Browsing by Subject "ADJUSTMENT"

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  • Matthews, David R.; Paldanius, Päivi M.; Stumvoll, Michael; Han, Jackie; Bader, Giovanni; Chiang, YannTong; Proot, Pieter; Del Prato, Stefano (2019)
    Aims To ensure the integrity of the planned analyses and maximize the clinical utility of the VERIFY study results by describing the detailed concepts behind its statistical analysis plan (SAP) before completion of data collection and study database lock. The SAP will be adhered to for the final primary data analysis of the VERIFY trial. Materials and Methods Vildagliptin efficacy in combination with metformin for early treatment of T2DM (VERIFY) is an ongoing, multicentre, randomized controlled trial aiming to demonstrate the clinical benefits of glycaemic durability and glucose control achieved with an early combination therapy in newly-diagnosed type 2 diabetes (T2DM) patients. Results The SAP was initially designed at the study protocol conception phase and later modified, as reported here, in collaboration between the steering committee members, statisticians, and the VERIFY study leadership team. All authors were blinded to treatment allocation. An independent statistician has additionally retrieved and presented unblinded data to the independent data safety monitoring committee. An overview of the trial design with a focus on describing the fine-tuning of the analysis plan for the primary efficacy endpoint, risk of initial treatment failure, and secondary, exploratory and pre-specified subgroup analyses is provided here. Conclusion According to optimal trial practice, the details of the statistical analysis and data-handling plan prior to locking the database are reported here. The SAP accords with high-quality standards of internal validity to minimize analysis bias and will enhance the utility of the reported results for improved outcomes in the management of T2DM.
  • Räisänen, Jouni (2017)
    An energy balance decomposition of temperature changes is conducted for idealized transient CO2-only simulations in the fifth phase of the Coupled Model Intercomparison Project. The multimodel global mean warming is dominated by enhanced clear-sky greenhouse effect due to increased CO2 and water vapour, but other components of the energy balance substantially modify the geographical and seasonal patterns of the change. Changes in the net surface energy flux are important over the oceans, being especially crucial for the muted warming over the northern North Atlantic and for the seasonal cycle of warming over the Arctic Ocean. Changes in atmospheric energy flux convergence tend to smooth the gradients of temperature change and reduce its land-sea contrast, but they also amplify the seasonal cycle of warming in northern North America and Eurasia. The three most important terms for intermodel differences in warming are the changes in the clear-sky greenhouse effect, clouds, and the net surface energy flux, making the largest contribution to the standard deviation of annual mean temperature change in 34, 29 and 20 % of the world, respectively. Changes in atmospheric energy flux convergence mostly damp intermodel variations of temperature change especially over the oceans. However, the opposite is true for example in Greenland and Antarctica, where the warming appears to be substantially controlled by heat transport from the surrounding sea areas.
  • Abdulhamed, Rekar; Lonka, Kirsti; Hietajärvi, Lauri; Ikonen, Riikka; Klemetti, Reija (2022)
    The focus in the present study is on how experienced discrimination, being able to discuss personal matters with parents, and having someone to discuss personal worries with relate to symptoms of depression and generalized anxiety among first-and second-generation immigrant background adolescents (aged 14-15) living in Finland. The data used was collected for the National School Health Promotion Study (2017) conducted by The Finnish Institute for Health and Welfare (N = 73,690). Mental health was assessed on the PHQ-2 (depression) and GAD-7 (generalized anxiety disorder) scales. The findings indicated that first-generation adolescents from immigrant families were significantly more likely than their second-generation counterparts to report mental-health symptoms, and they also provided worse scores on all measures examined. It was alarming that 42 per cent of the first-generation immigrant group reported that they could not discuss their personal worries with anyone, and more than one-fifth of these youth hardly ever talked about personal matters with their parents. Experienced discrimination was a slightly stronger predictor of generalized anxiety than depressive symptoms and it predicted both symptoms of depression and anxiety more prominently among first-generation immigrant adolescents compared with their second-generation counterparts. Being able to discuss personal matters with parents functioned as a protective factor with similar predictor values in both groups, whereas the possibility of having someone with whom to discuss personal worries was significantly associated to lower levels of anxiety only among first-generation immigrant adolescents.
  • Metsa-Simola, Niina S.; Remes, Hanna M.; Hiltunen, Elina M.; Martikainen, Pekka T. (2022)
    Background Symptoms of depression and anxiety are elevated among parents of children with cancer. However, knowledge of parents' psychotropic medication use following child's cancer diagnosis is scarce. Methods We use longitudinal Finnish register data on 3266 mothers and 2687 fathers whose child (aged 0-19) was diagnosed with cancer during 2000-2016. We record mothers' and fathers' psychotropic medication use (at least one annual purchase of anxiolytics, hypnotics, sedatives, or antidepressants) 5 years before and after the child's diagnosis and assess within-individual changes in medication use by time since diagnosis, cancer type, child's age, presence of siblings, and parent's living arrangements and education using linear probability models with the individual fixed-effects estimator. The fixed-effects models compare each parent's annual probability of psychotropic medication use after diagnosis to their annual probability of medication use during the 5-year period before the diagnosis. Results Psychotropic medication use was more common among mothers than fathers already before the child's diagnosis, 11.2% versus 7.3%. Immediately after diagnosis, psychotropic medication use increased by 6.0 (95% CI 4.8-7.2) percentage points among mothers and by 3.2 (CI 2.1-4.2) percentage points among fathers. Among fathers, medication use returned to pre-diagnosis level by the second year, except among those whose child was diagnosed with acute lymphoblastic leukemia or lymphoblastic lymphoma. Among mothers of children with a central nervous system cancer, medication use remained persistently elevated during the 5-year follow-up. For mothers with other under-aged children or whose diagnosed child was younger than 10 years, the return to pre-diagnosis level was also slow. Conclusions Having a child with cancer clearly increases parents' psychotropic medication use. The increase is smaller and more short-lived among fathers, but among mothers its duration depends on both cancer type and family characteristics. Our results suggest that an increased care burden poses particular strain to the long-term mental well-being of mothers.
  • Pylväläinen, Juho; Talala, Kirsi; Murtola, Teemu; Taari, Kimmo; Raitanen, Jani; Tammela, Teuvo L.; Auvinen, Anssi (2019)
    Purpose: To evaluate the performance of Charlson Comorbidity Index (CCI) calculated using hospitalization and medication reimbursement databases in predicting mortality. Patients and methods: Information on hospitalizations was obtained from the national Care Register for Health Care (HILMO) and on medication reimbursements and entitlements for special reimbursements for medications from the Social Insurance Institution for 77,440 men aged 56-71 years at baseline. The subjects were followed up for mortality via Statistics Finland with 20,562 deaths during a 13-year follow-up. Results: Compared to a CCI score of 0, the age-adjusted hazard ratio for all-cause mortality associated with HILMO-based CCI scores of 1, 2 and 3 or more were 2.39 (95% CI 2.29-2.49), 2.96 (95% CI 2.81-3.13) and 6.42 (95% CI 5.95-6.93) at 13 years. The C-statistic was 0.72 at 1, 0.68 at 5 and 0.66 at 13 years, with only minor improvement over age alone (0.10, 0.06 and 0.04 accordingly). Addition of medication data did not improve predictive abilities and medication-based CCI performed poorly on its own. Conclusion: The hospitalization-based CCI, as well as that based on both databases, predicts relative mortality adequately, but its discriminative ability diminishes over time. Conditions related to hospitalizations affect survival more than medications.
  • Lindfors, Olavi; Knekt, Paul; Lehtonen, Johannes; Virtala, Esa; Maljanen, Timo; Härkänen, Tommi (2019)
    The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20–45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.
  • Lindfors, Pirjo; Minkkinen, Jaana; Rimpelä, Arja; Hotulainen, Risto (2018)
    Research on the associations between family and school social capital, school burnout and academic achievement in adolescence is scarce and the results are inconclusive. We examined if family and school social capital at the age of 13 predicts lower school burnout and better academic achievement when graduating at the age of 16. Using data from 4467 Finnish adolescents from 117 schools and 444 classes a three-level multilevel analysis was executed. School social capital, the positive and supportive relationships between students and teachers, predicted lower school burnout and better academic achievement among students. Classmates' family social capital had also significance for students' academic achievement. Our results suggest that building school social capital is an important aspect of school health and education policies and practices.
  • Hellevuo, H.; Sainio, M.; Huhtala, H.; Olkkola, K. T.; Tenhunen, J.; Hoppu, S. (2018)
    BackgroundThe survival rate of cardiac arrest patients is increasing. Our aim was to compare the quality of life before and after cardiac arrest and analyse the factors associated with outcome. MethodsAll adult cardiac arrest patients admitted to the Tampere University Hospital intensive care unit between 2009 and 2011 were included in a retrospective follow-up study if surviving to discharge and were asked to return a questionnaire after 6 months. Data on patient demographics and pre-arrest quality of life were retrieved from medical records. Data are given as means (SD) or medians [Q(1), Q(3)]. We used logistic regression to identify factors associated with better quality of life after cardiac arrest. ResultsSix months after cardiac arrest, 36% (79/222) were alive and 70% (55/79) of those patients completed the follow-up EuroQoL (EQ-5D) quality of life questionnaire. Median values for the EQ-5D before and after cardiac arrest were 0.89 [0.63, 1] and 0.89 [0.62, 1], respectively (P = 0.75). Only the EQ-5D prior to cardiac arrest was associated with better quality of life afterwards (OR 1.2; 95% CI 1.0-1.3; P = 0.02). ConclusionsQuality of life remained good after cardiac arrest especially in those patients who had good quality of life before cardiac arrest.
  • Lahdenperä, Juulia; Nieminen, Juuso Henrik (2020)
    University mathematics has been described as a setting that has challenges in inviting everyone to be part of the mathematics community. Thus, university mathematics offers an important context for research on belonging. For this study, we utilised a mixed-methods approach to investigate the various ways mathematics students belong or do not belong to the mathematics community. Based on both quantitative and qualitative analyses, three student profiles were identified: Members of the Scientific Community, Members of the Social Community, and Non-Members. The first profile highlights students' belonging to the scientific community, the second profile emphasises belonging to the social community of students, and in the third profile students' responses reflected various ways of not belonging to the mathematics community. In addition, we elaborate on how university mathematics learning environments both promote and hinder students' sense of belonging. Overall, the study broadens the understanding of the ways of belonging in the mathematics context and provides suggestions for teaching to address the issues of exclusion that are currently present in the culture of university mathematics.
  • Salo, Saara Johanna; Lipsanen, Jari; Sourander, Johanna; Pajulo, Marjukka; Kalland, Mirjam (2022)
    Parent relationship satisfaction and parental reflective functioning (PRF) are significant factors in the transition to first-time parenting and are likely to affect a child's later wellbeing. However, little is known about their joint longitudinal effects from pregnancy onward. Starting in the prenatal period, this follow-up study of 1016 Finnish first-time parents (358 fathers and 658 mothers at baseline) examined the stability and the reciprocal associations between relationship satisfaction and PRF in predicting child behavioral problems (CBCL) at age 2. First, the results of the random-intercept cross-lagged panel models showed that both relationship satisfaction and PRF were stable from pregnancy onward for both mothers and fathers, with the exception of mothers' prenatal PRF. Second, there were significant reciprocal associations between low prenatal PRF and low relationship satisfaction at age 1, and vice versa. Third, for both mothers and fathers, a low level of relationship satisfaction, but not PRF, predicted consistently higher levels of child behavioral problems at age 2. These results suggest that parent relationship satisfaction and PRF are stable but largely independent parental factors during the transition to parenthood. In addition, our results highlight the significant role of parent relationship satisfaction in predicting toddler behavior problems, which indicates the relevance of early relationship-orientated help for first-time parents.
  • Mundy, Lisa K.; Canterford, Louise; Kosola, Silja; Degenhardt, Louisa; Allen, Nicholas B.; Patton, George C. (2017)
    OBJECTIVE: Peer victimization is a common antecedent of poor social and emotional adjustment. Its relationship with objectively measured academic performance is unclear. In this study we aimed to quantify the cross-sectional associations between peer victimization and academic performance in a large population sample of children. METHODS: Eight-to 9-year-old children were recruited from a stratified random sample of primary schools in Australia. Academic performance was measured on a national achievement test (1 year of learning equals 40 points). Physical and verbal victimization were measured according to child self-report. RESULTS: Multilevel mixed-effects linear regression analyses were conducted. For female children, verbal victimization was associated with poorer academic performance on writing (beta = 17.2; 95% confidence interval [CI], 28.2 to 6.2) and grammar/punctuation (beta = 20.8; 95% CI, 40.1 to 1.6). Physical victimization was associated with poorer performance on numeracy (male children: = 29.0; 95% CI, 53.8 to 4.1; female children: beta = 30.1; 95% CI, 56.6 to 3.5), and writing (female children: beta = -21.5; 95% CI, 40.4 to -2.7). Verbal and physical victimization were associated with poorer performance on reading (male children: beta = -31.5; 95% CI, -59.9 to -3.1; female children: beta = -30.2; 95% CI, -58.6 to -1.8), writing (female children: beta = 25.5; 95% CI, 4-2.8 to -8.2), spelling (female children: beta = -32.3; 95% CI, -59.6 to -4.9), and grammar/punctuation (female children: beta = -32.2; 95% CI, -62.4 to -2.0). CONCLUSIONS: Children who were physically victimized were 6 to 9 months behind their non-victimized peers on measures of academic performance. There are growing reasons for education systems to invest in the prevention of bullying and promotion of positive peer relationships from the earliest years of school.
  • Saarelainen, Suvi-Maria; Vähäkangas, Auli; Anttonen, Mirja Sisko (2020)
    Increasingly more older people are now being cared for in their own homes. Furthermore, it has become more common that people stay at home to receive end-of-life care. Using interpretative phenomenological analysis (IPA), we analyzed the religious experiences of older people (aged 65+). We answered these questions: What kind of religious experiences do older people have when death is approaching? What does this tell us about their religious coping? As IPA is based on the in-depth analysis of small amounts of homogenous data, we analyzed five interviews with older people who were dying. We identified three main themes. First, religious experiences are relational, that is, deeply rooted in personal relationships. Second, religious experiences are real and can provide both struggles and comfort in the last stage of life. Third, the experience of encountering one's mortality and planning for one's death was calming; while many had unclear views on the afterlife, the idea of continuing bonds after death was comforting. More open discussion on religious matters, death, and dying would be welcomed as part of home-based end-of-life care.
  • Salakari, Minna; Pylkkänen, Liisa; Sillanmäki, Lauri; Nurminen, Raija; Rautava, Päivi; Koskenvuo, Markku; Suominen, Sakari (2017)
    Objectives: Among breast cancer (BC) survivors, inadequate social support (SS) is associated with a significant increase in cancer-related mortality and reduction in quality of life (QoL). The aim of the study was to explore perceived SS during BC trajectory by comparing BC survivors, women with depression, women with arterial hypertension, and healthy female controls to each other, and to compare perceived balance of receiving and providing SS. Material and methods: The data of ongoing prospective postal survey was linked with national health registries. Respondents with BC (n = 64), depression (n = 471), arterial hypertension (n = 841) and healthy controls (n = 6274) formed the study population. SS was measured by a Sarason's 6-item shortened version of the Social Support Questionnaire (SSQ). The modified Antonucci's (1986) social support convoy model of the network of individuals was used to measure the dominating direction of SS. Results: The main provider of SS for all participants combined was the spouse or partner (94.3%), close relative (12.0%) and friends (5.4%). In all groups, particularly in the BC and arterial hypertension group, spouse or partner was seen as the most important supporter. The group suffering from depression reported significantly less SS in each domain of appraisal (p <0.001). In total, 24.6% of all respondents reported receipt dominance of SS. Conclusion: SS is a well-known determinant of wellbeing. Our study lends support to the spouse's or the partner's central role during the recovery phase of BC. Identification of factors improving the overall QoL of BC survivors is an important public health challenge. (C) 2017 Elsevier Ltd. All rights reserved.