Browsing by Subject "COUNTRIES"

Sort by: Order: Results:

Now showing items 1-20 of 65
  • Sadeniemi, Minna; Almeda, Nerea; Salinas-Perez, Jose A.; Gutierrez-Colosia, Mencia R.; Garcia-Alonso, Carlos; Ala-Nikkola, Taina; Joffe, Grigori; Pirkola, Sami; Wahlbeck, Kristian; Cid, Jordi; Salvador-Carulla, Luis (2018)
    Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.
  • Torlen, Klara; Kurland, Lisa; Castren, Maaret; Olanders, Knut; Bohm, Katarina (2017)
    Background: Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. Methods: A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study. Results: A total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively. Conclusion: In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.
  • Hemminki, Elina (2015)
    Background: The relevance and quantity of clinical research has caused concern and regulation is claimed to hinder clinical research. This paper compares clinical research regulations in Finland to those of England, Canada, and the USA around 2010-2011. Methods: Several approaches and data sources were used, including semi-or unstructured interviews of experts. For the analysis, a theoretical framework was made, data from various sources was synthesized, and features of the systems were simplified and classified. The various specific names and terms used in the data were changed into general ones. Results: Common structures for the regulation existed in all four countries, but the details and scope varied. The research regulated within the main system was determined by research type (Finland), the financer of the health system (England), or research site (Canada, USA). Only Finland had specific legislation on medical research. The overriding impression of the regulatory systems was one of complexity. All countries had extra regulation for drug research. The types of drug research covered varied from trials with unlicensed (new) products or new indications (USA and Canada), to all types of interventional drug research (England), where 'interventional' was interpreted broadly (Finland). The complexity of regulations had led to the creation of various big and small businesses to help researchers and sponsors. There was notable variation in the role played by the public research funder. The role played by health care was difficult to study and seemed to involve varying interests as researchers were also health care employees. Research ethics committees were important and their tasks also included aspects other than ethics. Conclusions: This study revealed that a comparison between countries can provide useful insights into the distinctive aspects of each country's system, as well as identifying common features that require international action.
  • Hellstrand, Julia Ingrid Sofia; Nisén, Jessica; Myrskylä, Mikko (2020)
    The ongoing period fertility decline in the Nordic countries is particularly strong in Finland, where the total fertility rate (TFR) reached an all-time low of 1.41 in 2018. We analyse the decrease in Finland's TFR in 2010–17, and assess its consequences for cohort fertility using complementary approaches. Decomposition of this fertility decline shows that first births and women aged <30 are making the largest contributions. However, women aged 30–39 are also, for the first time in decades, experiencing a sustained fertility decline. Tempo adjustments to the TFR suggest that quantum change is part of the decline. Several forecasting methods indicate that cohort fertility is likely to decline from the long-lasting level of 1.85–1.95 to 1.75 or lower among women born in the mid-1980s. Without an exceptionally strong recovery in fertility, Finnish cohort fertility is likely to decline to levels currently observed among countries with very low fertility.
  • But, Anna; De Bruin, Marie L.; Bazelier, Marloes T.; Hjellvik, Vidar; Andersen, Morten; Auvinen, Anssi; Starup-Linde, Jakob; Schmidt, Marjanka K.; Furu, Kari; de Vries, Frank; Karlstad, Oystein; Ekstrom, Nils; Haukka, Jari (2017)
    Aims/hypothesis The aim of this work was to investigate the relationship between use of certain insulins and risk for cancer, when addressing the limitations and biases involved in previous studies. Methods National Health Registries from Denmark (1996-2010), Finland (1996-2011), Norway (2005-2010) and Sweden (2007-2012) and the UK Clinical Practice Research Datalink database (1987-2013) were used to conduct a cohort study on new insulin users (N = 327,112). By using a common data model and semi-aggregate approach, we pooled individual-level records from five cohorts and applied Poisson regression models. For each of ten cancer sites studied, we estimated the rate ratios (RRs) by duration (6 years) of cumulative exposure to insulin glargine or insulin detemir relative to that of human insulin. Results A total of 21,390 cancer cases occurred during a mean follow-up of 4.6 years. No trend with cumulative treatment time for insulin glargine relative to human insulin was observed in risk for any of the ten studied cancer types. Of the 136 associations tested in the main analysis, only a few increased and decreased risks were found: among women, a higher risk was observed for colorectal (RR 1.54, 95% CI 1.06, 2.25) and endometrial cancer (RR 1.78, 95% CI 1.07, 2.94) for 6 years (RR 0.22, 95% CI 0.05, 0.92). Comparisons of insulin detemir with human insulin also showed no consistent differences. Conclusions/interpretation The present multi-country study found no evidence of consistent differences in risk for ten cancers for insulin glargine or insulin detemir use compared with human insulin, at follow-up exceeding 5 years.
  • Mikkola, T. M.; von Bonsdorff, M. B.; Osmond, C.; Salonen, M. K.; Kajantie, E.; Cooper, C.; Valimaki, M. J.; Eriksson, J. G. (2017)
    We examined the associations between childhood growth and bone properties among women at early old age. Early growth in height predicted greater bone area and higher bone mineral mass. However, information on growth did not improve prediction of bone properties beyond that predicted by body size at early old age. We examined the associations between body size at birth and childhood growth with bone area, bone mineral content (BMC), and areal bone mineral density (aBMD) in early old age. A subgroup of women (n = 178, mean 60.4 years) from the Helsinki Birth Cohort Study, born 1934-1944, participated in dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine and hip. Height and weight at 0, 2, 7, and 11 years, obtained from health care records, were reconstructed into conditional variables representing growth velocity independent of earlier growth. Weight was adjusted for corresponding height. Linear regression models were adjusted for multiple confounders. Birth length and growth in height before 7 years of age were positively associated with femoral neck area (p <0.05) and growth in height at all age periods studied with spine bone area (p <0.01). Growth in height before the age of 7 years was associated with BMC in the femoral neck (p <0.01) and birth length and growth in height before the age of 7 years were associated with BMC in the spine (p <0.05). After entering adult height into the models, nearly all associations disappeared. Weight gain during childhood was not associated with bone area or BMC, and aBMD was not associated with early growth. Optimal growth in height in girls is important for obtaining larger skeleton and consequently higher bone mass. However, when predicting bone mineral mass among elderly women, information on early growth does not improve prediction beyond that predicted by current height and weight.
  • Lohela, Terhi; Nesbitt, Robin Clark; Manu, Alexander; Vesel, Linda; Okyere, Eunice; Kirkwood, Betty; Gabrysch, Sabine (2016)
    Objectives To assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities. Design Cross-sectional Health Facility Assessment linked to population-based surveillance data. Setting 7 districts in Brong Ahafo region, Ghana. Participants Most experienced delivery care providers in all 64 delivery facilities in the 7 districts. Primary outcome measures Health worker competence in clinical vignette actions by cadre of delivery care provider and by type of facility. Competence was also compared with availability of relevant drugs and equipment, and to average annual workload per skilled birth attendant. Results Vignette scores were moderate overall, and differed significantly by respondent cadre ranging from a median of 70% correct among doctors, via 55% among midwives, to 25% among other cadres such as health assistants and health extension workers (p Conclusions Lack of competence might limit clinical practice even more than lack of relevant drugs and equipment. Cadres other than midwives and doctors might not be able to diagnose and manage delivery complications. Checking clinical competence through vignettes in addition to checklist items could contribute to a more comprehensive approach to evaluate quality of care.
  • Lahtinen, Katja; Hayrinen, Liina; Roos, Anders; Toppinen, Anne; Cabezas, Francisco X. Aguilar; Thorsen, Bo Jellesmark; Hujala, Teppo; Nyrud, Anders Q.; Hoen, Hans Fredrik (2021)
    So far, consumer housing values have not been addressed as factors affecting the market diffusion potential of multi-storey wood building (MSWB). To fill the void, this study addresses different types of consumer housing values in Denmark, Finland, Norway, and Sweden (i.e., Nordic region), and whether they affect the likelihood of prejudices against building with wood in the housing markets. The data collected in 2018 from 2191 consumers in the Nordic region were analyzed with exploratory factor analysis and logistic binary regression analysis. According to the results, consumers' perceptions on ecological sustainability, material usage and urban lifestyle were similar in all countries, while country-specific differences were detected for perceptions on aesthetics and natural milieus. In all countries, appreciating urban lifestyle and living in attractive neighborhoods with good reputation increased the likelihood of prejudices against wood building, while appreciation of aesthetics and natural milieus decreased the likelihood of prejudices. In strengthening the demand for MSWB and sustainable urbanization through actions in businesses (e.g., branding) and via public policy support (e.g., land zoning), few messages derive from the results. In all, abreast with the already existing knowledge on the supply side factors (e.g., wood building innovations), more customized information is needed on the consumer-driven issues affecting the demand potential of MSWB in the housing markets. This would enable, e.g., both enhancing the supply of wooden homes for consumers appreciating urban lifestyle and neighborhoods and fortifying positive image of wood among consumers especially appreciating good architecture and pleasant environmental milieus.
  • Adebayo, Folasade A.; Itkonen, Suvi T.; Koponen, Päivikki; Prättälä, Ritva; Härkänen, Tommi; Lamberg-Allardt, Christel; Erkkola, Maijaliisa (2017)
    Aims: We evaluated the consumption of healthy foods among Russian, Somali and Kurdish immigrants in Finland, and examined the relationship between socio-demographic factors and food consumption. Methods: We used data from the Migrant Health and Wellbeing Study (Maamu), a population-based health interview and examination survey in six different municipalities in Finland between 2010 and 2012. Altogether, 635 men and 737 women, aged 18-64 years, of Russian (n = 527), Somali (n = 337) and Kurdish (n = 508) origin were included. The important socio-demographic determinants of healthy food consumption - sex, age, education, place of residence and household size - were assessed by logistic regression. Results: Based on the consumption frequencies of recommended healthy foods - fruits, berries, vegetables, fish and rye bread - immigrants of Russian origin had higher consumption of healthy foods than their peers of Kurdish and Somali origin. Low consumption of fresh vegetables, fruits and berries was found among Somali immigrants. Sex and age were the most important determinants of healthy food consumption, as women and older age groups had diets closer to the national nutrition recommendations. High educational level was also positively associated with healthy food consumption. Conclusions: We found ethnic differences in the consumption of healthy foods among the immigrant groups of Russian, Somali and Kurdish origin in Finland. Socio-demographic factors, especially age, sex and education, seem to also play an important role in immigrants' food consumption. Further studies examining the consumption of fruits, berries and fresh vegetables among Somali immigrants in Finland are needed.
  • Rochette, Anne-Julie; Akpona, Jean Didier T.; Akpona, Hugues Adeloui; Akouehou, Gaston S.; Kwezi, Blanchard Mayundo; Djagoun, Chabi A. M. S.; Habonimana, Bernadette; Idohou, Rodrigue; Legba, Ingride S.; Nzigidahera, Benoit; Matilo, Augustin Orou; Taleb, Mohammed Sghir; Bamoninga, Benjamin Toirambe; Ivory, Sarah; de Bisthoven, Luc Janssens; Vanhove, Maarten P. M. (2019)
    There is an increasing need for monitoring schemes that help understand the evolution of the global biodiversity crisis and propose solutions for the future. Indicators, including temporal baselines, are crucial to measure the change in biodiversity over time, to evaluate progress towards its conservation and sustainable use and to set conservation priorities. They help design and monitor national and regional policies on biodiversity; they also feed into national reporting on international agreements such as the Convention on Biological Diversity and the Sustainable Development Goals. We analyse the methodological approach of five small African projects resulting from a call to promote indicator development, improve monitoring capacity and strengthen the science-policy interface in the field of biodiversity. We compared their approach to existing guidance provided by the international community, specifically the Biodiversity Indicators Partnership. To this end, we assess whether internationally recommended steps are effectively applied to national/local biodiversity monitoring in selected developing countries. We also present lessons learnt from workshop interactions between partners involved in these projects. Through our pilot projects we identified data availability and data accessibility, together with the involvement of stakeholders, as critical steps in indicator development. Moreover, there is a need for a better awareness and a wider application of the indicator concept itself. Hence, training of key actors both in the policy and science spheres is needed to operationalize indicators and ensure their continuity and sustainability. We hope that these case studies and lessons learnt can stimulate and support countries in the Global South to formulate policy-relevant biodiversity indicators.
  • Zamora-Ros, Raul; Cayssials, Valerie; Jenab, Mazda; Rothwell, Joseph A.; Fedirko, Veronika; Aleksandrova, Krasimira; Tjonneland, Anne; Kyro, Cecilie; Overvad, Kim; Boutron-Ruault, Marie-Christine; Carbonnel, Franck; Mahamat-Saleh, Yahya; Kaaks, Rudolf; Kuehn, Tilman; Boeing, Heiner; Trichopoulou, Antonia; Valanou, Elissavet; Vasilopoulou, Effie; Masala, Giovanna; Pala, Valeria; Panico, Salvatore; Tumino, Rosario; Ricceri, Fulvio; Weiderpass, Elisabete; Lukic, Marko; Sandanger, Torkjel M.; Lasheras, Cristina; Agudo, Antonio; Sanchez, Maria-Jose; Amiano, Pilar; Navarro, Carmen; Ardanaz, Eva; Sonestedt, Emily; Ohlsson, Bodil; Nilsson, Lena Maria; Rutegard, Martin; Bueno-de-Mesquita, Bas; Peeters, Petra H.; Khaw, Kay-Thee; Wareham, Nicholas J.; Bradbury, Kathryn; Freisling, Heinz; Romieu, Isabelle; Cross, Amanda J.; Vineis, Paolo; Scalbert, Augustin (2018)
    Polyphenols may play a chemopreventive role in colorectal cancer (CRC); however, epidemiological evidence supporting a role for intake of individual polyphenol classes, other than flavonoids is insufficient. We evaluated the association between dietary intakes of total and individual classes and subclasses of polyphenols and CRC risk and its main subsites, colon and rectum, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The cohort included 476,160 men and women from 10 European countries. During a mean follow-up of 14years, there were 5991 incident CRC cases, of which 3897 were in the colon and 2094 were in the rectum. Polyphenol intake was estimated using validated centre/country specific dietary questionnaires and the Phenol-Explorer database. In multivariable-adjusted Cox regression models, a doubling in total dietary polyphenol intake was not associated with CRC risk in women (HRlog2=1.06, 95% CI 0.99-1.14) or in men (HRlog2=0.97, 95% CI 0.90-1.05), respectively. Phenolic acid intake, highly correlated with coffee consumption, was inversely associated with colon cancer in men (HRlog2=0.91, 95% CI 0.85-0.97) and positively associated with rectal cancer in women (HRlog2=1.10, 95% CI 1.02-1.19); although associations did not exceed the Bonferroni threshold for significance. Intake of other polyphenol classes was not related to colorectal, colon or rectal cancer risks. Our study suggests a possible inverse association between phenolic acid intake and colon cancer risk in men and positive with rectal cancer risk in women.
  • Hagquist, Curt; Valimaa, Raili; Simonsen, Nina; Suominen, Sakari (2017)
    Although there is an increasing focus on trend analyses of adolescent mental health, yet too little attention is paid to the methodological challenges and pitfalls inherent in this type of analyses. The purpose of the study is to analyse the psychometric properties of a Finnish instrument on psychosomatic problems, with a major focus on Differential Item Functioning (DIF) across time. Questionnaire data collected in 1994, 1998, 2006 and 2014 among Finnish schoolchildren in grade 9 (15-year-olds) as part of the Health Behaviour in School-aged Children (HBSC) study were utilised. The polytomous Rasch model was used to examine the psychometric properties of a composite measure of psychosomatic problems. The results clearly indicate that the composite measure on psychosomatic problems consisting of nine items does not work invariantly over time. In particular, the item depressed shows DIF across years of investigations. This item works quite differently at the first year of investigation compared to the last year showing higher expected values 2014 (=less frequent problems) than 1994. This DIF affects the person measure of change in psychosomatic problems between 1994 and 2014. Resolving the item depressed for year of investigation DIF, or removing it, increases the difference in person mean values between the two years, implying increasing psychosomatic problems over time. Since the DIF affects the trend results, different options to address the problems need to be considered. Removing the item depressed would bring the Finnish measure of psychosomatic problems in better accordance with the content of the questions on psychosomatic problems in the international HBSC protocol in which the item depressed is not included.
  • Halonen, Jaana I.; Koskinen, Aki; Kouvonen, Anne Maria; Varje, Pekka; Pirkola, Sami Pekka; Väänänen, Ari (2018)
    Background It is unknown whether newer, mainly selective serotonin reuptake inhibitors, and older tricyclic antidepressants are used similarly regardless of the geographical area of residence and education. Methods We included four randomly sampled cohorts of the Finnish working aged population (n = 998,540–1,033,135). The sampling (Dec 31st in 1995, 2000, 2004 and 2010) resulted in non-overlapping time windows where each participant was followed up for four years for the first antidepressant use. Using Cox proportional hazards models, we examined whether the hazard of antidepressant use differed between the capital area and three other areas (Southern, Western and Northern/Eastern Finland). Educational differences were examined using four sub-groups: capital area/high education (reference category); other areas/high education; capital area/low education; and other areas/low education. Results Hazard ratios for the use of newer antidepressants were significantly lower in all other areas compared to the capital area after adjustment for age, sex, marital status, employment status, education, income, and area-level unemployment. Findings remained consistent in all time windows, differences increasing slightly. In the sub-group analysis those with low education had the lowest level of use in all areas, also within the capital area. The results were opposite for older antidepressants in all but the last time window. Limitations Some degree of unmeasured confounding and exposure misclassification is likely to exist. Conclusions Newer antidepressants were more commonly used in the capital than in the other areas, and among those with high versus low education. These differences in antidepressant use suggest socioeconomic inequalities in the mental health treatment quality.
  • Vahamurto, Lauri; Pahkala, Katja; Magnussen, Costan G.; Mikkilä, Vera; Hutri-Kahonen, Nina; Kahonen, Mika; Laitinen, Tomi; Taittonen, Leena; Tosavainen, Paivi; Lehtimaki, Terho; Jokinen, Eero; Telama, Risto; Ronnemaa, Tapio; Viikari, Jorma; Juonala, Markus; Raitakari, Olli (2016)
    Background: Coronary heart disease mortality has been internationally high in eastern Finland. The excessive mortality risk in Eastern compared with western Finns is explained by differences in cardiometabolic risk profile. Current risk profile differences and association with migration have not been reported. We examined the association of place of residence (east west) and specifically migration with cardiometabolic risk markers and carotid intima media thickness (IMT). Methods: The study population included 2204 participants with data available from childhood/youth in 1980 and follow-up examination in 2007. Results: Participants residing in eastern Finland in adulthood had 0.022 +/- 0.004mm higher IMT than Western participants. Those who migrated east-to-west had lower IMT than those staying in the east (0.027 +/- 0.006mm, p
  • Silventoinen, Karri; Jelenkovic, Aline; Latvala, Antti; Sund, Reijo; Yokoyama, Yoshie; Ullemar, Vilhelmina; Almqvist, Catarina; Derom, Catherine A.; Vlietinck, Robert F.; Loos, Ruth J. F.; Kandler, Christian; Honda, Chika; Inui, Fujio; Iwatani, Yoshinori; Watanabe, Mikio; Rebato, Esther; Stazi, Maria A.; Fagnani, Corrado; Brescianini, Sonia; Hur, Yoon-Mi; Jeong, Hoe-Uk; Cutler, Tessa L.; Hopper, John L.; Busjahn, Andreas; Saudino, Kimberly J.; Ji, Fuling; Ning, Feng; Pang, Zengchang; Rose, Richard J.; Koskenvuo, Markku; Heikkilä, Kauko; Cozen, Wendy; Hwang, Amie E.; Mack, Thomas M.; Siribaddana, Sisira H.; Hotopf, Matthew; Sumathipala, Athula; Rijsdijk, Fruhling; Sung, Joohon; Kim, Jina; Lee, Jooyeon; Lee, Sooji; Nelson, Tracy L.; Whitfield, Keith E.; Tan, Qihua; Zhang, Dongfeng; Llewellyn, Clare H.; Fisher, Abigail; Burt, S. Alexandra; Klump, Kelly L.; Knafo-Noam, Ariel; Mankuta, David; Abramson, Lior; Medland, Sarah E.; Martin, Nicholas G.; Montgomery, Grant W.; Magnusson, Patrik K. E.; Pedersen, Nancy L.; Aslan, Anna K. Dahl; Corley, Robin P.; Huibregtse, Brooke M.; OEncel, Sevgi Y.; Aliev, Fazil; Krueger, Robert F.; Mcgue, Matt; Pahlen, Shandell; Willemsen, Gonneke; Bartels, Meike; Van Beijsterveldt, Catharina E. M.; Silberg, Judy L.; Eaves, Lindon J.; Maes, Hermine H.; Harris, Jennifer R.; Brandt, Ingunn; Nilsen, Thomas S.; Rasmussen, Finn; Tynelius, Per; Baker, Laura A.; Tuvblad, Catherine; Ordonana, Juan R.; Sanchez-Romera, Juan F.; Colodro-Conde, Lucia; Gatz, Margaret; Butler, David A.; Lichtenstein, Paul; Goldberg, Jack H.; Harden, K. Paige; Tucker-Drob, Elliot M.; Duncan, Glen E.; Buchwald, Dedra; Tarnoki, Adam D.; Tarnoki, David L.; Franz, Carol E.; Kremen, William S.; Lyons, Michael J.; Maia, Jose A.; Freitas, Duarte L.; Turkheimer, Eric; Sorensen, Thorkild I. A.; Boomsma, Dorret I.; Kaprio, Jaakko (2017)
    Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990-1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
  • Vandenheede, Hadewijch; Deboosere, Patrick; Espelt, Albert; Bopp, Matthias; Borrell, Carme; Costa, Giuseppe; Eikemo, Terje Andreas; Gnavi, Roberto; Hoffmann, Rasmus; Kulhanova, Ivana; Kulik, Margarete; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Rodriguez-Sanz, Maica; Rychtarikova, Jitka; Mackenbach, Johan P.; EURO-GBD-SE Consortium (2015)
    To evaluate educational inequalities in diabetes mortality in Europe in the 2000s, and to assess whether these inequalities differ between genders. Data were obtained from mortality registries covering 14 European countries. To determine educational inequalities in diabetes mortality, age-standardised mortality rates, mortality rate ratios, and slope and relative indices of inequality were calculated. To assess whether the association between education and diabetes mortality differs between genders, diabetes mortality was regressed on gender, educational rank and 'gender x educational rank'. An inverse association between education and diabetes mortality exists in both genders across Europe. Absolute educational inequalities are generally larger among men than women; relative inequalities are generally more pronounced among women, the relative index of inequality being 2.8 (95 % CI 2.0-3.9) in men versus 4.8 (95 % CI 3.2-7.2) in women. Gender inequalities in diabetes mortality are more marked in the highest than the lowest educated. Education and diabetes mortality are inversely related in Europe in the 2000s. This association differs by gender, indicating the need to take the socioeconomic and gender dimension into account when developing public health policies.
  • Rydland, Håvard T.; Fjær, Erlend L.; Eikemo, Terje A.; Eikemo, Terje A.; Bambra, Clare; Wendt, Claus; Kulhánová, Ivana; Martikainen, Pekka; Dibben, Chris; Kalėdienė, Ramunė; Borrell, Carme; Leinsalu, Mall; Bopp, Matthias; Mackenbach, Johan P. (2020)
    Background Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types. Methods This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35–79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities. Results All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences. Conclusions This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.
  • Liira, Helena; Koskela, Tuomas; Thulesius, Hans; Pitkala, Kaisu (2016)
    Objective: Research and PhDs are relatively rare in family medicine and primary care. To promote research, regular one-year research courses for primary care professionals with a focus on clinical epidemiology were started. This study explores the academic outcomes of the first four cohorts of research courses and surveys the participants' perspectives on the research course. Design: An electronic survey was sent to the research course participants. All peer-reviewed scientific papers published by these students were retrieved by literature searches in PubMed. Setting: Primary care in Finland. Subjects: A total of 46 research course participants who had finished the research courses between 2007 and 2012. Results: Of the 46 participants 29 were physicians, eight nurses, three dentists, four physiotherapists, and two nutritionists. By the end of 2014, 28 of the 46 participants (61%) had published 79 papers indexed in PubMed and seven students (15%) had completed a PhD. The participants stated that the course taught them critical thinking, and provided basic research knowledge, inspiration, and fruitful networks for research. Conclusion: A one-year, multi-professional, clinical epidemiology based research course appeared to be successful in encouraging primary care research as measured by research publications and networking. Activating teaching methods, encouraging focus on own research planning, and support from peers and tutors helped the participants to embark on research projects that resulted in PhDs for 15% of the participants.
  • Adults Born Preterm Int Collaborat; Doyle, Lex W.; Andersson, Sture; Bush, Andy; Cheong, Jeanie L. Y.; Clemm, Hege; Evensen, Kari Anne I.; Gough, Aisling; Halvorsen, Thomas; Hovi, Petteri; Kajantie, Eero; Lee, Katherine J.; McGarvey, Lorcan; Narang, Indra; Näsänen-Gilmore, Pieta; Steinshamn, Sigurd; Vollsaeter, Maria; Vrijlandt, Elianne J. L. E. (2019)
    Background Maximal expiratory airflow peaks early in the third decade of life, then gradually declines with age. The pattern of airflow through adulthood for individuals born very preterm (at 2499 g) or at term. Methods We did a meta-analysis of individual participant data from cohort studies, mostly from the pre-surfactant era. Studies were identified through the Adults born Preterm International Collaboration and by searching PubMed and Embase (search date May 25, 2016). Studies were eligible if they reported on expiratory flow rates beyond 16 years of age in individuals born very preterm or with very low birthweight, as well as controls born at term or with normal birthweight. Studies with highly selected cohorts (eg, only participants with bronchopulmonary dysplasia) or in which few participants were born very preterm or with very low birthweight were excluded. De-identified individual participant data from each cohort were provided by the holders of the original data to a central site, where all the data were pooled into one data file. Any data inconsistencies were resolved by discussion with the individual sites concerned. Individual participant data on expiratory flow variables (FEV1, forced vital capacity [FVC], FEV1/FVC ratio, and forced expiratory flow at 25-75% of FVC [FEF25-75%]) were converted to Z scores and analysed with use of generalised linear mixed models in a one-step approach. Findings Of the 381 studies identified, 11 studies, comprising a total of 935 participants born very preterm or with very low birthweight and 722 controls, were eligible and included in the analysis. Mean age at testing was 21 years (SD 3.4; range 16-33). Mean Z scores were close to zero (as expected) in the control group, but were reduced in the very preterm or very low birthweight group for FEV1 (-0.06 [SD 1.03] vs -0.81 [1.33], mean difference -0.78 [95% CI -0.96 to -0.61], p Interpretation Individuals born very preterm or with very low birthweight are at risk of not reaching their full airway growth potential in adolescence and early adulthood, suggesting an increased risk of chronic obstructive pulmonary disease in later adulthood. Copyright (C) 2019 Elsevier Ltd. All rights reserved.
  • Zhang, Luyao; Yu, Hongyao; Hemminki, Otto; Försti, Asta; Sundquist, Kristina; Hemminki, Kari (2018)
    Familial risks for testicular cancer (TC) are among the highest of all cancers. However, data are limited for histological types of TC and for possible familial associations of TC with other cancers. We used the nationwide Swedish Family-Cancer Database for years 1958 to 2015 to analyse familial relative risks (RR) for 11,138 TC patients when first-degree relatives were diagnosed with TC or other cancer in reference to those without a family history. A total of 191 familial TCs were found, which accounted for 2.0% of all TC. The RR was 5.06 when one family member was diagnosed with TC with no significant difference between seminoma and nonseminoma. However, the risk for nonseminoma was 33.59 when two family members were affected. Internally consistent familial associations of TC, particularly of seminoma, were found with breast and nervous system cancers and melanoma. Individual significant associations were found for a number of sites, including ovarian, endometrial and prostate cancers. Our results suggest that nonseminoma may have a stronger genetic background than seminoma but seminoma shares more familial associations with discordant cancers. Clustering of TC with hormone-dependent cancers of the breast, ovary, endometrium and prostate may suggest mechanistic links and possibly gene-environment interactions.