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Despite uncertain benefits, antidepressants are used in the management of personality disorders (PDs). We investigated the association between antidepressants and two adverse outcomes - suicidal behaviour and violent crimes - in individuals with PDs. We used nationwide Danish healthcare registries to identify all individuals with a diagnosed PD aged 18-64 years from 2007 to 2016. Antidepressant use was identified using dispensed prescriptions. Individuals were followed up for healthcare presentations of suicidal behaviour and separately for police-recorded charges of violent crimes. We applied a within-individual design comparing rates of suicidal behaviour and violent crimes during time periods of antidepressant treatment with periods without treatment. Subgroup analyses were performed according to PD clusters, individual antidepressants, specific PDs, psychiatric comorbidities, and history of suicidal behaviour and violent crime. The cohort included 167,319 individuals with a diagnosed PD, 19,519 (12%) of whom were prescribed antidepressants and presented at least one outcome event during follow-up, making them eligible for within-individual analyses. Overall, we found an association with lower rates of suicidal behavior during periods of antidepressant treatment, compared with periods when individuals were not on antidepressants (incidence rate ratio 0.86, 95% CI 0.84-0.89). However, this association was modified by specific PDs, individual antidepressants, comorbidities, and past history. For violent crimes, we did not observe consistent associations in any direction. Antidepressants were associated with lower rates of suicidal behaviour, but less clearly in violent crimes. Types of PDs, individual antidepressants, and comorbidities modified these associations.

Background Fatigue is a concern in ferry shipping as it has a negative impact on crew members health and plays a major role in marine incidents and accidents. Research within land-based occupational settings has found that work-family conflict is an important risk factor for fatigue and that support from leaders constitutes a possible resource with the potential to buffer a negative impact from work-family conflict. Though, the working conditions of ferry shipping are likely to interfere with employee’s family life those two factors have received little attention in research on seafarers’ health. Therefore, the aim of this study was to investigate the direct associations between work-family conflict as well as leaders’ support with fatigue in employees of the Danish ferry shipping industry. Further, the study aimed at testing whether support could buffer potential detrimental associations between work-family conflict and fatigue. Methods The study design was cross-sectional, and 193 respondents answered to a self-administered questionnaire. Fatigue was measured with the Swedish Occupational Fatigue Inventory. Perceived work-family conflict and perceived supervisor support were assessed with two subscales from the Copenhagen Psychosocial Questionnaire. The association of potential risk factors with fatigue was determined using hierarchical multiple linear regression analyses. Results After controlling for confounding, work-family conflict was found to be positively associated with four of the five subdimensions of fatigue; lack of energy, physical discomfort, lack of motivation and sleepiness, while more support from supervisors was related to less lack of energy, physical exhaustion and lack of motivation. Further, supervisor support was found to moderate the effect from work-family conflict on the physical subdimensions of fatigue. Conclusion Although restricted by its cross-sectional design and a limited sample, this study provides support for the independent relevance of work family conflict and support from nearest superior for employee fatigue in ferry shipping. Further, there was evidence for a moderating role of such support on the negative impact of work-family conflict on the physical aspects of fatigue. Shipping companies may consider commencing initiatives which reduce conflicts between family life and work obligations, and that leader support may be a relevant component in such initiatives.

Background There is still controversy over the clinical interpretation of the association between metabolic syndrome (MetS) and serum uric acid (SUA) levels. Therefore, the aim of this study was to investigate the association of SUA levels with MetS and other cardio-metabolic risk factors (CMRF) in seafarers working on tankers. Methods This cross-sectional study was conducted in 2015 and included 234 male seafarers working on tankers. The participants were divided into three groups based on the tertiles of SUA. The report from of the National Committee of Obesity was used to define the MetS. The relationship between SUA, CMRF and MetS adjusted for age, educational level, job history, shift work, smoking and BMI was assessed by logistic regression analysis. Results The subjects were aged 36.0 ± 10.3 years (mean ± SD). A notable upward trend was observed in mean weight, body mass index (BMI), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL) and very low-density lipoprotein (VLDL) as tertiles of SUA increased ( P  < 0.001). In all models of the logistic regression analyses, the odds ratio (OR) of high TG for participants in the 3rd tertile of SUA was four times higher than that for participants in the 1st tertile of SUA ( P  < 0.001). The odds ratio of high TC and the SUA levels increased, so that the odds ratio of high TC for participants in the 2nd tertile was 2.47 (95% CI: 1.10–5.53) ( P  < 0.05) as compared with that for participants in the 1st tertile. Significant association was observed between MetS and the levels of SUA; 6.10 (95% CI: 1.77–20.94) ( P  < 0.05). Conclusions Findings revealed that SUA levels were associated with MetS, high TG and high TC. Therefore, it is recommended that clinical attention should be given to symptoms related to elevated SUA - being one of the most important remediable risk factors for MetS - in the annual medical examinations of seafarers.

Background Although there are numerous studies on the global prevalence of cardiometabolic risk factors (CMRFs) in military personnel, the pooled prevalence of CMRFs in this population remains unclear. We aimed to systematically review the literature on the estimation of the global prevalence of CMRFs in the military population. Methods We simultaneously searched PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS with using standard keywords. All papers published up to March 2018 were reviewed. Two independent reviewers assessed papers and extracted the data. Chi-square-based Q test was used to assess the heterogeneity of reported prevalence among studies. The overall prevalence of all CMRFs, including overweight, obesity, high low-density lipoprotein (LDL), high total cholesterol (TC), high triglyceride (TG), low high-density lipoprotein (HDL), hypertension (HTN) and high fasting blood sugar (FBS) was estimated by using the random effects meta-analysis. A total of 37 studies met the eligibility criteria and were included in the meta-analysis. Results According the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of MetS, high LDL, high TC, high TG, low HDL and high FBS were 21% (17–25), 32% (27–36), 34% (10–57), 24% (16–31), 28% (17–38) and 9% (5–12), respectively. Moreover, global pooled prevalence of overweight, generalized obesity, abdominal obesity and HTN were estimated to be 35% (31–39), 14% (13–16), 29% (20–39) and 26 (19–34), respectively. Conclusions The overall prevalence of some cardio-metabolic risk factors was estimated to be higher in military personnel. Therefore, the necessary actions should be taken to reduce risk of developing cardiovascular diseases. Systematic review registration number in PROSPERO CRD42018103345

BackgroundPrices of alcohol and income tend to influence how much people buy and consume alcohol. Price and income may be combined into one measure, affordability of alcohol. Research on the association between affordability of alcohol and alcohol-related harm is scarce. Furthermore, no research exists on how this association varies across different subpopulations. We estimated the effects of affordability of alcohol on alcohol-related mortality according to gender and education in Finland and Sweden.MethodsVector-autoregressive time series modelling was applied to the quarter-annual aggregations of alcohol-related deaths and affordability of alcohol in Finland in 1988–2007 and in Sweden in 1991–2008. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. We calculated affordability of alcohol index using information on personal taxable income and prices of various types of alcohol.ResultsAmong Finnish men with secondary education, an increase of 1% in the affordability of total alcohol was associated with an increase of 0.028% (95% CI 0.004 to 0.053) in alcohol-related mortality. Similar associations were also found for affordability for various types of alcohol and for beer only in the lowest education group. We found few other significant positive associations for other subpopulations in Finland or Sweden. However, reverse associations were found among secondary-educated Swedish women.ConclusionsOverall, the associations between affordability of alcohol and alcohol-related mortality were relatively weak. Increased affordability of total alcoholic beverages was associated with higher rates of alcohol-related mortality only among Finnish men with secondary education.

Background The prevalence of musculoskeletal disorders (MSDs) among occupational fishers is high, yet knowledge of the risk factors is scarce and inconsistent. The aim of this study was to investigate the risk from various work-related characteristics on incident hospital contact due to a musculoskeletal disorders and other pain disorders among Danish occupational fishers. Methods This register-based study comprised data from the Danish Occupational Cohort with eXposure (DOC*X) for all persons registered as occupational fishers between 1994 and 2017. Time-to-event analysis with Cox regression model was used with age as the time scale. Results Among the 15,739 fishers, 40% (n = 5,669 cases) had an incident hospital contact with an MSD during follow-up. Back disorders were the dominant complaint. Male fishers working less than 5 years or more than 15 years had higher risks of MSD (HR 2.40 (95% CI: 2.06, 2.80), HR: 2.04 (95% CI: 1.76, 2.35), respectively, than those working for over 20 years. Period effects confounded and reduced the risk from occupational seniority. Conclusion Fishers occupational seniority vary in risk of MSDs across working life. Results showed a nonlinear relationship between the highest risk for fishers working less than 5 years and the lowest risk working more than 20 years as occupational fisher. More years in the workforce, a captain education, and primarily working part time significantly reduced the risk of experiencing a first MSDs for men. Healthy worker effect was documented.

BackgroundBipolar disorder (BD) is associated with increased mortality, but evidence on cause-specific mortality is limited.ObjectiveTo investigate cause-specific premature excess mortality in BD.MethodsFinnish nationwide cohort study of individuals with and without a diagnosis of BD who were aged 15–64 years during 2004–2018. Standardised mortality ratios (SMRs) with 95% CIs were calculated for BD using the mortality rates in the Finnish general population without BD as weights. Causes of death were defined by the International Classification of Diseases, 10th revision codes.FindingsOf the included 47 018 individuals with BD, 3300 (7%) died during follow-up. Individuals with BD had sixfold higher mortality due to external causes (SMR: 6.01, 95% CI: 5.68, 6.34) and twofold higher mortality due to somatic causes (SMR: 2.06, 95% CI: 1.97, 2.15). Of the deaths due to external causes, 83% (1061/1273) were excess deaths, whereas 51% (1043/2027) of the deaths due to somatic causes were excess. About twice the number of potential years of life were lost in excess due to external causes than due to somatic causes. Alcohol-related causes contributed more to excess mortality than deaths due to cardiovascular disease.ConclusionExternal causes of death contributed more to the mortality gap than somatic causes after controlling for age-specific background general population mortality.Clinical implicationA balanced consideration between therapeutic response, different treatment options and risk of cause-specific mortality is needed to prevent premature mortality in BD and to reduce the mortality gap.

ObjectivesCharacterisation of worker injuries on board merchant ships is modest. Using telemedical service contacts in Denmark, we describe the worker injuries patterns and factors related to injury incidence.MethodsThe data for this study were based on contacts (n=1401) from ships to Telemedical Assistance Service (TMAS) in Denmark in 2004–2014, which were supplemented with data on the annual estimation of all seafarers from the Danish Maritime Authority (n=73 336). The final data included information on broad age groups, occupation and nationality. The outcomes were injuries from any cause and six broad categories of injuries characterised by anatomic location or type of injury.ResultsDuring the observation period of 11 years, there were 1401 contacts to TMAS due to injuries, of which 36% were in upper limb, 18% in lower limb and 13% in the head. Age-adjusted incidence rates for all injuries varied between 13.6 and 26.8 incidences per 1000 person-years in 2004–2014. In most types of injuries, younger and older seafarers had higher risk for injuries than seafarers aged 30–49 years. Depending on the type of injury, non-officers had threefold to fivefold increased odds of injuries compared with officers, the risk being highest for head injuries with an OR of 5.00 (95% CI 3.19 to 7.83). Non-officers from the European Union (EU) had higher risk in most types of injuries than non-officers from outside the EU, whereas the pattern of this risk was inverse among officers.ConclusionsThese findings suggest that non-officers and European seafarers have an increased risk for several types of injuries on board Danish-flagged merchant ships. Additionally, age affected risk with the younger (<30 years) and older (>50 years) seafarers having increased risk.

Social isolation and living alone are increasingly common in industrialised countries. However, few studies have investigated the potential public health implications of this trend. We estimated the relative risk of death from alcohol-related causes among individuals living alone and determined whether this risk changed after a large reduction in alcohol prices. We conducted a population-based natural experimental study of a change in the price of alcohol that occurred because of new laws enacted in Finland in January and March of 2004, utilising national registers. The data are based on an 11% sample of the Finnish population aged 15-79 y supplemented with an oversample of deaths. The oversample covered 80% of all deaths during the periods January 1, 2000-December 31, 2003 (the four years immediately before the price reduction of alcohol), and January 1, 2004-December 31, 2007 (the four years immediately after the price reduction). Alcohol-related mortality was defined using both underlying and contributory causes of death. During the 8-y follow-up about 18,200 persons died due to alcohol-related causes. Among married or cohabiting people the increase in alcohol-related mortality was small or non-existing between the periods 2000-2003 and 2004-2007, whereas for those living alone, this increase was substantial, especially in men and women aged 50-69 y. For liver disease in men, the most common fatal alcohol-related disease, the age-adjusted risk ratio associated with living alone was 3.7 (95% confidence interval 3.3, 4.1) before and 4.9 (95% CI 4.4, 5.4) after the price reduction (p<0.001 for difference in risk ratios). In women, the corresponding risk ratios were 1.7 (95% CI 1.4, 2.1) and 2.4 (95% CI 2.0, 2.9), respectively (p ≤ 0.01). Living alone was also associated with other mortality from alcohol-related diseases (range of risk ratios 2.3 to 8.0) as well as deaths from accidents and violence with alcohol as a contributing cause (risk ratios between 2.1 and 4.7), both before and after the price reduction. Living alone is associated with a substantially increased risk of alcohol-related mortality, irrespective of gender, socioeconomic status, or the specific cause of death. The greater availability of alcohol in Finland after legislation-instituted price reductions in the first three months of 2004 increased in particular the relative excess in fatal liver disease among individuals living alone.

Long-term employment trajectories of young problem drinkers are poorly understood. We constructed retrospective labour market participation histories at ages 18-34 of 64 342 persons born in 1969-1982. Beginning from the year of each subject's 18th birthday, we extracted information from the records of Statistics Finland on educational attainment, main type of economic activity, months in employment, and months in unemployment for a minimum of seven years (range 7-16 years). We used information on the timing of alcohol-related hospitalizations and deaths in the same period to define problem drinkers with early onset limited course, early onset persistent course, and late onset problem drinking. Early onset limited course problem drinkers improved their employment considerably by age, whereas early onset persistent problem drinkers experienced a constant decline in their employment by age. From the age of 18 to 34, early onset persistent problem drinkers were in employment merely 12% of the time, in comparison with 39% among the early onset limited course problem drinkers, and 58% among the general population. These results indicate that young adults who were retrospectively defined as having early onset persistent course problem drinking were extensively marginalized from the labour market early on during their life course, and that their employment trajectory was significantly worse compared to other problem drinkers.