Browsing by Subject "epidemiology"

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  • Cannistraci, Carlo Vittorio; Nieminen, Tuomo; Nishi, Masahiro; Khachigian, Levon M.; Viikilä, Juho; Laine, Mika; Cianflone, Domenico; Maseri, Attilio; Yeo, Khung Keong; Bhindi, Ravinay; Ammirati, Enrico (2018)
    Background-ST-elevation acute myocardial infarction (STEMI) represents one of the leading causes of death. The time of STEMI onset has a circadian rhythm with a peak during diurnal hours, and the occurrence of STEMI follows a seasonal pattern with a salient peak of cases in the winter months and a marked reduction of cases in the summer months. Scholars investigated the reason behind the winter peak, suggesting that environmental and climatic factors concur in STEMI pathogenesis, but no studies have investigated whether the circadian rhythm is modified with the seasonal pattern, in particular during the summer reduction in STEMI occurrence. Methods and Results-Here, we provide a multiethnic and multination epidemiological study (from both hemispheres at different latitudes, n= 2270 cases) that investigates whether the circadian variation of STEMI onset is altered in the summer season. The main finding is that the difference between numbers of diurnal (6:00 to 18:00) and nocturnal (18:00 to 6:00) STEMI is markedly decreased in the summer season, and this is a prodrome of a complex mechanism according to which the circadian rhythm of STEMI time onset seems season dependent. Conclusions-The "summer shift" of STEMI to the nocturnal interval is consistent across different populations, and the sunshine duration (a measure related to cloudiness and solar irradiance) underpins this season-dependent circadian perturbation. Vitamin D, which in our results seems correlated with this summer shift, is also primarily regulated by the sunshine duration, and future studies should investigate their joint role in the mechanisms of STEMI etiogenesis.
  • Breast Canc Assoc Consortium; Beeghly-Fadiel, Alicia; Khankari, Nikhil K.; Delahanty, Ryan J.; Zheng, Wei; Blomqvist, Carl; Nevanlinna, Heli (2020)
    Background: Conventional epidemiologic studies have evaluated associations between circulating lipid levels and breast cancer risk, but results have been inconsistent. As Mendelian randomization analyses may provide evidence for causal inference, we sought to evaluate potentially unbiased associations between breast cancer risk and four genetically predicted lipid traits. Methods: Previous genome-wide association studies (GWAS) have identified 164 discrete variants associated with high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), triglycerides and total cholesterol. We used 162 of these unique variants to construct weighted genetic scores (wGSs) for a total of 101 424 breast cancer cases and 80 253 controls of European ancestry from the Breast Cancer Association Consortium (BCAC). Unconditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between per standard deviation increase in genetically predicted lipid traits and breast cancer risk. Additional Mendelian randomization analysis approaches and sensitivity analyses were conducted to assess pleiotropy and instrument validity. Results: Corresponding to approximately 15 mg/dL, one standard deviation increase in genetically predicted HDL-C was associated with a 12% increased breast cancer risk (OR: 1.12, 95% CI: 1.08-1.16). Findings were consistent after adjustment for breast cancer risk factors and were robust in several sensitivity analyses. Associations with genetically predicted triglycerides and total cholesterol were inconsistent, and no association for genetically predicted LDL-C was observed. Conclusions: This study provides strong evidence that circulating HDL-C may be associated with an increased risk of breast cancer, whereas LDL-C may not be related to breast cancer risk.
  • Elovainio, Marko; Hakulinen, Christian; Pulkki-Raback, Laura; Juonala, Markus; Raitakari, Olli T. (2020)
    We modeled early psychosocial risks as a network of interconnected variables to study their associations with later depressive symptoms and cardiometabolic outcomes. The participants were a nationally representative sample of 2580 men and women aged 3-18 years in 1980. Their parents reported the psychosocial risks in 1980, including the following: (1) child-specific life events, (2) parental health behavior, (3) parental socioeconomic status, and (4) parental psychological problems. Adulthood depressive symptoms and cardiometabolic outcomes were measured in 2007-2012. The most central risks (most number of connections to other risks) were socioeconomic risks that also predicted health outcomes more consistently than others.
  • Susi, Hanna; Laine, Anna-Liisa (2021)
    Human alteration of natural habitats may change the processes governing species interactions in wild communities. Wild populations are increasingly impacted by agricultural intensification, yet it is unknown whether this alters biodiversity mediation of disease dynamics. We investigated the association between plant diversity (species richness, diversity) and infection risk (virus richness, prevalence) in populations of Plantago lanceolata in natural landscapes as well as those occurring at the edges of cultivated fields. Altogether, 27 P. lanceolata populations were surveyed for population characteristics and sampled for PCR detection of five recently characterized viruses. We find that plant species richness and diversity correlated negatively with virus infection prevalence. Virus species richness declined with increasing plant diversity and richness in natural populations while in agricultural edge populations species richness was moderately higher, and not associated with plant richness. This difference was not explained by changes in host richness between these two habitats, suggesting potential pathogen spill-over and increased transmission of viruses across the agro-ecological interface. Host population connectivity significantly decreased virus infection prevalence. We conclude that human use of landscapes may change the ecological laws by which natural communities are formed with far reaching implications for ecosystem functioning and disease.
  • Mertsalmi, Tuomas H.; Pekkonen, Eero; Scheperjans, Filip (2020)
    Background Gut microbiota alterations have been found in prodromal and established Parkinson's disease (PD). Antibiotic exposure can have long-term effects on the composition of human intestinal microbiota, but a potential connection between antibiotic exposure and risk of PD has not been studied previously. Objective To evaluate the impact of antibiotic exposure on the risk of PD in a nationwide, register-based, case-control study. Methods We identified all patients who were diagnosed with PD in Finland during the years 1998 to 2014. Information was obtained on individual purchases of orally administered antibiotics during the years 1993 to 2014. We assessed the association between prior antibiotic exposure and PD using conditional logistic regression. Results The study population consisted of 13,976 PD cases and 40,697 controls. The strongest connection with PD risk was found for oral exposure to macrolides and lincosamides (adjusted odds ratio up to 1.416; 95% confidence interval, 1.053-1.904). After correction for multiple comparisons, exposure to antianaerobics and tetracyclines 10 to 15 years before the index date, sulfonamides and trimethoprim 1 to 5 years before the index date, and antifungal medications 1 to 5 years before the index date were positively associated with PD risk. In post hoc analyses, further positive associations were found for broad-spectrum antibiotics. Conclusions Exposure to certain types of oral antibiotics seems to be associated with an elevated risk of PD with a delay that is consistent with the proposed duration of a prodromal period. The pattern of associations supports the hypothesis that effects on gut microbiota could link antibiotics to PD, but further studies are needed to confirm this. (c) 2019 International Parkinson and Movement Disorder Society
  • Korhonen, Kaarina; Tarkiainen, Lasse; Leinonen, Taina; Einiö, Elina; Martikainen, Pekka (2022)
    Background Depression is associated with an increased dementia risk, but the nature of the association in the long-term remains unresolved, and the role of sociodemographic factors mainly unexplored. Aims To assess whether a history of clinical depression is associated with dementia in later life, controlling for observed sociodemographic factors and unobserved factors shared by siblings, and to test whether gender, educational level and marital status modify the association. Method We conducted a national cohort study of 1 616 321 individuals aged 65 years or older between 2001 and 2018 using administrative healthcare data. A history of depression was ascertained from the national hospital register in the period 15-30 years prior to dementia follow-up. We used conventional and sibling fixed-effects Cox regression models to analyse the association between a history of depression, sociodemographic factors and dementia. Results A history of depression was related to an adjusted hazard ratio of 1.27 (95% CI 1.23-1.31) for dementia in the conventional Cox model and of 1.55 (95% CI 1.09-2.20) in the sibling fixed-effects model. Depression was related to an elevated dementia risk similarly across all levels of education (test for interaction, P = 0.84), but the association was weaker for the widowed than for the married (P = 0.003), and stronger for men than women (P = 0.006). The excess risk among men attenuated following covariate adjustment (P = 0.10). Discussion This study shows that a history of depression is consistently associated with later-life dementia risk. The results support the hypothesis that depression is an aetiological risk factor for dementia.
  • Tarkiainen, Lasse; Moustgaard, Heta; Korhonen, Kaarina; Noordzij, J. Mark; Beenackers, Marielle A.; van Lenthe, Frank J.; Burstrom, Bo; Martikainen, Pekka (2021)
    Background Research evidence on the association between neighbourhood characteristics and individual mental health at older ages is inconsistent, possibly due to heterogeneity in the measurement of mental-health outcomes, neighbourhood characteristics and confounders. Register-based data enabled us to avoid these problems in this longitudinal study on the associations between socioeconomic and physical neighbourhood characteristics and individual antidepressant use in three national contexts. Methods We used register-based longitudinal data on the population aged 50+ from Turin (Italy), Stockholm (Sweden), and the nine largest cities in Finland linked to satellite-based land-cover data. This included individual-level information on sociodemographic factors and antidepressant use, and on neighbourhood socioeconomic characteristics, levels of urbanicity, green space and land-use mix (LUM). We assessed individual-level antidepressant use over 6 years in 2001-2017 using mixed-effects logistic regression. Results A higher neighbourhood proportion of low-educated individuals predicted lower odds for antidepressant use in Turin and Stockholm when individual-level sociodemographic factors were controlled for. Urbanicity predicted increased antidepressant use in Stockholm (OR=1.02; 95% CI 1.01 to 1.03) together with more LUM (OR=1.03; 1.01-1.05) and population density (OR=1.08; 1.05-1.10). The two latter characteristics also predicted increased antidepressant use in the Finnish cities (OR=1.05; 1.02-1.08 and OR=1.14; 1.02-1.28, respectively). After accounting for all studied neighbourhood and individual characteristics of the residents, the neighbourhoods still varied by odds of antidepressant use. Conclusions Overall, the associations of neighbourhood socioeconomic and physical characteristics with older people's antidepressant use were small and inconsistent. However, we found modest evidence that dense physical urban environments predicted higher antidepressant use among older people in Stockholm and the Finnish cities.
  • Sund, Malin; Fonseca-Rodriguez, Osvaldo; Josefsson, Andreas; Welen, Karin; Connolly, Anne-Marie Fors (2022)
    Objective Determine whether augmentation of oestrogen in postmenopausal women decreases the risk of death following COVID-19. Design Nationwide registry-based study in Sweden based on registries from the Swedish Public Health Agency (all individuals who tested positive for SARS-CoV-2); Statistics Sweden (socioeconomical variables) and the National Board of Health and Welfare (causes of death). Participants Postmenopausal women between 50 and 80 years of age with verified COVID-19. Interventions Pharmaceutical modulation of oestrogen as defined by (1) women with previously diagnosed breast cancer and receiving endocrine therapy (decreased systemic oestrogen levels); (2) women receiving hormone replacement therapy (increased systemic oestrogen levels) and (3) a control group not fulfilling requirements for group 1 or 2 (postmenopausal oestrogen levels). Adjustments were made for potential confounders such as age, annual disposable income (richest group as the reference category), highest level of education (primary, secondary and tertiary (reference)) and the weighted Charlson Comorbidity Index (wCCI). Primary outcome measure Death following COVID-19. Results From a nationwide cohort consisting of 49 853 women diagnosed with COVID-19 between 4 February and 14 September 2020 in Sweden, 16 693 were between 50 and 80 years of age. We included 14 685 women in the study with 11 923 (81%) in the control group, 227 (2%) women in group 1 and 2535 (17%) women in group 2. The unadjusted ORs for death following COVID-19 were 2.35 (95% CI 1.51 to 3.65) for group 1 and 0.45 (0.34 to 0.6) for group 2. Only the adjusted OR for death remained significant for group 2 with OR 0.47 (0.34 to 0.63). Absolute risk of death was 4.6% for the control group vs 10.1% and 2.1%, for the decreased and increased oestrogen groups, respectively. The risk of death due to COVID-19 was significantly associated with: age, OR 1.15 (1.14 to 1.17); annual income, poorest 2.79 (1.96 to 3.97), poor 2.43 (91.71 to 3.46) and middle 1.64 (1.11 to 2.41); and education (primary 1.4 (1.07 to 1.81)) and wCCI 1.13 (1.1 to 1.16). Conclusions Oestrogen supplementation in postmenopausal women is associated with a decreased risk of dying from COVID-19 in this nationwide cohort study. These findings are limited by the retrospective and non-randomised design. Further randomised intervention trials are warranted.
  • Saltychev, Mikhail; Juhola, Juhani; Ervasti, Jenni; Kivimäki, Mika; Pentti, Jaana; Myllyntausta, Saana; Vahtera, Jussi (2021)
    Objectives To investigate the association between changes in lifestyle risk factors and changes is sleep difficulties. Design Longitudinal repeated measures cohort study. Setting University and national institute of occupational health. Participants Participants of the Finnish Public Sector study with information on sleep and lifestyle-related risk factors collected in five repeat surveys with 4-year intervals from 2000 to 2017. The participants were those, who had responded at least twice and had a change in sleep difficulties (having sleep difficulties vs not) (142 969 observations from 38 400 respondents (mean age 45.5 (SD 9.2) years, 83% women). Primary and secondary outcome measures Changes in sleep quality over time. Longitudinal fixed effects analysis, a method that accounts for time-invariant confounders by design, was used. Results At first available response, sleep difficulties were experienced by 13 998 (36%) of the respondents. Respectively, the mean age was 44.3 (10.0) years, 7526 (20%) were obese, 13 487 (35%) reported low physical activity, 3338 (9%) extensively drinking and 6547 (17%) were smoking. Except for smoking, the changes in the studied modifiable risks were associated with changes in sleep difficulties. The ORs for having sleep difficulties were 1.41 (95% CI 1.35 to 1.48) for obesity, 1.10 (95% CI 1.06 to 1.13) for low physical activity and 1.43 (95% CI 1.35 to 1.51) for heavy drinking. For smoking, the association was negative with OR 0.81 (95% CI 0.76 to 0.86). Including all four modifiable risks into model changed the estimates only little. Conclusions The results of this longitudinal study suggest that changes in sleep quality are interconnected with changes in lifestyle.
  • Basnet, Syaron; Merikanto, Ilona; Lahti, Tuuli; Männistö, Satu; Laatikainen, Tiina; Vartiainen, Erkki; Partonen, Timo (2016)
  • Koponen, Kari (Helsingin yliopisto, 2020)
    BACKGROUND: Diet has a major influence on the human gut microbiome, which has been linked to health and disease. However, epidemiological studies on the association of a healthy diet with the gut microbiome utilizing a whole-diet approach are still scant. OBJECTIVES: To assess associations between healthy food choices and human gut microbiome composition, and to determine the strength of association with the functional potential of the microbiome. DESIGN: The study sample consisted of 4,930 participants in the FINRISK 2002 study. Food intake was assessed using a food propensity questionnaire. Intake of food items recommended to be part of a healthy diet in the Nordic Nutrition Recommendations were transformed into a healthy food choices (HFC) score. Microbial diversity (alpha diversity) and compositional differences (beta diversity) and their associations with the HFC score and its components were assessed using linear regression and permutational multivariate analysis of variance (PERMANOVA). Associations between specific taxa and HFC were analyzed using multivariate associations with linear models (MaAsLin). Functional associations were derived from KEGG orthologies (KO) with linear regression models. RESULTS: Both microbial alpha (p = 1.90x10-4) and beta diversity (p ≤ 0.001) associated with HFC score. For alpha diversity, the strongest associations were observed for fiber-rich breads, poultry, fruits, and low-fat cheeses. For beta diversity, most prominent associations were observed for vegetables followed by berries and fruits. Genera with fiber-degrading and short-chain fatty acids (SCFA) producing capacity were positively associated with the HFC score. HFC associated positively with KO-based functions such as vitamin biosynthesis and SCFA metabolism, and inversely with fatty acid biosynthesis and the sulfur relay system. CONCLUSIONS: These results from a large and representative population-based survey confirm and extend findings of other smaller-scale studies that plant and fiber-rich dietary choices are associated with a more diverse and compositionally distinct microbiome, and with a greater potential to produce SCFAs.
  • Koponen, Kari K.; Salosensaari, Aaro; Ruuskanen, Matti O.; Havulinna, Aki S.; Männistö, Satu; Jousilahti, Pekka; Palmu, Joonatan; Salido, Rodolfo; Sanders, Karenina; Brennan, Caitriona; Humphrey, Gregory C.; Sanders, Jon G.; Meric, Guillaume; Cheng, Susan; Inouye, Michael; Jain, Mohit; Niiranen, Teemu J.; Valsta, Liisa M.; Knight, Rob; Salomaa, Veikko V. (2021)
    Background: Diet has a major influence on the human gut microbiota, which has been linked to health and disease. However, epidemiological studies on associations of a healthy diet with the microbiota utilizing a whole-diet approach are still scant. Objectives: To assess associations between healthy food choices and human gut microbiota composition, and to determine the strength of association with functional potential. Methods: This population-based study sample consisted of 4930 participants (ages 25-74; 53% women) in the FINRISK 2002 study. Intakes of recommended foods were assessed using a food propensity questionnaire, and responses were transformed into healthy food choices (HFC) scores. Microbial diversity (alpha diversity) and compositional differences (beta diversity) and their associations with the HFC score and its components were assessed using linear regression. Multiple permutational multivariate ANOVAs were run from whole-metagenome shallow shotgun-sequenced samples. Associations between specific taxa and HFC were analyzed using linear regression. Functional associations were derived from Kyoto Encyclopedia of Genes and Genomes orthologies with linear regression models. Results: Both microbial alpha diversity (beta/SD, 0.044; SE, 6.18 x 10(-5); P = 2.21 x 10(-3)) and beta diversity (R-2, 0.12; P Conclusions: Our results from a large, population-based survey confirm and extend findings of other, smaller-scale studies that plant and fiber-rich dietary choices are associated with a more diverse and compositionally distinct microbiota, and with a greater potential to produce SCFAs.
  • Atallah, Sarah; Marc, Morgane; Schernberg, Antoine; Huguet, Florence; Wagner, Isabelle; Mäkitie, Antti; Baujat, Bertrand (2022)
    Introduction: Adenoid cystic carcinoma (AdCC) is a rare tumour as it accounts for about 10% of all salivary gland neoplasms. It occurs in all age groups with a predominance of women, but no risk factors have been identified to date. Although AdCC behaves as a slow-growing tumour, it is characterized by multiple and late recurrences. Therefore, we aim to update the knowledge of the treatment options in advanced and recurrent cases. Materials and Methods: We performed a systematic literature review to provide a synthesis of the practical knowledge required for AdCC non-surgical management. Altogether, 99 out of the 1208 available publications were selected for analysis. Results: AdCC is described as a basaloid tumour consisting of epithelial and myoepithelial cells. Immunohistochemistry is useful for diagnosis (PS100, Vimentin, CD117, CKit, muscle actin, p63) and for prognosis (Ki67). Identified mutations could lead to therapeutic opportunities (MYB-NFIB, Notch 1). The work-up is mainly based on neck and chest CT scan and MRI, and PET-CT with 18-FDG or PSMA can be considered. Surgical treatment remains the gold standard in resectable cases. Post-operative intensity modulated radiotherapy is the standard of care, but hadron therapy may be used in specific situations. Based on the available literature, no standard chemotherapy regimen can be recommended. Conclusion: There is currently no consensus on the use of chemotherapy in AdCC, either concomitantly to RT in a postoperative setting or at a metastatic stage. Further, the available targeted therapies do not yet provide significant tumour response.
  • Guo, Qi; Burgess, Stephen; Turman, Constance; Bolla, Manjeet K.; Wang, Qin; Lush, Michael; Abraham, Jean; Aittomäki, Kristiina; Andrulis, Irene L.; Apicella, Carmel; Arndt, Volker; Barrdahl, Myrto; Benitez, Javier; Berg, Christine D.; Blomqvist, Carl; Bojesen, Stig E.; Bonanni, Bernardo; Brand, Judith S.; Brenner, Hermann; Broeks, Annegien; Burwinkel, Barbara; Caldas, Carlos; Campa, Daniele; Canzian, Federico; Chang-Claude, Jenny; Chanock, Stephen J.; Chin, Suet-Feung; Couch, Fergus J.; Cox, Angela; Cross, Simon S.; Cybulski, Cezary; Czene, Kamila; Darabi, Hatef; Devilee, Peter; Diver, W. Ryan; Dunning, Alison M.; Earl, Helena M.; Eccles, Diana M.; Ekici, Arif B.; Eriksson, Mikael; Evans, D. Gareth; Fasching, Peter A.; Figueroa, Jonine; Flesch-Janys, Dieter; Flyger, Henrik; Gapstur, Susan M.; Gaudet, Mia M.; Giles, Graham G.; Muranen, Taru A.; Nevanlinna, Heli; kConFab-AOCS Investigators (2017)
    There is increasing evidence that elevated body mass index (BMI) is associated with reduced survival for women with breast cancer. However, the underlying reasons remain unclear. We conducted a Mendelian randomization analysis to investigate a possible causal role of BMI in survival from breast cancer. We used individual-level data from six large breast cancer case-cohorts including a total of 36 210 individuals (2475 events) of European ancestry. We created a BMI genetic risk score (GRS) based on genotypes at 94 known BMI-associated genetic variants. Association between the BMI genetic score and breast cancer survival was analysed by Cox regression for each study separately. Study-specific hazard ratios were pooled using fixed-effect meta-analysis. BMI genetic score was found to be associated with reduced breast cancer-specific survival for estrogen receptor (ER)-positive cases [hazard ratio (HR) = 1.11, per one-unit increment of GRS, 95% confidence interval (CI) 1.01-1.22, P = 0.03). We observed no association for ER-negative cases (HR = 1.00, per one-unit increment of GRS, 95% CI 0.89-1.13,P = 0.95). Our findings suggest a causal effect of increased BMI on reduced breast cancer survival for ER-positive breast cancer. There is no evidence of a causal effect of higher BMI on survival for ER-negative breast cancer cases.
  • Sievanen, Tero; Tormakangas, Timo; Laakkonen, Eija K.; Mecklin, Jukka-Pekka; Pylvänäinen, Kirsi; Seppälä, Toni T.; Peltomäki, Paivi; Sipila, Sarianna; Sillanpää, Elina (2021)
    Simple Summary Lifestyle modifies cancer risk in the general public. How lifestyle modifies cancer risk in individuals carrying the inherited pathogenic gene variants in DNA mismatch repair genes (Lynch syndrome) remains understudied. We conducted a retrospective study with cancer register data to investigate associations between body weight, physical activity, and cancer risk among Finnish Lynch syndrome carriers (n = 465, 54% women). The results of our study indicated that longitudinal weight gain increases cancer risk, whereas being highly physically active during adulthood could decrease cancer risk in men. Further, women were observed to be less prone to lifestyle-related risk factors than men. The results emphasize the role of weight maintenance and high-intensity physical activity throughout the lifespan, especially in men with Lynch syndrome. Lynch syndrome (LS) increases cancer risk. There is considerable individual variation in LS cancer occurrence, which may be moderated by lifestyle factors, such as body weight and physical activity (PA). The potential associations of lifestyle and cancer risk in LS are understudied. We conducted a retrospective study with cancer register data to investigate associations between body weight, PA, and cancer risk among Finnish LS carriers. The participants (n = 465, 54% women) self-reported their adulthood body weight and PA at 10-year intervals. Overall cancer risk and colorectal cancer (CRC) risk was analyzed separately for men and women with respect to longitudinal and near-term changes in body weight and PA using extended Cox regression models. The longitudinal weight change was associated with an increased risk of all cancers (HR 1.02, 95% CI 1.00-1.04) and CRC (HR 1.03, 1.01-1.05) in men. The near-term weight change was associated with a lower CRC risk in women (HR 0.96, 0.92-0.99). Furthermore, 77.6% of the participants retained their PA category over time. Men in the high-activity group had a reduced longitudinal cancer risk of 63% (HR 0.37, 0.15-0.98) compared to men in the low-activity group. PA in adulthood was not associated with cancer risk among women. These results emphasize the role of weight maintenance and high-intensity PA throughout the lifespan in cancer prevention, particularly in men with LS.
  • Kruit, Heidi; Gissler, Mika; Heinonen, Seppo; Rahkonen, Leena (2022)
    Objectives To determine the association between the rate of labour induction and caesarean delivery. Design Medical Birth Register-based study. We used data from the nationwide Medical Birth Register collecting data on delivery outcomes on all births from 22+0 weeks and/or birth weight of at least 500 g. Setting Finland. Participants 663 024 live births in Finland from 2008 to 2019. Main outcome measures The rates of labour induction and caesarean delivery. Results The rate of labour induction increased from 17.8% to 30.3%; p Conclusions The 70% increase in the rate of labour induction in Finland has not led to a significant increase in the rate of caesarean delivery, which has remained one of the lowest in the world. Pregnant women in Finland are more frequently obese, older and diagnosed with gestational diabetes, which may partly explain the increase in the rate of labour induction.
  • Haagsma, Juanita A.; James, Spencer L.; Castle, Chris D.; Dingels, Zachary; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Lucchesi, Lydia R.; Roberts, Nicholas L. S.; Sylte, Dillon O.; Adebayo, Oladimeji M.; Ahmadi, Alireza; Ahmed, Muktar Beshir; Aichour, Miloud Taki Eddine; Alahdab, Fares; Alghnam, Suliman A.; Aljunid, Syed Mohamed; Al-Raddadi, Rajaa M.; Alsharif, Ubai; Altirkawi, Khalid; Anjomshoa, Mina; Antonio, Carl Abelardo T.; Appiah, Seth Christopher Yaw; Aremu, Olatunde; Arora, Amit; Asayesh, Hamid; Assadi, Reza; Awasthi, Ashish; Ayala Quintanilla, Beatriz Paulina; Balalla, Shivanthi; Banstola, Amrit; Barker-Collo, Suzanne Lyn; Baernighausen, Till Winfried; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Behzadifar, Masoud; Behzadifar, Meysam; Benjet, Corina; Bennett, Derrick A.; Bensenor, Isabela M.; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A.; Bijani, Ali; Borges, Guilherme; Borschmann, Rohan; Bose, Dipan; Boufous, Soufiane; Brazinova, Alexandra; Rincon, Julio Cesar Campuzano; Cardenas, Rosario; Carrero, Juan J.; Carvalho, Felix; Castaneda-Orjuela, Carlos A.; Catala-Lopez, Ferran; Choi, Jee-Young J.; Christopher, Devasahayam J.; Crowe, Christopher Stephen; Dalal, Koustuv; Daryani, Ahmad; Davitoiu, Dragos Virgil; Degenhardt, Louisa; De Leo, Diego; De Neve, Jan-Walter; Deribe, Kebede; Dessie, Getenet Ayalew; deVeber, Gabrielle Aline; Dharmaratne, Samath Dhamminda; Linh Phuong Doan; Dolan, Kate A.; Driscoll, Tim Robert; Dubey, Manisha; El-Khatib, Ziad; Ellingsen, Christian Lycke; Zaki, Maysaa El Sayed; Endries, Aman Yesuf; Eskandarieh, Sharareh; Faro, Andre; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Franklin, Richard Charles; Fukumoto, Takeshi; Gezae, Kebede Embaye; Gill, Tiffany K.; Goulart, Alessandra C.; Grada, Ayman; Guo, Yuming; Gupta, Rahul; Bidgoli, Hassan Haghparast; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hamadeh, Randah R.; Hamidi, Samer; Maria Haro, Josep; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hendrie, Delia; Henok, Andualem; Hijar, Martha; Hole, Michael K.; Rad, Enayatollah Homaie; Hossain, Naznin; Hostiuc, Sorin; Hu, Guoqing; Igumbor, Ehimario U.; Ilesanmi, Olayinka Stephen; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q.; Jacobsen, Kathryn H.; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jayatilleke, Achala Upendra; Jha, Ravi Prakash; Jonas, Jost B.; Shushtari, Zahra Jorjoran; Jozwiak, Jacek Jerzy; Jurisson, Mikk; Kabir, Ali; Kalani, Rizwan; Kasaeian, Amir; Kelbore, Abraham Getachew; Kengne, Andre Pascal; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khan, Ejaz Ahmad; Khoja, Abdullah T.; Kiadaliri, Aliasghar A.; Kim, Young-Eun; Kim, Daniel; Kisa, Adnan; Koyanagi, Ai; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kumar, Manasi; Lalloo, Ratilal; Lam, Hilton; Lami, Faris Hasan; Lansingh, Van C.; Leasher, Janet L.; Li, Shanshan; Linn, Shai; Lunevicius, Raimundas; Machado, Flavia R.; Abd El Razek, Hassan Magdy; Abd El Razek, Muhammed Magdy; Mahotra, Narayan Bahadur; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Malik, Manzoor Ahmad; Malta, Deborah Carvalho; Manda, Ana-Laura; Mansournia, Mohammad Ali; Massenburg, Benjamin Ballard; Maulik, Pallab K.; Meheretu, Hailemariam Abiy Alemu; Mehndiratta, Man Mohan; Melese, Addisu; Mendoza, Walter; Mengesha, Melkamu Merid; Meretoja, Tuomo J.; Meretoja, Atte; Mestrovic, Tomislav; Miazgowski, Tomasz; Miller, Ted R.; Mini, G. K.; Mirrakhimov, Erkin M.; Moazen, Babak; Mezerji, Naser Mohammad Gholi; Mohammadibakhsh, Roghayeh; Mohammed, Shafiu; Molokhia, Mariam; Monasta, Lorenzo; Mondello, Stefania; Montero-Zamora, Pablo A.; Moodley, Yoshan; Moosazadeh, Mahmood; Moradi, Ghobad; Moradi-Lakeh, Maziar; Morawska, Lidia; Moreno Velasquez, Ilais; Morrison, Shane Douglas; Moschos, Marilita M.; Mousavi, Seyyed Meysam; Murthy, Srinivas; Musa, Kamarul Imran; Naik, Gurudatta; Najafi, Farid; Nangia, Vinay; Nascimento, Bruno Ramos; Ndwandwe, Duduzile Edith; Negoi, Ionut; Trang Huyen Nguyen; Son Hoang Nguyen; Long Hoang Nguyen; Huong Lan Thi Nguyen; Ningrum, Dina Nur Anggraini; Nirayo, Yirga Legesse; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oh, In-Hwan; Oladimeji, Olanrewaju; Olagunju, Andrew T.; Olagunju, Tinuke O.; Olivares, Pedro R.; Orpana, Heather M.; Otstavnov, Stanislav S.; Mahesh, P. A.; Pakhale, Smita; Park, Eun-Kee; Patton, George C.; Pesudovs, Konrad; Phillips, Michael R.; Polinder, Suzanne; Prakash, Swayam; Radfar, Amir; Rafay, Anwar; Rafiei, Alireza; Rahimi, Siavash; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rai, Rajesh Kumar; Ramezanzadeh, Kiana; Rawaf, Salman; Rawaf, David Laith; Renzaho, Andre M. N.; Resnikoff, Serge; Rezaeian, Shahab; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Sabde, Yogesh Damodar; Saddik, Basema; Salamati, Payman; Salimi, Yahya; Salz, Inbal; Samy, Abdallah M.; Sanabria, Juan; Riera, Lidia Sanchez; Milicevic, Milena M. Santric; Satpathy, Maheswar; Sawhney, Monika; Sawyer, Susan M.; Saxena, Sonia; Saylan, Mete; Schneider, Ione J. C.; Schwebel, David C.; Seedat, Soraya; Sepanlou, Sadaf G.; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamsizadeh, Morteza; Sharif-Alhoseini, Mahdi; Sheikh, Aziz; Shen, Jiabin; Shigematsu, Mika; Shiri, Rahman; Shiue, Ivy; Silva, Joao Pedro; Singh, Jasvinder A.; Sinha, Dhirendra Narain; Soares Filho, Adauto Martins; Soriano, Joan B.; Soshnikov, Sergey; Soyiri, Ireneous N.; Starodubov, Vladimir; Stein, Dan J.; Stokes, Mark A.; Sufiyan, Mu'awiyyah Babale; Sunshine, Jacob E.; Sykes, Bryan L.; Tabares-Seisdedos, Rafael; Tabb, Karen M.; Tehrani-Banihashemi, Arash; Tessema, Gizachew Assefa; Thakur, Jarnail Singh; Khanh Bao Tran; Bach Xuan Tran; Car, Lorainne Tudor; Uthman, Olalekan A.; Uzochukwu, Benjamin S. Chudi; Valdez, Pascual R.; Varavikova, Elena; Nogales Vasconcelos, Ana Maria; Venketasubramanian, Narayanaswamy; Violante, Francesco S.; Vlassov, Vasily; Waheed, Yasir; Wang, Yuan-Pang; Wijeratne, Tissa; Winkler, Andrea Sylvia; Yadav, Priyanka; Yano, Yuichiro; Yenesew, Muluken Azage; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Younis, Mustafa Z.; Yu, Chuanhua; Zafar, Shamsa; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zhao, Yong; Zodpey, Sanjay; Hay, Simon; Lopez, Alan D.; Mokdad, Ali H.; Vos, Theo (2020)
    Background The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. Results For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
  • Young, T. Kue; Kelly, Janet J.; Friborg, Jeppe; Soininen, Leena; Wong, Kai O. (2016)
    Objectives. To determine and compare the incidence of cancer among the 8 Arctic States and their northern regions, with special focus on 3 cross-national indigenous groups - Inuit, Athabaskan Indians and Sami. Methods. Data were extracted from national and regional statistical agencies and cancer registries, with direct age-standardization of rates to the world standard population. For comparison, the "world average'' rates as reported in the GLOBOCAN database were used. Findings. Age-standardized incidence rates by cancer sites were computed for the 8 Arctic States and 20 of their northern regions, averaged over the decade 2000 - 2009. Cancer of the lung and colon/rectum in both sexes are the commonest in most populations. We combined the Inuit from Alaska, Northwest Territories, Nunavut and Greenland into a "Circumpolar Inuit'' group and tracked cancer trends over four 5-year periods from 1989 to 2008. There has been marked increase in lung, colorectal and female breast cancers, while cervical cancer has declined. Compared to the GLOBOCAN world average, Inuit are at extreme high risk for lung and colorectal cancer, and also certain rare cancers such as nasopharyngeal cancer. Athabaskans (from Alaska and Northwest Territories) share some similarities with the Inuit but they are at higher risk for prostate and breast cancer relative to the world average. Among the Sami, published data from 3 cohorts in Norway, Sweden and Finland show generally lower risk of cancer than non-Sami. Conclusions. Cancer among certain indigenous people in the Arctic is an increasing public health concern, especially lung and colorectal cancer.
  • Nieminen, Markus; Aro, Katri; Mäkitie, Antti; Harlin, Vappu; Kainulainen, Satu; Jouhi, Lauri; Atula, Timo (2021)
    Background Early diagnosis of head and neck cancer (HNC) will improve patient outcomes. The low incidence of HNC renders its detection challenging for a general practitioner (GP) in primary health care (PHC). Patients and methods To examine these challenges, our cohort consisted of all patients visiting PHC centres in the City of Helsinki in 2016. We chose 57 ICD-10 codes representing a sign or symptom resulting from a possible HNC and compared data for all new HNC patients. Results A total of 242,211 patients (499,542 appointments) visited PHC centres, 11,896 (5%) of whom presented with a sign or symptom possibly caused by HNC. Altogether, 111 new HNCs were diagnosed within the Helsinki area, of which 40 (36%) were referred from PHC. The median delay from the initial PHC visit to the referral to specialist care was 5 days, whereby 88% of patients were referred within one month. Conclusions Despite the low incidence of HNC and the large number of patients presenting with HNC-related symptoms, GPs working in PHC sort out potential HNC patients from the general patient group in most cases remarkably effectively.KEY MESSAGES For every head and neck cancer (HNC) patient encountered in the primary health care, a general practitioner (GP) will meet approximately 6000 other patients, 100 of whom exhibit a sign or a symptom potentially caused by a HNC. Despite the low incidence of HNC, GPs referred patients to specialist care effectively, limiting the median delay from the initial appointment to referral to only 5 days.
  • Bronnum-Hansen, Henrik; Ostergren, Olof; Tarkiainen, Lasse; Hermansen, Åsmund; Martikainen, Pekka; van der Wel, Kjetil A.; Lundberg, Olle (2021)
    Objectives Levels, trends or changes in socioeconomic mortality differentials are typically described in terms of means, for example, life expectancies, but studies have suggested that there also are systematic social disparities in the dispersion around those means, in other words there are inequalities in lifespan variation. This study investigates changes in income inequalities in mean and distributional measures of mortality in Denmark, Finland, Norway, and Sweden over two decades. Design Nationwide register-based study. Setting The Danish, Finnish, Norwegian and Swedish populations aged 30 years or over in 1997 and 2017. Main outcome measures Income-specific changes in life expectancy, lifespan variation and the contribution of 'early' and 'late' deaths to increasing life expectancy. Results Increases in life expectancy has taken place in all four countries, but there are systematic differences across income groups. In general, the largest gains in life expectancy were observed in Denmark, and the smallest increase among low-income women in Sweden and Norway. Overall, life expectancy increased and lifespan variation decreased with increasing income level. These differences grew larger over time. In all countries, a marked postponement of early deaths led to a compression of mortality in the top three income quartiles for both genders. This did not occur for the lowest income quartile. Conclusion Increasing life expectancy is typically accompanied by postponement of early deaths and reduction of lifespan inequality in the higher-income groups. However, Nordic welfare societies are challenged by the fact that postponing premature deaths among people in the lowest-income groups is not taking place.