Data are insufficient on the protective effect of a farm environment in childhood regarding sensitization in middle age and new-onset sensitization in adulthood. A skin prick test (SPT) and questionnaire data from the Northern Finland Birth Cohort 1966 study (NFBC66) were used to investigate sensitization at age 46 years related to childhood living environment. A subpopulation of 3409 participants was analyzed to study factors related to new-onset sensitization between ages of 31 and 46 years. Data on complete SPTs were available for 5373 cohort members at age 46. Professional farming by parents (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.43-0.68) and keeping of farm animals (OR 0.53; 95% CI 0.43-0.66) in infancy were associated with a lower risk of sensitization at age 46. Sensitization (OR 0.58; 95% CI 0.47-0.72) and polysensitization (OR 0.43; 95% CI 0.32-0.57) were less common in those who lived in a rural area in infancy compared to a city area. The childhood living environment had no effect on new-onset sensitization between ages 31 and 46. We conclude that living on a farm or in a rural environment in childhood had a protective effect on sensitization even in middle age, but these factors did not protect from new-onset sensitization in adults.

Background: Mental disorders can affect work ability and lead to early exit from the labour market through disability pension. Aims: This study aimed to identify childhood determinants of psychiatric disability pension in early adulthood. Methods: The 1987 Finnish Birth Cohort includes a complete census of children born in a single year. The children were followed up from birth until 31 December 2012 using official registers maintained by the Finnish authorities. Risk factors for disability pension were examined in the full 1987 cohort (N = 58,739) and among children who had received mental health care (N = 9,599). Odds ratios were calculated for disability pension due to all mental disorders and separately for schizophrenia, depressive and anxiety and other mental and behavioural disorders in association with childhood determinants. Results: Altogether, 1.4% of cohort members had retired due to mental disorders in 2003-2012. In the full 1987 cohort, female sex, parental divorce and social assistance, both mother's and father's psychiatric care and mother's psychiatric disability pension increased the risk for disability pension due to mental disorders. Among children who had received mental health care, risk factors for psychiatric disability pension were father's psychiatric care and mother's psychiatric disability pension. Conclusion: Childhood determinants were related to the risk of psychiatric disability pension before the age of 25. The risk factors varied by the diagnosis of the disability pension. Using knowledge of this study's risk factors should enable the identification of adolescents and young adults in general population and especially in the mental health care population who are at greatest risk of receipt of psychiatric disability pension.

This population-based cross-sectional study evaluates the clinical value of electroretinography and visual evoked potentials in childhood brain tumor survivors. A flash electroretinography and a checkerboard reversal pattern visual evoked potential (or alternatively a flash visual evoked potential) were done for 51 survivors (age 3.8-28.7 years) after a mean follow-up time of 7.6 (1.5-15.1) years. Abnormal electroretinography was obtained in 1 case, bilaterally delayed abnormal visual evoked potentials in 22/51 (43%) cases. Nine of 25 patients with infratentorial tumor location, and altogether 12 out of 31 (39%) patients who did not have tumors involving the visual pathways, had abnormal visual evoked potentials. Abnormal electroretinographies are rarely observed, but abnormal visual evoked potentials are common even without evident anatomic lesions in the visual pathway. Bilateral changes suggest a general and possibly multifactorial toxic/adverse effect on the visual pathway. Electroretinography and visual evoked potential may have clinical and scientific value while evaluating long-term effects of childhood brain tumors and tumor treatment.

The target phenomenon of the study is the experiences of adoptive parenting and family life by those parents who has a child adopted from South Africa. The object of interest is the adoptive parenthood and the experience of the adoptive family's everyday life. In Finland the interest about international adoption is great. As a contact country, South Africa has steadily raised interest. My goal in this study together with the wide theory of adoptions and adoptive parents' personal experiences is to serve those parents who are considering participate to international adoption process and especially thinking to adopt a child from South Africa. The frame of reference of this research is qualitative and theory guiding. The theoretical background examines the nature of the adoption process, the various stages of the process, as well as jurisprudence and ethics through the process as part of the protection of children. The approach in this study is a narrative. I gathered the research data by writing quest for the adoptive parents. The data consists the total of the six subjective reports written by six adoptive parents whose children where born in South Africa. The study revealed how the adoption is a very strongly legal process which is closely linked to the authorities' actions. During the process of adoption, the adoptive applicants are required to make a number of informed choices. During this process related to every party – both children and parents – there are always present the changes, losses, and hopes. While examining and comparing the data it became clear how an adoptive parenting is pretty much the same as a biological parenthood. Despite this, the adoptive parenting is always at the same a time different and special. The challenges of the spectrum appears to be mostly: adoptive children with special needs and responding to those special needs, attachment relationship and sometimes in different ways racist encounters.

This study used variable- and pattern-centered approaches to better capture the impact of adolescents’ joint developmental trajectories of subjective task values (STVs) in three domains (Finnish, math and science, and social subject) from grades 9 to 11 on science, technology, engineering, and mathematics (STEM) aspirations at four years postsecondary school and STEM participation at six years postsecondary school (N = 849 Finnish youth; 52.1% female; 99% native Finnish). Results showed that while adolescents’ average STVs in different domains remained stable, three differential joint STV trajectories emerged across domains. Individual changes of STVs in one domain shaped STVs in other domains to form unique relative STV hierarchies within subgroups that impacted long-term STEM aspirations and participation. Gender differences in STV trajectory profile distributions partially explained the overall underrepresentation of women in STEM fields. This study is among the first to incorporate multiple domains and explore how STVs fluctuate over time in both homogeneous and heterogeneous fashions. These findings underscore the importance of examining heterogeneity in motivational trajectories across domains.

Mental disorders are common during childhood and they are associated with various negative consequences later in life, such as lower educational attainment and unemployment. In addition, the reduction of socioeconomic health disparities has attracted both political, research and media interest. While mental health inequalities have been found consistently in literature and regional disparities in health have been well documented in Finland altogether, the question of possible variation in mental disorder inequalities during childhood among Finnish regions is not fully examined. This master’s thesis contributes to this gap in the research with a statistical perspective and use of a multilevel logistic model, which allows random variation between levels. Using register-based data, I ask whether the association between socioeconomic status and mental disorder in childhood varies between the child’s municipality of residence, and which regional factors possibly explain the differences. The second objective of this thesis is to find out whether the use of a multilevel logistic model provides additional value to this context. The method used in the thesis is a multilevel logistic model, which can also be called a generalized linear mixed-effects model. In multilevel models, the observations are nested within hierarchical levels, which all have corresponding variables. Both intercept and slopes of independent variables can be allowed to vary between the Level 2 units. Intraclass correlation coefficient and median odds ratio (MOR) are used to measure group level variation. In addition, centering of variables and choosing a suitable analysis strategy are central steps in model application. High-quality Finnish register data from Statistics Finland and the Finnish Institute of Health and Welfare is utilised. The study sample consists of 815 616 individuals aged 4–17 living in Finland in the year 2018. The individuals who are used as Level 1 units are nested within 306 Level 2 units based on their municipality of residence. The dependent variable is a dichotomous variable indicating a mental disorder and it is based on visits and psychiatric diagnoses given in specialised healthcare during 2018. Independent variables in Level 1 are maternal education level and household income quintile, and models are controlled for age group, gender, family structure and parental mental disorders. In Level 2, the independent variables are urbanisation, major region, share of higher-educated population and share of at-risk-of-poverty children. In the final model, children with the lowest maternal education level are more likely (OR=1.37, SE=0.0026) to have mental disorders than children with the highest maternal education level. Odds ratios for the household income quintile mostly decline close to one when control variables are included. Interestingly, children from the poorest quintile have slightly lower odds for mental disorder (OR=0.84, SE=0.017) compared with children from the richest quintile. Urbanisation, share of higher-educated population and share of at-risk-of-poverty children are statistically insignificant variables. Differences are found between major regions; children from Åland are more likely (OR=1.5, SE=0.209) to have a mental disorder compared with Helsinki-Uusimaa residents, whereas children from Western Finland (OR=0.71, SE 0.053) have lower odds compared to the same reference. Random slopes for maternal education are not significant, and the model fit does not improve. However, there is some variation among municipalities (MOR=1.34), and this finding defends the usefulness of the multilevel model in the context of mental disorders in childhood. The results show that mental disorder inequalities persist in childhood, but there is complexity. Although no variation in socioeconomic inequalities among municipalities is found, there are still contextual effects between municipalities. Health policies should focus on reducing overall mental health inequalities in the young population, but it is an encouraging finding that disparities in childhood mental disorders are not shown to be stronger in some municipalities than others. Multilevel models can contribute to the methodology of future mental disorder research, if societal context is assumed to affect the outcomes of individuals.

Background Childhood cancer survivors have been reported to be vulnerable to psychiatric morbidities and risky health behavior. Suicides, substance abuse, accidents, and violence as causes of death can be regarded as an extreme manifestation of risky health behavior. In the current study, the authors studied the risk of suicide and other risky health behavior-related deaths among childhood cancer patients in Denmark, Finland, and Sweden. Methods Using linkage between national cancer, population, and cause-of-death registries, the authors investigated the causes of death in 29,285 patients diagnosed with cancer before age 20 years between 1971 and 2009 compared with a cohort of 146,282 age-matched, sex-matched, and country-matched population comparisons. Rate ratios (RRs) with 95% CIs were estimated using Poisson regression models, adjusting for demographic factors. Results The overall risk of dying of a risky health behavior was found to be increased among childhood cancer patients (RR, 1.25; 95% CI, 1.06-1.47) when compared with population comparisons. The elevated risk was statistically significant among patients with central nervous system tumors (RR, 1.49; 95% CI, 1.08-2.05) and patients diagnosed at ages 5 to 9 years and 15 to 19 years (RR, 1.50 [95% CI, 1.01-2.24] and RR, 1.31 [95% CI, 1.03-1.67], respectively). The overall risk of suicide was found to be increased (RR, 1.37; 95% CI, 1.02-1.83), and statistically significantly so when patients were diagnosed between ages 15 and 19 years (RR, 1.61; 95% CI, 1.09-2.39). Conclusions Childhood cancer patients appear to have an increased risk of risky health behavior-related causes of death compared with the general population. The results of the current study suggest the importance of integrating psychosocial support into the follow-up care of these individuals.

Excess sugar consumption—common in youth—is associated with poor health. Evidence on the relationship between sugar consumption and the oral microbiome, however, remains scarce and inconclusive. We explored whether the diversity, composition, and functional capacities of saliva microbiota differ based on the consumption of select sugary foods and drinks (“sweet treats”). Using 16S rRNA gene sequencing, we characterized saliva microbiota from 11 to 13-year-old children who participated in the Finnish Health in Teens (Fin-HIT) cohort study. The sample comprised children in the lowest (n = 227) and highest (n = 226) tertiles of sweet treat consumption. We compared differences in the alpha diversity (Shannon, inverse Simpson, and Chao1 indices), beta diversity (principal coordinates analysis based on Bray–Curtis dissimilarity), and abundance (differentially abundant operational taxonomic units (OTUs) at the genus level) between these low and high consumption groups. We performed PICRUSt2 to predict the metabolic pathways of microbial communities. No differences emerged in the alpha diversity between low and high sweet treat consumption, whereas the beta diversity differed between groups (p = 0.001). The abundance of several genera such as Streptococcus, Prevotella, Veillonella, and Selenomonas was higher in the high consumption group compared with the low consumption group following false discovery rate correction (p < 0.05). Children with high sweet treat consumption exhibited higher proportions of nitrate reduction IV and gondoate biosynthesis pathways compared with the low consumption group (p < 0.05). To conclude, sweet treat consumption shapes saliva microbiota. Children who consume a high level of sweet treats exhibited different compositions and metabolic pathways compared with children who consume low levels of sweet treats. Our findings reveal novel insights into the relationship between sugary diets and oral microbiota.

Background: Childhood asthma prevalence is significantly greater in urban areas compared with rural/farm environments. Murine studies have shown that TNF-alpha-induced protein 3 (TNFAIP3; A20), an anti-inflammatory regulator of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kappa B) signaling, mediates environmentally induced asthma protection. Objective: We aimed to determine the role of TNFAIP3 for asthma development in childhood and the immunomodulatory effects of environmental factors. Methods: In a representative selection of 250 of 2168 children from 2 prospective birth cohorts and 2 cross-sectional studies, we analyzed blood cells of healthy and asthmatic children from urban and rural/farm environments from Europe and China. PBMCs were stimulated ex vivo with dust from "asthma-protective'' farms or LPS. NF-kappa B signaling-related gene and protein expression was assessed in PBMCs and multiplex gene expression assays (NanoString Technologies) in isolated dendritic cells of schoolchildren and in cord blood mononuclear cells from newborns. Results: Anti-inflammatory TNFAIP3 gene and protein expression was consistently decreased, whereas proinflammatory Toll-like receptor 4 expression was increased in urban asthmatic patients (P <.05), reflecting their increased inflammatory status. Ex vivo farm dust or LPS stimulation restored TNFAIP3 expression to healthy levels in asthmatic patients and shifted NF-kappa B signaling-associated gene expression toward an anti-inflammatory state (P <.001). Farm/rural children had lower expression, indicating tolerance induction by continuous environmental exposure. Newborns with asthma at school age had reduced TNFAIP3 expression at birth, suggesting TNFAIP3 as a possible biomarker predicting subsequent asthma. Conclusion: Our data indicate TNFAIP3 as a key regulator during childhood asthma development and its environmentally mediated protection. Because environmental dust exposure conferred the anti-inflammatory effects, it might represent a promising future agent for asthma prevention and treatment.