Browsing by Subject "LEVEL"

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  • Peddinti, Gopal; Bergman, Michael; Tuomi, Tiinamaija; Groop, Leif (2019)
    Context: Early prediction of dysglycemia is crucial to prevent progression to type 2 diabetes. The 1-hour postload plasma glucose (PG) is reported to be a better predictor of dysglycemia than fasting plasma glucose (FPG), 2-hour PG, or glycated hemoglobin (HbA1c). Objective: To evaluate the predictive performance of clinical markers, metabolites, HbA1c, and PG and serum insulin (INS) levels during a 75-g oral glucose tolerance test (OGTT). Design and Setting: We measured PG and INS levels at 0, 30, 60, and 120 minutes during an OGTT in 543 participants in the Botnia Prospective Study, 146 of whom progressed to type 2 diabetes within a 10-year follow-up period. Using combinations of variables, we evaluated 1527 predictive models for progression to type 2 diabetes. Results: The 1-hour PG outperformed every individual marker except 30-minute PG or mannose, whose predictive performances were lower but not significantly worse. HbA1c was inferior to 1-hour PG according to DeLong test P value but not false discovery rate. Combining the metabolic markers with PG measurements and HbA1c significantly improved the predictive models, and mannose was found to be a robust metabolic marker. Conclusions: The 1-hour PG, alone or in combination with metabolic markers, is a robust predictor for determining the future risk of type 2 diabetes, outperforms the 2-hour PG, and is cheaper to measure than metabolites. Metabolites add to the predictive value of PG and HbA1c measurements. Shortening the standard 75-g OGTT to 1 hour improves its predictive value and clinical usability.
  • Salminen, Liina; Nadeem, Nimrah; Jain, Shruti; Grènman, Seija; Carpén, Olli; Hietanen, Sakari; Oksa, Sinikka; Lamminmäki, Urpo; Pettersson, Kim; Gidwani, Kamlesh; Huhtinen, Kaisa; Hynninen, Johanna (2020)
    Objective. Cancer antigen 125 (CM 25) is generally considered the gold standard of biomarkers in the diagnosis and monitoring of high grade serous ovarian carcinoma (HGSC). We recently reported, that two CM 25 glycoforms (CA125-STn and CA125-MGL) have a high specificity to HGSC and further hypothesized, that these cancer specific glycoforms are feasible candidates as biomarkers in HGSC treatment and follow up. Methods. Our cohort consisted of 122 patients diagnosed with HGSC. Serum samples were collected longitudinally at the time of diagnosis, during treatment and follow up. Serum levels of CA125, CM 25-STn and CA125MGL were determined and compared or correlated with different end points (tumor load assessed intraoperatively, residual disease, treatment response, progression free survival). Results. Serum CA125-STn levels at diagnosis differentiated patients with low tumor load and high tumor load (p = 0,030), indicating a favorable detection of tumor volume. Similarly, the CA125-STn levels at diagnosis were significantly lower in patients with subsequent complete cytoreduction than in patients with suboptimal cytoreduction (p = 0,025). Conventional CA125 did not differentiate these patients (p = 0,363 and p = 0,154). The CA125-STn nadir value predicted the progression free survival of patients. The detection of disease relapse was improved with CA125-STn, which presented higher fold increase in 80,0% of patients and earlier increase in 37,0% of patients. Conclusions. CA125-STn showed promise as a useful biomarker in the monitoring and follow up of patients with HGSC utilizing a robust and affordable technique. Our findings are topical as a suitable indicator of tumor load facilitates patient selection in an era of new targeted therapies. (C) 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
  • Renkonen, Suvi; Linden, Riikka; Bäck, Leif; Silen, Robert; Mäenpää, Hanna; Tapiovaara, Laura; Aro, Katri (2017)
    Primary treatment of papillary thyroid carcinoma (PTC) with lateral lymph node metastasis is surgery, but the extent of lateral neck dissection remains undefined. Preoperative imaging is used to guide the extent of surgery, although its sensitivity and specificity for defining the number and level of affected lymph nodes on the lateral neck is relatively modest. Our aim was to assess the role of preoperative magnetic resonance imaging (MRI) in predicting the requisite levels of neck dissection in patients with regionally metastatic PTC, with a focus on Levels II and V. All patients with PTC and lateral neck metastasis who had undergone neck dissection at the Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland from 2013 to 2016 and had a preoperative MRI available were retrospectively reviewed. A head and neck radiologist re-evaluated all MRIs, and the imaging findings were compared with histopathology after neck dissection. In the cohort of 39 patients, preoperative MRI showed concordance with histopathology for Levels II and V as follows: sensitivity of 94 and 67%, specificity of 20 and 91%, positive predictive value of 56 and 75%, and negative predictive value of 75 and 87%, respectively. In PTC, MRI demonstrated fairly high specificity and negative predictive value for Level V metastasis, and future studies are needed to verify our results to omit prophylactic dissection of this level. Routine dissection of Level II in patients with regionally metastatic PTC needs to be considered, as MRI showed low specificity.
  • Vastaranta, Mikko; Yrttimaa, Tuomas; Saarinen, Ninni; Yu, Xiaowei; Karjalainen, Mika; Nurminen, Kimmo; Karila, Kirsi; Kankare, Ville; Luoma, Ville; Pyörälä, Jiri; Junttila, Samuli; Tanhuanpaa, Topi; Kaartinen, Harri; Kukko, Antero; Honkavaara, Eija; Jaakkola, Anttoni; Liang, Xinlian; Wang, Yunsheng; Vaaja, Matti; Hyyppä, Hannu; Katoh, Masato; Wulder, Michael A.; Holopainen, Markus; Hyyppä, Juha (2018)
    The objective of this study is to better understand the relationship between forest structure and point cloud features generated from certain airborne and space borne sensors. Point cloud features derived from airborne laser scanning (ALS), aerial imagery (AI), WorldView-2 imagery (WV2), TerraSAR-X, and Tandem-X (TDX) data were classified as features characterizing forest height and density as well as variation in tree height. Correlations between these features and field-measured attributes describing forest height, density and tree height variation were investigated at plot scale. From the field-measured attributes, basal area (G) and the number of trees per unit area (N) were used as forest density indicators whereas maximum tree height (H-max) and standard deviation in tree height (H-std) were used as indicators for forest height and tree height variation, respectively. In the analyses, field observations from 91 sample plots (32 m x 32 m) located in southern Finland were used. Even though ALS was found to be the most accurate data source in characterizing forest structure, AI, WV2, and TDX were also capable of characterizing forest height at plot scale with correlation coefficients stronger than 0.85. However, ALS was the only data source capable of providing separate features for characterizing also the variation in tree height and forest density. Features related to forest height, generated from the other data sources besides ALS, also provided strongest correlation with the forest density attributes and variation in tree height, in addition to H-max. Due to these more diverse characterization capabilities, forest structural attributes can be predicted more accurately by using ALS, also in the areas where the relation between the attributes of interest is not solely dependent on forest height, compared to the other investigated 3D remote sensing data sources.
  • Yu, Xiaowei; Litkey, Paula; Hyyppa, Juha; Holopainen, Markus; Vastaranta, Mikko (2014)
  • Niskanen, Mirka Carita; Mattila, Pauli Taneli; Niinimaa, Ahti Olavi; Vehkalahti, Miira Marjaliisa; Knuuttila, Matti (2020)
    Objective: The aim was to evaluate the association of behavioural and socioeconomic factors with the occurrence of periodontal disease and dental caries, paying special attention to the simultaneous occurrence of these diseases. Materials and methods: The study population consisted of 5255 dentate persons aged >= 30 years from a nationally representative survey. Caries and probing pocket depth were recorded by tooth and calculated in relation to the number of existing teeth. The groups were: non-affected (A), the two most affected quintiles for periodontal disease with little or no dental caries (B), the two most affected quintiles for dental caries with little or no periodontal disease (C) and the two most affected quintiles for both periodontal disease and dental caries (D). Presence of dental plaque was determined, and behavioural and socioeconomic factors were established. Results: Dental plaque, smoking, lack of regular dental check-ups, older age and a basic level of education were strongly associated with the simultaneous occurrence of periodontal disease and dental caries. Conclusions: There are many behavioural and socioeconomic factors that associate with the occurrence of both periodontal disease and dental caries. These factors also increase the risk of individuals having these diseases simultaneously.
  • Liang, Yajun; Ngandu, Tiia; Laatikainen, Tiina; Soininen, Hilkka; Tuomilehto, Jaakko; Kivipelto, Miia; Qiu, Chengxuan (2020)
    Background Very few studies have explored the patterns of cardiovascular health (CVH) metrics in midlife and late life in relation to risk of dementia. We examined the associations of composite CVH metrics from midlife to late life with risk of incident dementia. Methods and findings This cohort study included 1,449 participants from the Finnish Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study, who were followed from midlife (baseline from1972 to 1987; mean age 50.4 years; 62.1% female) to late life (1998), and then 744 dementia-free survivors were followed further into late life (2005 to 2008). We defined and scored global CVH metrics based on 6 of the 7 components (i.e., smoking, physical activity, and body mass index [BMI] as behavioral CVH metrics; fasting plasma glucose, total cholesterol, and blood pressure as biological CVH metrics) following the modified American Heart Association (AHA)'s recommendations. Then, the composite global, behavioral, and biological CVH metrics were categorized into poor, intermediate, and ideal levels. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Data were analyzed with Cox proportional hazards and the Fine and Gray competing risk regression models. During the follow-up examinations, dementia was diagnosed in 61 persons in 1998 and additional 47 persons in 2005 to 2008. The fully adjusted hazard ratio (HR) of dementia was 0.71 (95% confidence interval [CI]: 0.43, 1.16; p = 0.174) and 0.52 (0.29, 0.93; p = 0.027) for midlife intermediate and ideal levels (versus poor level) of global CVH metrics, respectively; the corresponding figures for late-life global CVH metrics were 0.60 (0.22, 1.69; p = 0.338) and 0.91 (0.34, 2.41; p = 0.850). Compared with poor global CVH metrics in both midlife and late life, the fully adjusted HR of dementia was 0.25 (95% CI: 0.08, 0.86; p = 0.028) for people with intermediate global CVH metrics in both midlife and late life and 0.14 (0.02, 0.76; p = 0.024) for those with midlife ideal and late-life intermediate global CVH metrics. Having an intermediate or ideal level of behavioral CVH in both midlife and late life (versus poor level in both midlife and late life) was significantly associated with a lower dementia risk (HR range: 0.03 to 0.26; p <0.05), whereas people with midlife intermediate and late-life ideal biological CVH metrics had a significantly increased risk of dementia (p = 0.031). Major limitations of this study include the lack of data on diet and midlife plasma glucose, high rate of attrition, as well as the limited power for certain subgroup analyses. Conclusions In this study, we observed that having the ideal CVH metrics, and ideal behavioral CVH metrics in particular, from midlife onwards is associated with a reduced risk of dementia as compared with people having poor CVH metrics. Maintaining life-long health behaviors may be crucial to reduce late-life risk of dementia. Author summary Why was this study done? Dementia is a global public health problem, but there is currently no cure or a disease-modifying therapy for dementia. Simulation studies suggested that interventions targeting modifiable risk factors (e.g., cardiovascular factors) could prevent up to one-third of dementia cases. A better understanding of the life-long cardiovascular health (CVH) metrics and risk of dementia may facilitate the development of optimal intervention strategies. What did the researchers do and find? We examined the associations of CVH metrics in midlife and late life with risk of incident dementia in a population-based cohort of 1,449 participants in Finland followed for around 30 years. Compared with poor CVH metrics, the ideal global and behavioral CVH metrics in midlife were associated with a reduced risk of dementia, whereas the ideal biological CVH metrics in late life appeared to be associated with an increased risk of dementia. Having an intermediate or ideal level of behavioral CVH metrics from midlife onwards was associated with a late-life reduced risk of dementia. What do these findings mean? The association of ideal global CVH metrics with a reduced dementia risk disappeared from midlife to old age, driven largely by the age-varying association between biological CVH metrics and risk of dementia. Maintaining a life-long optimal level of CVH metrics, especially behavioral health metrics, may reduce late-life risk of dementia. The association of late-life ideal biological CVH metrics with an increased risk of dementia may largely reflect the potential of reverse causality.
  • Clavert, Maria; Löfström, Erika; Niemi, Hannele; Nevgi, Anne (2018)
    In the face of organizational transformations, academics are given a role as informal ‘change agents’ in their discipline-specific communities of practice (DCoP). Simultaneous participation in pedagogically oriented communities of practice (PCoP) enables them to promote pedagogical development through brokering at community interfaces. This empirical study explores academics’ experiences of acting as informal change agents at the interfaces of DCoP and PCoP during an organizational transition phase of three years. The longitudinal data were collected with interviews of 13 academics from the fields of science and technology. The findings reveal a variety of pedagogical development activities related to shared meanings, practices, identities, and ways of belonging. The activities are aligned with the organizational transition process and enabled by collegial support. The findings indicate that lack of supportive formal leadership may terminate the informal development activities. The resulting model of change agency provides a novel approach to pedagogical development in higher education.
  • Seiluri, Tina; Lahti, Jouni Markku Mikael; Rahkonen, Ossi; Lahelma, Eero; Lallukka, Tea (2011)
    BACKGROUND: Physical activity is known to have health benefits across population groups. However, less is known about changes over time in socioeconomic differences in leisure-time physical activity and the reasons for the changes. We hypothesised that class differences in leisure-time physical activity would widen over time due to declining physical activity among the lower occupational classes. We examined whether occupational class differences in leisure-time physical activity change over time in a cohort of Finnish middle-aged women and men. We also examined whether a set of selected covariates could account for the observed changes. METHODS: The data were derived from the Helsinki Health Study cohort mail surveys; the respondents were 40-60-year-old employees of the City of Helsinki at baseline in 2000-2002 (n = 8960, response rate 67%). Follow-up questionnaires were sent to the baseline respondents in 2007 (n = 7332, response rate 83%). The outcome measure was leisure-time physical activity, including commuting, converted to metabolic equivalent tasks (MET). Socioeconomic position was measured by occupational class (professionals, semi-professionals, routine non-manual employees and manual workers). The covariates included baseline age, marital status, limiting long-lasting illness, common mental disorders, job strain, physical and mental health functioning, smoking, body mass index, and employment status at follow-up. Firstly the analyses focused on changes over time in age adjusted prevalence of leisure-time physical activity. Secondly, logistic regression analysis was used to adjust for covariates of changes in occupational class differences in leisure-time physical activity. RESULTS: At baseline there were no occupational class differences in leisure-time physical activity. Over the follow-up leisure-time physical activity increased among those in the higher classes and decreased among manual workers, suggesting the emergence of occupational class differences at follow-up. Women in routine non-manual and manual classes and men in the manual class tended to be more often physically inactive in their leisure-time (<14 MET hours/week) and to be less often active (>30 MET hours/week) than those in the top two classes. Adjustment for the covariates did not substantially affect the observed occupational class differences in leisure-time physical activity at follow-up. CONCLUSIONS: Occupational class differences in leisure-time physical activity emerged over the follow-up period among both women and men. Leisure-time physical activity needs to be promoted among ageing employees, especially among manual workers.
  • Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta (2019)
    Background: Previous research has revealed nurses' knowledge gaps in venous leg ulcer (VLU) nursing care, and continuing education is needed. The closer nurses' perceived knowledge is to their evidence-based theoretical knowledge, the better possibilities they have to conduct evidence-based VLU nursing care. Objectives: To assess the congruence between nurses' perceived and theoretical knowledge about VLU nursing care before and after an internet-based education about VLU nursing care (eVLU). Design: Quasi-experimental study with intervention and comparison groups and pre- and post-measurements. Setting: Home health care in two Finnish municipalities. Participants: Nurses (n = 946) working in home health care were invited to participate. In the intervention group, 239 nurses and 229 nurses in the comparison group met the inclusion criteria, and they were all recruited to the study. Method: Nurses were divided into intervention and comparison groups with lottery between the municipalities. Nurses in both groups took care of patients with VLU according to their organizations' instructions. In addition to this, nurses in the intervention group received a 6-week eVLU while those in the comparison group did not. Data were collected with a questionnaire about perceived and theoretical knowledge before education, at six weeks, and at 10 weeks. The percentages of congruence were calculated at every measurement point, and the McNemar test was used to detect statistical significance of changes between measurements. Results: The increase of congruence was more often statistically significant in the intervention group than in the comparison group. Conclusion: The results support the hypothesis that the congruence between perceived and theoretical knowledge will be higher among nurses receiving eVLU. Because of the low participation and drop-outs, the results should be interpreted with caution.
  • Ketonen, Elina E.; Hotulainen, Risto (2019)
    The development of students' learning and test-taking behavior may derive from the social context and the group of peers they associate with daily for years. Consequently, it is assumed that students' academic achievements are to some degree affected by their classmates and the composition of the classroom. The present study provides evidence on how Finnish students (N = 5071) from different classrooms (N = 435) develop distinct patterns regarding their mathematics and literacy achievement during lower secondary school. We analysed longitudinal large-scale educational assessment data using a multilevel latent profile analysis (MLPA) to investigate the impact of classroom effect on students' achievement patterns, that is, on the development of students' low-stakes mathematics and literacy test scores from 7th to 9th grade. The results demonstrated the added value of modelling the multilevel structure inherent in educational assessment data: we identified four student achievement patterns that displayed different distributions across the school classes. More precisely, besides individual characteristics, the development of students' low-stakes mathematics and literacy test scores was associated with class-level factors and some of the classrooms seemed to have a stronger effect on students' test scores. These results suggest that classroom context is associated with students' achievement patterns, especially regarding the worst achieving students. The findings may reflect a combination of class placement practices as well as classroom and peer effect. Although the differences between Finnish schools have been one of the lowest in the OECD countries, the findings of the present study suggest that the classroom membership may create class level quality differences in both the preconditions and the development of learning.
  • 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.
  • Luoma, Ville; Vastaranta, Mikko; Eyvindson, Kyle; Kankare, Ville; Saarinen, Ninni; Holopainen, Markus; Hyyppa, Juha (Springer International Publishing AG, 2017)
    Lecture Notes in Geoinformation and Cartography
    Currently the forest sector in Finland is looking towards the next generation's forest resource information systems. Information used in forest planning is currently collected by using an area-based approach (ABA) where airborne laser scanning (ALS) data are used to generalize field-measured inventory attributes over an entire inventory area. Inventories are typically updated at 10-year interval. Thus, one of the key challenges is the age of the inventory information and the cost-benefit trade-off between using the old data and obtaining new data. Prediction of future forest resource information is possible through growth modelling. In this paper, the error sources related to ALS-based forest inventory and the growth models applied in forest planning to update the forest resource information were examined. The error sources included (i) forest inventory, (ii) generation of theoretical stem distribution, and (iii) growth modelling. Error sources (ii) and (iii) stem from the calculations used for forest planning, and were combined in the investigations. Our research area, Evo, is located in southern Finland. In all, 34 forest sample plots (300 m(2)) have been measured twice tree-by-tree. First measurements have been carried out in 2007 and the second measurements in 2014 which leads to 7 year updating period. Respectively, ALS-based forest inventory data were available for 2007. The results showed that prediction of theoretical stem distribution and forest growth modelling affected only slightly to the quality of the predicted stem volume in short-term information update when compared to forest inventory error.
  • Kujansuu, Eila; Kujansuu, Leena; Paassilta, Marita; Mustonen, Jukka; Vaarala, Outi (2019)
    Background The hygiene hypothesis suggests that a decreased microbial load contributes to an increased risk of allergies. In the Finnish municipality of Nokia, sewage water was accidentally mixed with drinking water for 2 days. We studied the association between exposure and the emergence of allergies in children. Methods Children aged 2-5 years living in the accident area and an age-matched cohort from the control municipality were recruited. Based on the questionnaires, we identified 139 children exposed to the contaminated water and selected age- and sex-matched controls for them (mean age 16.59 months at the time of the accident). Allergic symptoms and diseases were recorded by ISAAC questionnaires and skin prick tests (SPTs) performed 2 and 5 years after the accident. Results SPT positivity at 5 years of follow-up was decreased in the children exposed to the sewage water below 1 year of age (OR 0.311, 95% CI 0.118-0.820; P = 0.019), particularly in children who did not develop gastroenteritis at exposure. In contrast, the children over 1 year of age at the exposure tended more likely to be SPT-positive at 5 years of follow-up (OR 1.997, 95% CI 0.963-4.143; P = 0.070). Conclusions Sewage water exposure during the first year of life, but not later, decreased the risk of IgE sensitization emphasizing the importance of age as a modulator. The modulation of IgE sensitization by the presence of clinical gastroenteritis at the exposure suggests that the nature of microbial load may have importance or alternatively shared host defense mechanisms protect from infection and atopic sensitization.
  • Kirsebom, O. S.; Tengblad, O.; Lica, R.; Munch, M.; Riisager, K.; Fynbo, H. O. U.; Borge, M. J. G.; Madurga, M.; Marroquin, I.; Andreyev, A. N.; Berry, T. A.; Christensen, E. R.; Fernandez, P. Diaz; Doherty, D. T.; Van Duppen, P.; Fraile, L. M.; Gallardo, M. C.; Greenlees, P. T.; Harkness-Brennan, L. J.; Hubbard, N.; Huyse, M.; Jensen, J. H.; Johansson, H.; Jonson, B.; Judson, D. S.; Konki, J.; Lazarus, I.; Lund, M. V.; Marginean, N.; Marginean, R.; Perea, A.; Mihai, C.; Negret, A.; Page, R. D.; Pucknell, V.; Rahkila, P.; Sorlin, O.; Sotty, C.; Swartz, J. A.; Sorensen, H. B.; Toernqvist, H.; Vedia, V.; Warr, N.; De Witte, H. (2018)
    The C-12(alpha,gamma)O-16 reaction plays a central role in astrophysics, but its cross section at energies relevant for astrophysical applications is only poorly constrained by laboratory data. The reduced a width, gamma(11), of the bound 1(-) level in O-16 is particularly important to determine the cross section. The magnitude of gamma(11) is determined via sub-Coulomb a-transfer reactions or the beta-delayed a decay of N-16, but the latter approach is presently hampered by the lack of sufficiently precise data on the beta-decay branching ratios. Here we report improved branching ratios for the bound 1(-) level [b(beta,11) = (5.02 +/- 0.10) x 10(-2)] and for beta-delayed alpha emission [b(beta alpha) = (1.59 +/- 0.06) x 10(-5)]. Our value for b(beta alpha) is 33% larger than previously held, leading to a substantial increase in gamma(11). Our revised value for gamma(11) is in good agreement with the value obtained in a-transfer studies and the weighted average of the two gives a robust and precise determination of gamma(11), which provides significantly improved constraints on the C-12(alpha,gamma) cross section in the energy range relevant to hydrostatic He burning.
  • Latvala, Tiina; Alho, Hannu; Raisamo, Susanna; Salonen, Anne H. (2019)
    Aims: This study explores the associations between gambling involvement, type of gambling, at-risk and problem gambling (ARPG) and register-based grade point average (GPA), among Finnish people aged 18-29 years (N = 676). It is assumed that high gambling involvement and engaging in certain types of gambling are linked to ARPG, and that low school achievement is positively associated with these measures. Methods: A nationwide cross-sectional random sample was collected in 2015. The data were weighted based on gender, age and region. Analyses were carried out using logistic regression models. Results: Frequent gambling, playing several game types, online gambling and ARPG were more common among men than women. Those with low GPA played fast and low-paced daily lottery games and used online casinos significantly more often than men and women with average/high GPA. Men with a low GPA were also more likely to gamble on a weekly basis and played casino games and online poker more often. For women with a low GPA online gambling and playing slot machines were more common than for women with an average/high GPA. When controlling for sociodemographic variables and gambling involvement, men's participation in daily lottery games and online poker was significantly associated with a low GPA, but among women none of the game types remained statistically significant. Among women, playing several different game types was linked with a low GPA. Conclusions: It seems that poorer school achievement is associated not only with frequent gambling, a large number of game types played and online gambling, but also, to some extent at least, with game type preferences.
  • CardShock Investigators; Jäntti, Toni; Tarvasmäki, Tuukka; Harjola, Veli-Pekka; Parissis, John; Javanainen, Tuija; Tolppanen, Heli; Jurkko, Raija; Hongisto, Mari; Kataja, Anu; Lassus, Johan; Jurkko, Raija; Jarvinen, Kristiina; Nieminen, Tuomo (2019)
    Introduction The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. Results Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5–4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1–3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2–5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2–7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. Trial registration NCT01374867 at ClinicalTrials.gov.
  • Dobewall, Henrik; Koivusilta, Leena; Karvonen, Sakari; Lindfors, Pirjo; Kinnunen, Jaana M.; Vainikainen, Mari-Pauliina; Rimpelä, Arja (2020)
    Background: The Finnish government has emphasized the need to expedite educational transitions. We study if a late start of upper secondary education is related to health-related selection, namely health-compromising behaviours in adolescence. Methods: A large cohort of adolescents from the seventh (12-13 years) and ninth (15-16 years) grades answered online classroom surveys (total n = 10 873). They were followed to the start of upper secondary education, obtained from the Joint Application Registry. We compared those who continued studies directly from the ninth grade with later starters. We measured late bedtime, breakfast not every school day, tooth brushing less than twice-a-day, monthly alcohol consumption, weekly smoking, daily energy drinks, physical activity <6 days/week and excessive screen time. Multilevel logistic regressions and latent class analyses were conducted. Results: In gender and school adjusted models in the seventh grade, all behaviours except physical activity predicted the late start. The strongest predictor was smoking, OR = 2.96 (CI = 2.25-3.89). In the ninth grade, smoking, breakfast, tooth brushing and energy drinks, OR = 1.80, (CI = 1.36-2.39, strongest), were predictive. After controlling for sociodemographic background and academic achievement, associations for alcohol and screen time became non-significant in the seventh grade. In the ninth grade, only screen time remained significant, OR = 1.33 (CI = 1.04-1.71). Health-compromising behaviours formed clusters. Belonging to the unhealthy cluster predicted the late start in both grades, in adjusted models only in the seventh grade. Conclusions: Students with health-compromising behaviours are less likely to start upper secondary education directly after the compulsory education. This may increase the risk for fragmentary educational trajectories and work careers.
  • Einiö, Elina; Hiltunen, Elina; Martikainen, Pekka; Korhonen, Kaarina (2020)
    Background: Men's age at first birth may negatively or positively affect alcohol-related morbidity and mortality, although little evidence is available. Methods: We used register data of over 22,000 brothers to analyze the associations between age at first birth and alcohol-related morbidity and mortality from the age of 35 until the age of 60 or 72. We employed conventional Cox models and inter-sibling models, which allowed adjustment for unobserved social and genetic characteristics shared by brothers. Results: The findings show that men's age at first birth was inversely associated with alcohol-related morbidity and mortality, independent of unobserved characteristics shared by brothers and of observed demographic confounders. Men who had their first child late at 35-45 years experienced lower alcohol-related morbidity and mortality (hazard ratio (HR) = 0.57, 95 % confidence interval (CI) = 0.43, 0.75) than men who had their first child at 25-29. Men who had their first child before age 20 had the highest morbidity and mortality among all fathers (HR = 1.36, 95 % CI = 1.09, 1.69), followed by men who had their child at 20-24 (HR = 1.12, 95 % CI = 1.00, 1.25). Conclusions: The results imply that the inverse association between men's age at first birth and alcohol-related morbidity and mortality is not driven by familial characteristics.
  • Marshall, Karen; Salmon, G.R.; Tebug, Stanly; Juga, Jarmo; MacLeod, M.; Poole, Elizabeth Jane; Baltenweck, I.; Missohou, Ayao (2020)
    Senegal, located in West Africa, is an example of a low-to middle-income country where the govern-ment has prioritized improving livestock production self-sufficiency, with a strong focus on dairy. Among other initiatives, the use of exotic dairy cattle has been promoted, despite no evidence for the potential liveli-hood benefits (or otherwise) to smallholder farmers on adopting the new genetics. The current work fills this evidence gap by performing a farm-level economic study comparing the keeping of different breed and cross-breed types of dairy cattle under different management levels. Data for the study were obtained by monitoring 220 smallholder dairy cattle farms, with a combined cattle population of about 3,000 animals, over an almost 2-yr period. Findings of the study suggest that the most net-beneficial and cost-beneficial dairy cattle enterprise that could be used by the smallholder farmers was to keep crossbred indigenous zebu by exotic Bos taurus animals under management standards that are consid-ered good compared with local standards. This dairy enterprise type was 7.4-fold more net beneficial and had a 1.4-fold more favorable cost-benefit ratio than the traditional system of keeping indigenous zebu animals under poor (low-input) management. Interestingly, the keeping of (near) pure B. taurus dairy cattle resulted in the highest milk yields and thus benefit from milk, but was not the most net beneficial due to the high costs of keeping these animals, particularly in terms of feed. We also found that increasing the managementlevel of any of the breed or cross-breed types under consideration, including the indigenous zebu animals, resulted in an increased net benefit of 2.2-to 2.9-fold. Results of this economic analysis are discussed as part of a broader trade-off analysis, resulting in recommendations to strengthen the Senegal dairy sector. The combined intervention of improved dairy cattle genetics and management is considered a promising intervention to improve livelihoods of the rural poor as well as livestock production self-sufficiency for Senegal; some other system constraints are addressed.