the previous 12 months. Finnish elderly more often visited a specialist compared to Norwegians. Self-rated health was strongly associated with visits to a specialist in both countries and to a GP in Norway. In Finland visits to a GP were only weakly connected with self-rated health. The use of specialist services increased with increasing education in both countries and in Finland the association was steeper than in Norway. Marital status was not consistently associated with visiting a physician. CONCLUSIONS: Higher rates of specialist care among the elderly in Finland may indicate a more efficient gate-keeping role among Norwegian general practitioners or inducement caused by two overlapping service sectors. Inconsistent associations between utilization and health variables may be due to cultural differences.
The aim of the study was to examine the association of childhood circumstances with overweight and obesity in early adulthood, to analyse whether the respondent's education and current circumstances mediate these associations, and to explore whether the respondent's health behaviour affects these associations.
This was a cross-sectional study with retrospective inquiries.
The study was based on a representative two-stage cluster sample (N= 1894, participation rate 79%) of young adults aged 18-29 years in Finland in 2000. The outcome measure was three-class body mass index (BMI) (normal weight, overweight, and obesity). Multinomial logistic regression was used as the main statistical tool.
In women, childhood circumstances (low parental education (relative risk ratio (RRR) = 2.43), parental unemployment (RRR= 2.09) and single-parent family (RRR= 1.99)) increased the risk of overweight (25 or = 30) in women in the age-adjusted models, and being bullied at school remained a significant predictor after adjusting for all childhood and current determinants. In both genders, the strong association between parental education and obesity remained significant after adjusting for all other determinants (for the lowest educational category, RRR= 3.56 in women, and RRR= 6.55 in men).
Childhood factors predict overweight and obesity in early adulthood. This effect is stronger on obesity than on overweight and in women than in men, and it seems to be partly mediated by adult circumstances. The results emphasize the lasting effect of childhood socioeconomic position on adult obesity. When preventive policies are being planned, social circumstances in childhood should be addressed.
In earlier studies, determinants of socioeconomic gradient in mobility have not been measured comprehensively.
To assess the contribution of chronic morbidity, obesity, smoking and physical workload to inequalities in mobility.
This was a cross-sectional study on 2572 persons (76% of a nationally representative sample of the Finnish population aged > or = 55 years). Mobility limitations were measured by self-reports and performance rates.
According to a wide array of self-reported and test-based indicators, persons with a lower level of education showed more mobility limitations than those with a higher level. The age-adjusted ORs for limitations in stair climbing were threefold in the lowest-educational category compared with the highest one (OR 3.3 in men and 2.9 in women for self-reported limitations, and 3.5 in men and 2.2 in women for test-based limitations). When obesity, smoking, work-related physical loading and clinically diagnosed chronic diseases were simultaneously accounted for, the educational differences in stair-climbing limitations vanished or were greatly diminished. In women, obesity contributed most to the differences, followed by a history of physically strenuous work, knee and hip osteoarthritis and cardiovascular diseases. In men, diabetes, work-related physical loading, musculoskeletal diseases, obesity and smoking contributed substantially to the inequalities.
Great educational inequalities exist in various measures of mobility. Common chronic diseases, obesity, smoking and workload appeared to be the main pathways from low education to mobility limitations. General health promotion using methods that also yield good results in the lowest-educational groups is thus a good strategy to reduce the disparities in mobility.
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Research demonstrates that migrants are more vulnerable to poor mental health than general populations, but population-based studies with distinct migrant groups are scarce. We aim to (1) assess the prevalence of mental health symptoms in Russian, Somali and Kurdish origin migrants in Finland; (2) compare the prevalence of mental health symptoms in these migrant groups to the Finnish population; (3) determine which socio-demographic factors are associated with mental health symptoms.
We used data from the Finnish Migrant Health and Wellbeing Study and Health 2011 Survey. Depressive and anxiety symptoms were measured using the Hopkins Symptom Checklist-25 (HSCL-25), and 1.75 was used as cut-off for clinically significant symptoms. Somatization was measured using the Symptom Checklist-90 (SCL-90) somatization scale. The age-adjusted prevalence of mental health symptoms in the studied groups was calculated by gender using predicted margins. Logistic regression analysis was used to determine which socio-demographic factors are associated with mental health symptoms in the studied population groups.
The prevalence of depressive and anxiety symptoms was higher in Russian women (24%) and Kurdish men (23%) and women (49%) than in the Finnish population (9-10%). These differences were statistically significant (p