Browsing by Subject "SERVICES"

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  • Tiihonen, R.; Alaranta, R.; Helkamaa, T.; Nurmi-Lüthje, I.; Kaukonen, J.-P.; Lüthje, P. (2019)
    Background and Aims: Reoperations after operative treatment of hip fracture patients may be associated with higher costs and inferior survival. We examined the acute hospital costs, long-term reoperation rates, and survival of patients with a new hip fracture. Materials and Methods: A total of 490 consecutive new hip fracture patients treated at a single center between 31 December 2004 and 6 December 2006 were analyzed retrospectively. Fractures were classified according to Garden and AO. All medical records were checked manually. The costs of reoperations were calculated using the diagnosis-related groups (DRG)-based prices. Survival analysis was performed using the life-table method. The follow-up time was 10 years. Results: In all, 70/490 patients (14.3%) needed reoperations. Of all reoperations, 34.2% were performed during the first month and 72.9% within 1 year after the primary operation. The hemiarthroplasty dislocation rate was 8.5%, and mechanical failures of osteosynthesis occurred in 6.2%. Alcohol abuse was associated with a heightened risk of reoperation. The mean direct costs of primary fracture care were lower than the mean costs of reoperations (euro7500 vs euro9800). The mortality rate at 10 years was 79.8% among non-reoperated patients and 62.9% among reoperated patients. Conclusions: According to our hypothesis, the cost per patient of reoperation in acute care was 31% higher than the corresponding cost of a primary operation. Reoperations increased the overall immediate costs of index fractures by nearly 20%. One-third of all reoperations were performed during the first month and almost 75% within 1 year after the primary operation.
  • Bagheri, Mehrdad; Mladenovic, Milos; Kosonen, Iisakki; Nurminen, Jukka K; Roncoli, Claudio; Ylä-Jääski, Antti (2020)
    Evaluating potential of shifting to low-carbon transport modes requires considering limited travel-time budget of travelers. Despite previous studies focusing on time-relevant modal shift, there is a lack of integrated and transferable computational frameworks, which would use emerging smartphone-based high-resolution longitudinal travel datasets. This research explains and illustrates a computational framework for this purpose. The proposed framework compares observed trips with computed alternative trips and estimates the extent to which alternatives could reduce carbon emission without a significant increase in travel time.. The framework estimates potential of substituting observed car and public-transport trips with lower-carbon modes, evaluating parameters per individual traveler as well as for the whole city, from a set of temporal and spatial viewpoints. The illustrated parameters include the size and distribution of modal shifts, emission savings, and increased active-travel growth, as clustered by target mode, departure time, trip distance, and spatial coverage throughout the city. Parameters are also evaluated based on the frequently repeated trips. We evaluate usefulness of the method by analyzing door-to-door trips of a few hundred travelers, collected from smartphone traces in the Helsinki metropolitan area, Finland, during several months. The experiment's preliminary results show that, for instance, on average, 20% of frequent car trips of each traveler have a low-carbon alternative, and if the preferred alternatives are chosen, about 8% of the carbon emissions could be saved. In addition, it is seen that the spatial potential of bike as an alternative is much more sporadic throughout the city compared to that of bus, which has relatively more trips from/to city center. With few changes, the method would be applicable to other cities, bringing possibly different quantitative results. In particular, having more thorough data from large number of participants could provide implications for transportation researchers and planners to identify groups or areas for promoting mode shift. Finally, we discuss the limitations and lessons learned, highlighting future research directions.
  • Wennlund, Klara Torlen; Kurland, Lisa; Olanders, Knut; Castren, Maaret; Bohm, Katarina (2022)
    Background The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition. Methods A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. chi(2)-test was used for comparisons. P-levels < 0.05 were regarded as significant. Results A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01). Conclusions A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.
  • Kangasniemi, Heidi; Setälä, Piritta; Huhtala, Heini; Olkinuora, Anna; Kämäräinen, Antti; Virkkunen, Ilkka; Tirkkonen, Joonas; Yli-Hankala, Arvi; Jamsen, Esa; Hoppu, Sanna (2022)
    Background We investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT). Methods A prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period. Results Of all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or 'not eligible for intensive care' (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician. Conclusion Consultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.
  • Voss, Rudi; Quaas, Martin F.; Schmidt, Joern O.; Tahvonen, Olli; Lindegren, Martin; Moellmann, Christian (2014)
  • Nikander, Kirsi; Kosola, Silja; Vahlberg, Tero; Kaila, Minna; Hermanson, Elina (2022)
    Background The benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression. Results Doctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91-17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit. Conclusions Doctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor.
  • Elands, B. H. M.; Vierikko, K.; Andersson, E.; Fischer, L. K.; Concalves, P.; Haase, D.; Kowarik, Ingo; Luz, A. C.; Niemela, J.; Santos-Reis, M.; Wiersum, K. F. (2019)
    Biocultural diversity is an evolving perspective for studying the interrelatedness between people and their natural environment, not only in ecoregional hotspots and cultural landscapes, but also in urban green spaces. Developed in the 1990s in order to denote the diversity of life in all its manifestations. biological, cultural and linguistic. co-evolving within complex socio-ecological systems such as cities, biocultural diversity was identified in the GREEN SURGE project as a response to recent challenges cities face. Most important challenges are the loss of nature and degradation of ecosystems in and around cities as well as an alienation of urban residents from and loss of interaction with nature. The notion of biocultural diversity is dynamic in nature and takes local values and practices of relating to biodiversity of different cultural groups as a starting point for sustainable living with biodiversity. The issue is not only how to preserve or restore biocultural practices and values, but also how to modify, adapt and create biocultural diversity in ways that resonate with urban transformations. As future societies will largely diverge from today's societies, the cultural perspective on living with (urban) nature needs careful reconsideration. Biocultural diversity is not conceived as a definite concept providing prescriptions of what to see and study, but as a reflexive and sensitising concept that can be used to assess the different values and knowledge of people that reflect how they live with biodiversity. This short communication paper introduces a conceptual framework for studying the multi-dimensional features of biocultural diversity in cities along the three key dimensions of materialized, lived and stewardship, being departure points from which biocultural diversity can be studied.
  • Oksuz, Duygu P.; Palmeirim, Jorge M.; Correia, Ricardo A. (2021)
    Wood-pastures are socio-ecological systems covering vast areas in Europe. Although used for grazing and production of various forest goods, wood-pastures harbour a rich biodiversity and are usually considered as High Nature Value Farmlands. However, socio-economic pressures are driving the transformation of these valuable landscapes from multi-functional, heterogeneous habitats to homogeneous areas through either intensification or land abandonment. We investigated how changes in management intensity influence the taxonomic diversity, functional diversity and functional composition of birds in these landscapes using generalized linear models. In contrast to taxonomic diversity, functional diversity decreased significantly towards shrub-dominated and less heterogeneous areas related to the abandonment of grazing and/or understory management practices. Grassland and generalist species, and associated guilds such as granivores, ground-nesters and ground-foragers are almost absent less managed areas. On the other hand, shrub-dominated areas favour forest species, particularly understory/canopy foragers and arboreal nesters, although the forest guild is still well-represented in actively managed, heterogeneous areas. Our results indicate the abandonment of wood-pasture management affects the prevalence of grassland and generalist species, leading to functional diversity loss and potentially reduced ecosystem functioning. We suggest non-intensive, active management is needed to maintain habitat heterogeneity and canopy openness, enhancing trait diversity in wood-pastures.
  • Cadilhac, Dominique A.; Dewey, Helen M.; Denisenko, Sonia; Bladin, Christopher F.; Meretoja, Atte (2019)
    BackgroundHospital costs for stroke are increasing and variability in care quality creates inefficiencies. In 2007, the Victorian Government (Australia) employed clinical facilitators for three years in eight public hospitals to improve stroke care. Literature on the cost implications of such roles is rare. We report changes in the costs of acute stroke care following implementation of this program.MethodsObservational controlled before-and-after cohort design. Standardised hospital costing data were compared pre-program (financial year 2006-07) and post-program (2010-11) for all admitted episodes of stroke or transient ischaemic attack (TIA) using ICD-10 discharge codes. Costs in Australian dollars (AUD) were adjusted to a common year 2010. Generalised linear regression models were used for adjusted comparisons.ResultsA 20% increase in stroke and TIA episodes was observed: 2624 pre-program (age>75years: 53%) and 3142 post-program (age>75years: 51%); largely explained by more TIA admissions (up from 785 to 1072). Average length of stay reduced by 22% (pre-program 7.3days to post-program 5.7days, p
  • Valimaki, Maritta; Kuosmanen, Lauri; Hatonen, Heli; Koivunen, Marita; Pitkanen, Anneli; Athanasopoulou, Christina; Anttila, Minna (2017)
    Purpose: Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs). Patients and methods: A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients' medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics. Results: In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and > 30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45-65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P <0.001), and younger people and those with higher education were associated with more active use. Conclusion: Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care.
  • Villnäs, Anna; Norkko, Joanna; Lukkari, Kaarina; Hewitt, Judi; Norkko, Alf (2012)
    Disturbance-mediated species loss has prompted research considering how ecosystem functions are changed when biota is impaired. However, there is still limited empirical evidence from natural environments evaluating the direct and indirect (i.e. via biota) effects of disturbance on ecosystem functioning. Oxygen deficiency is a widespread threat to coastal and estuarine communities. While the negative impacts of hypoxia on benthic communities are well known, few studies have assessed in situ how benthic communities subjected to different degrees of hypoxic stress alter their contribution to ecosystem functioning. We studied changes in sediment ecosystem function (i.e. oxygen and nutrient fluxes across the sediment water-interface) by artificially inducing hypoxia of different durations (0, 3, 7 and 48 days) in a subtidal sandy habitat. Benthic chamber incubations were used for measuring responses in sediment oxygen and nutrient fluxes. Changes in benthic species richness, structure and traits were quantified, while stress-induced behavioral changes were documented by observing bivalve reburial rates. The initial change in faunal behavior was followed by non-linear degradation in benthic parameters (abundance, biomass, bioturbation potential), gradually impairing the structural and functional composition of the benthic community. In terms of ecosystem function, the increasing duration of hypoxia altered sediment oxygen consumption and enhanced sediment effluxes of NH4 + and dissolved Si. Although effluxes of PO4 were not altered significantly, changes were observed in sediment PO4 sorption capability. The duration of hypoxia (i.e. number of days of stress) explained a minor part of the changes in ecosystem function. Instead, the benthic community and disturbancedriven changes within the benthos explained a larger proportion of the variability in sediment oxygen- and nutrient fluxes. Our results emphasize that the level of stress to the benthic habitat matters, and that the link between biodiversity and ecosystem function is likely to be affected by a range of factors in complex, natural environments.
  • Pfaar, Oliver; Agache, Ioana; Bonini, Matteo; Brough, Helen Annaruth; Chivato, Tomas; Del Giacco, Stefano R.; Gawlik, Radoslaw; Gelincik, Asli; Hoffmann-Sommergruber, Karin; Jutel, Marek; Klimek, Ludger; Knol, Edward F.; Lauerma, Antti; Ollert, Markus; O'Mahony, Liam; Mortz, Charlotte G.; Palomares, Oscar; Riggioni, Carmen; Schwarze, Jurgen; Skypala, Isabel; Torres, Maria Jose; Untersmayr, Eva; Walusiak-Skorupa, Jolanta; Chaker, Adam; Giovannini, Mattia; Heffler, Enrico; Jensen-Jarolim, Erika; Quecchia, Cristina; Sandoval-Ruballos, Monica; Sahiner, Umit; Tomic Spiric, Vesna; Alvaro-Lozano, Montserrat (2021)
    Background As in many fields of medical care, the coronavirus disease 2019 (COVID-19) resulted in an increased uncertainty regarding the safety of allergen immunotherapy (AIT). Therefore, the European Academy of Allergy and Clinical Immunology (EAACI) aimed to analyze the situation in different countries and to systematically collect all information available regarding tolerability and possible amendments in daily practice of sublingual AIT (SLIT), subcutaneous AIT (SCIT) for inhalant allergies and venom AIT. Methods Under the framework of the EAACI, a panel of experts in the field of AIT coordinated by the Immunotherapy Interest Group set-up a web-based retrospective survey (SurveyMonkey(R)) including 27 standardized questions on practical and safety aspects on AIT in worldwide clinical routine. Results 417 respondents providing AIT to their patients in daily routine answered the survey. For patients (without any current symptoms to suspect COVID-19), 60% of the respondents informed of not having initiated SCIT (40% venom AIT, 35% SLIT) whereas for the maintenance phase of AIT, SCIT was performed by 75% of the respondents (74% venom AIT, 89% SLIT). No tolerability concern arises from this preliminary analysis. 16 physicians reported having performed AIT despite (early) symptoms of COVID-19 and/or a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Conclusions This first international retrospective survey in atopic diseases investigated practical aspects and tolerability of AIT during the COVID-19 pandemic and gave no concerns regarding reduced tolerability under real-life circumstances. However, the data indicate an undertreatment of AIT, which may be temporary, but could have a long-lasting negative impact on the clinical care of allergic patients.
  • Editorial Board BMJ Sexual Reprodu (2018)
  • Heikinheimo, Vuokko; Järv, Olle; Tenkanen, Henrikki; Hiippala, Tuomo; Toivonen, Tuuli (2022)
    Identifying users' place of residence is an important step in many social media analysis workflows. Various techniques for detecting home locations from social media data have been proposed, but their reliability has rarely been validated using ground truth data. In this article, we compared commonly used spatial and Spatio-temporal methods to determine social media users' country of residence. We applied diverse methods to a global data set of publicly shared geo-located Instagram posts from visitors to the Kruger National Park in South Africa. We evaluated the performance of each method using both individual-level expert assessment for a sample of users and aggregate-level official visitor statistics. Based on the individual-level assessment, a simple Spatio-temporal approach was the best-performed for detecting the country of residence. Results show why aggregate-level official statistics are not the best indicators for evaluating method performance. We also show how social media usage, such as the number of countries visited and posting activity over time, affect the performance of methods. In addition to a methodological contribution, this work contributes to the discussion about spatial and temporal biases in mobile big data.
  • Gabrysch, Sabine; Nesbitt, Robin C.; Schoeps, Anja; Hurt, Lisa; Soremekun, Seyi; Edmond, Karen; Manu, Alexander; Lohela, Terhi J.; Danso, Samuel; Tomlin, Keith; Kirkwood, Betty; Campbell, Oona M. R. (2019)
    Background Maternal and perinatal mortality are still unacceptably high in many countries despite steep increases in facility birth. The evidence that childbirth in facilities reduces mortality is weak, mainly because of the scarcity of robust study designs and data. We aimed to assess this link by quantifying the influence of major determinants of facility birth (cluster-level facility birth, wealth, education, and distance to childbirth care) on several mortality outcomes, while also considering quality of care. Methods Our study is a secondary analysis of surveillance data on 119 244 pregnancies from two large population-based cluster-randomised controlled trials in Brong Ahafo, Ghana. In addition, we specifically collected data to assess quality of care at all 64 childbirth facilities in the study area. Outcomes were direct maternal mortality, perinatal mortality, first-day and early neonatal mortality, and antepartum and intrapartum stillbirth. We calculated cluster-level facility birth as the percentage of facility births in a woman's village over the preceding 2 years, and we computed distances from women's regular residence to health facilities in a geospatial database. Associations between determinants of facility birth and mortality outcomes were assessed in crude and multivariable multilevel logistic regression models. We stratified perinatal mortality effects by three policy periods, using April 1, 2005, and July 1, 2008, as cutoff points, when delivery-fee exemption and free health insurance were introduced in Ghana. These policies increased facility birth and potentially reduced quality of care. Findings Higher proportions of facility births in a cluster were not linked to reductions in any of the mortality outcomes. In women who were wealthier, facility births were much more common than in those who were poorer, but mortality was not lower among them or their babies. Women with higher education had lower mortality risks than less-educated women, except first-day and early neonatal mortality. A substantially higher proportion of women living in areas closer to childbirth facilities had facility births and caesarean sections than women living further from childbirth facilities, but mortality risks were not lower despite this increased service use. Among women who lived in areas closer to facilities offering comprehensive emergency obstetric care (CEmOC), emergency newborn care, or high-quality routine care, or to facilities that had providers with satisfactory competence, we found a lower risk of intrapartum stillbirth (14.2 per 1000 deliveries at >20 km from a CEmOC facility vs 10.4 per 1000 deliveries at Interpretation Facility birth does not necessarily convey a survival benefit for women or babies and should only be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safeguarding uncomplicated births. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
  • Raatikainen, Ilkka; Vanhala, Mauno; Mäntyselkä, Pekka; Heinonen, Ari; Koponen, Hannu; Kautiainen, Hannu; Korniloff, Katariina (2018)
    Objectives: The main aim of this study was to investigate the association between leisure time physical activity (LTPA) and health care utilization (HCU) and furthermore, socio-demographic and clinical factors according to LTPA level among depressed patients based on data drawn from the Finnish Depression and Metabolic Syndrome in Adults (FDMSA)-study (2009-2016). Methods: 447 depressed patients aged 35-65 from municipalities within the Central Finland Hospital District participated in this study. Depressive symptoms (DS) were determined with the Beck Depression Inventory (a 10 points) and the psychiatric diagnosis confirmed with a diagnostic interview (M.I.N.I.). Severity of depression was evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS). LTPA was assessed using a self reported questionnaire. Use of health services was counted from participant's health care records. Results: Of the 447 depressed patients, 25% reported their LTPA level as low, 41% as moderate and 34% as high. Among depressed patients, higher levels of LTPA were linearly associated with lower BDI (p <0.001), MADRS (p = 0.002), BMI (p = 0.005), triglyceride (p = 0.025) and higher HDL (p = 0.002) values. LTPA level was not related to health care utilization among depressed patients. The health services most used were physician services. Conclusions: According to this study, the level of LTPA in baseline does not predict the future use of health care services among depressed patients in Finnish adult population. Although higher levels of LTPA are positively associated with many health-related factors, promoting PA alone is not enough when aiming to manage and modify HCU among depressed patients.
  • 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.
  • Wu, Zhuochun; Viisainen, Kirsi; Wang, Ying; Hemminki, Elina (2011)
  • Bosqui, Tania; O'Reilly, Dermot; Vaananen, Ari; Patel, Kishan; Donnelly, Michael; Wright, David; Close, Ciara; Kouvonen, Anne (2019)
    PurposeThere is a recent and growing migrant population in Northern Ireland. However, rigorous research is absent regarding access to mental health care by different migrant groups. In order to address this knowledge gap, this study aimed to identify the relative use of psychotropic medication between the largest first generation migrant groups in Northern Ireland and the majority population.MethodsCensus (2011) data was linked to psychotropic prescriptions for the entire enumerated population of Northern Ireland using data linkage methodology through the Administrative Data Research Centre Northern Ireland (ADRC-NI).ResultsLower prescription dispensation for all psychotropic medication types, particularly antidepressants (OR=0.35, CI 95% 0.33-0.36) and anxiolytics (OR=0.42, CI 95% 0.40-0.44), was observed for all migrant groups with the exception of migrants from Germany.ConclusionsIt is likely that the results reflect poorer access to services and indicate a need to improve access and the match between resources, services and the health and social care needs of migrants. Further research is required to identify barriers to accessing primary care and mental health services.
  • Karppinen, Heimo; Hänninen, Maria; Valsta, Lauri Tapani (2018)
    Given the high percentage of private forest ownership in Finland, family forest owners have an important role in mitigating climate change. The study aims to explore Finnish family forest owners' perceptions on climate change and their opinions on increasing carbon storage in their forests through new kinds of management activities and policy instruments. The data consists of thematic face-to-face interviews among Helsinki metropolitan area forest owners (n = 15). These city-dwellers were expected to be more aware of and more interested in climate change mitigation than forest owners at large. Forests as carbon fluxes appear to be a familiar concept to most of the forest owners, but carbon storage in their own forests was a new idea. Four types concerning forest owners' view on storing carbon in their forests could be identified. The Pioneer utilizes forestland versatilely and has already adopted practices to mitigate climate change. The Potential is concerned about climate change, but this is not seen in forest practices applied. The Resistant is generally aware of climate change but sees a fundamental contradiction between carbon storing and wood production. The Indifferent Owner believes that climate change is taking place but does not acknowledge a relation between climate change and the owner's forests.