Browsing by Subject "follow-up"

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  • Lahti, Jouni; Laaksonen, Mikko; Lahelma, Eero; Rahkonen, Ossi (2011)
    BACKGROUND: Retirement is a major life change that is likely to affect lifestyles. The aim of this study was to examine changes in leisure-time physical activity of moderate and vigorous intensity among ageing employees facing transition to retirement over a follow-up of 5-7 years. METHODS: The baseline data were collected by questionnaire surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki. A follow-up survey was conducted among the baseline respondents in 2007 (n=7332, response rate 83%). Those who were on disability retirement at the follow-up were distinguished from old-age retirees. Leisure-time physical activity was measured using similar questions in both surveys. RESULTS: Old-age retirees increased significantly their time spent in moderate-intensity physical activity: women 31 minutes per week and men 42 minutes per week on average. Such changes were not found among disability retirees or those remaining employed. There were no changes in vigorous activity. Leisure-time physical inactivity at follow-up was lower among old-age retirees compared with employees of nearly the same age. Adjustments made for potential baseline covariates had no effects on these findings. CONCLUSIONS: Transition to old-age retirement was associated with an increase in moderate-intensity leisure-time physical activity and a decrease in the proportion of inactive. Encouraging people to leisure-time physical activity after retirement is worthwhile as the increase in free time brings new possibilities for it.
  • Manty, Minna; Kouvonen, Anne; Lallukka, Tea; Lahti, Jouni; Lahelma, Eero; Rahkonen, Ossi (2015)
    Objectives The aim this study was to examine the effect of changes in physical and psychosocial working conditions on physical health functioning among ageing municipal employees. Methods Follow-up survey data were collected from midlife employees of the City of Helsinki, Finland, at three time points: wave 1(2000-2002), wave 2(2007), and wave 3 (2012). Changes in physical and psychosocial working conditions were assessed between waves 1 and 2. Physical health functioning was measured by the physical component summary (PCS) of the Short-Form 36 questionnaire at each of the three waves. In total, 2784 respondents (83% women) who remained employed over the follow-up were available for the analyses. Linear mixed-effect models were used to assess the associations and adjust for key covariates (age, gender, obesity, chronic diseases, and health behaviors). Results Repeated and increased exposure to adverse physical working conditions was associated with greater decline in physical health functioning over time. In contrast, decrease in exposures reduced the decline Of the psychosocial working conditions, changes in job demands had no effects on physical health functioning. However, decreased job control was associated with greater decline and repeated high or increased job control reduced the decline in physical health functioning over time. Conclusions Adverse changes in physical working conditions and job control were associated with greater decline in physical health functioning over time, whereas favorable changes in these exposures reduced the decline. Preventing deterioration and promoting improvement of working conditions are likely to help maintain better physical health functioning among ageing employees.
  • Kivelä, Laura; Euren, Anna; Repo, Marleena; Huhtala, Heini; Kaukinen, Katri; Kurppa, Kalle (2022)
    PurposeWe evaluated adherence to a gluten-free diet and associated factors in adult celiac disease patients diagnosed in childhood. MethodsComprehensive medical data on 955 pediatric celiac disease patients was collected and study questionnaires sent to 559 who were now adults. All variables were compared between strictly adherent and non-adherent patients. ResultsAltogether 237 adults (median age 27 years, 69% women) responded to the questionnaires a median of 18 (range 3-51) years after the childhood diagnosis. Altogether 78% were reportedly adherent and 22% non-adherent. The non-adherent patients had more concomitant type 1 diabetes (18% vs. 4%, p = 0.003), whereas the groups did not differ in demographic data or clinical and histological features at diagnosis, or in short-term dietary adherence. In adulthood, non-adherent patients found gluten-free diet more challenging (39% vs. 17%, p < 0.001) and had higher prevalence (39% vs. 19%, p = 0.004) and severity of symptoms. The main motivation factors for dietary adherence were attempts to avoid symptoms and complications, but these were considered less important and price of gluten-free products more important among non-adherent patients. Adherent and non-adherent patients did not differ in socioeconomic or lifestyle factors, comorbidities other than type 1 diabetes, self-reported general health, health concerns, follow-up, or in quality of life. ConclusionMost originally pediatric celiac disease patients reported strict dietary adherence in adulthood. However, particularly those with concomitant type 1 diabetes, persistent symptoms or financial issues may require attention during the transition from pediatric to adult care.
  • Venermo, Maarit; Sprynger, Muriel; Desormais, Ileana; Björck, Martin; Brodmann, Marianne; Cohnert, Tina; De Carlo, Marco; Espinola-Klein, Christine; Kownator, Serge; Mazzolai, Lucia; Naylor, Ross; Vlachopoulos, Charalambos; Ricco, Jean-Baptiste; Aboyans, Victor (2019)
    Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often challenging. Early and late procedural complications, but also local and remote recurrences frequently lead to revascularisation failure. The rationale for surveillance is to propose the accurate implementation of preventive strategies to avoid other cardiovascular events and disease progression and avoid recurrence of symptoms and the need for redo revascularisation. Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularisation failures. Other non-invasive examinations (ankle and toe brachial index, computed tomography scan, magnetic resonance imaging) at regular intervals can optimise surveillance in specific settings. Currently, optimal revascularisation surveillance programmes are not well defined and systematic reviews addressing long-term results after revascularisation are lacking. We have systematically reviewed the literature addressing follow-up after revascularisation and we propose this consensus document as a complement to the recent guidelines for optimal surveillance of revascularised patients beyond the perioperative period.
  • Kosola, Salla (Helsingin yliopisto, 2021)
    Objectives – Neonatal hyperbilirubinemia (HB), also referred to as neonatal jaundice, can alter child’s neurodevelopment, and thus significantly increase infant’s risk for severe neurological disability. Although the majority of neonatal HB cases benign, there are several cases where bilirubin levels grow alarmingly and remain elevated, eventually causing permanent physical harm and frequently altering the development of central nervous system. Research on the long-term effects of HB has been lacking: the follow-ups have been relative short, and there are not many studies focusing on how neonatal HB might influence neurocognition in later adulthood (> 30 year of age). The aim of this study is to further investigate the association between neonatal HB and later cognitive performance in adulthood by using data from over 40-year-long Finnish follow-up study. Methods – In a longitudinal prospective study, data were collected from 125 subject who had experienced neonatal HB and from 77 controls. Cognitive performance was assessed at age of 40 by using various previously validated methods designed to assess executive function and attention, memory, verbal functions, and visuo-perceptual functions. Four factors were formed for neuropsychological variables: Cognitive flexibility, Visual memory and perception, Verbal memory, and Reading. In addition, all subjects had performed WAIS-IV assessments. Data from these assessments were used to create four new factors – Verbal comprehension, Working Memory, Perceptual Reasoning, and Processing Speed – reflecting different cognitive areas. Also, Full-Scale Intelligence Quotient (FSIQ) was included. Linear regression analyses were used to assess the relation between HB-classification and neuropsychological variables. Differences between the groups were further studied by pair-wise comparisons using t-test, after which Mann–Whitney-U test was used to take into account moderate to highly skewed distributions of the variables. Effects of different HB levels on later neurocognition was studied by using linear regression, where sex, mother’s age at birth, and mother’s education level were controlled. Results – Neonatal HB was associated with slower performance in Cognitive Flexibility, and with lower performance in Perceptual Reasoning and in FSIQ. Highest measured neonatal bilirubin levels within HB group had a linear effect on Verbal Comprehension at age of 40; however, the effect was not found in other cognitive domains. Conclusions – Neonatal HB has effect on performance in FSIQ at age of 40 years. In addition, it was associated with both poorer Perceptual Reasoning and slower Cognitive Flexibility. Results might be due to perceptual reasoning’s high vulnerability to neuronal damage and to difficulty of compensating perceptual biological limitations with learning. Since the measured neonatal bilirubin levels within HB group was associated only with lower performance in Verbal Reasoning in this study, it could be concluded that after reaching the inclusion criteria the excess level of bilirubin was no longer significant influence on severity of the outcome.
  • Venermo, Maarit; Sprynger, Muriel; Desormais, Ileana; Björck, Martin; Brodmann, Marianne; Cohnert, Tina; Carlo, Marco De; Espinola-Klein, Christine; Kownator, Serge; Mazzolai, Lucia; Naylor, Ross; Vlachopoulos, Charalambos; Ricco, Jean-Baptiste; Aboyans, Victor (2019)
    Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often challenging. Early and late procedural complications, but also local and remote recurrences frequently lead to revascularisation failure. The rationale for surveillance is to propose the accurate implementation of preventive strategies to avoid other cardiovascular events and disease progression and avoid recurrence of symptoms and the need for redo revascularisation. Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularisation failures. Other non-invasive examinations (ankle and toe brachial index, computed tomography scan, magnetic resonance imaging) at regular intervals can optimise surveillance in specific settings. Currently, optimal revascularisation surveillance programmes are not well defined and systematic reviews addressing long-term results after revascularisation are lacking. We have systematically reviewed the literature addressing follow-up after revascularisation and we propose this consensus document as a complement to the recent guidelines for optimal surveillance of revascularised patients beyond the perioperative period.
  • Lindhom, Vivian; Lahti, Jouni; Rahkonen, Ossi; Lahelma, Eero; Lallukka, Tea (2013)
    BACKGROUND: Physical inactivity and overweight are major threats to public health. However, it is not well understood to what extent physical activity might counteract the harmful effects of overweight on functioning. Thus, we examined the joint associations of leisure-time physical activity and body mass index (BMI) with subsequent physical and mental functioning over a follow-up of five to seven years. METHODS: The data were derived from the Helsinki Health Study, which is a cohort study among employees of the City of Helsinki, Finland. The baseline postal survey data were collected among 40-60-year-old employees in 2000-02 (n = 8960, response rate 67%), and the follow-up data in 2007 among all baseline survey respondents (n = 7332, response rate 83%). We divided the participants into six groups according to their amount of physical activity (inactive, moderately active and highly active) and their relative weight (normal weight and overweight). Highly active normal-weight participants were used as a reference group in all the analyses. Poor functioning was defined as the lowest quartile of the Short Form 36 (SF-36) health survey's physical and mental component summaries, with the follow-up cut-off point also applied at baseline. We used logistic regression analysis adjusted for age, gender, baseline functioning, smoking, alcohol use, marital status, socioeconomic position and working conditions. RESULTS: At baseline 48% of the participants were overweight and 11% were inactive. After adjustments inactivity was associated with poor physical functioning at follow-up both among the normal-weight (OR 1.51, 95% CI 1.09-2.10) and overweight (OR 2.02, 95% CI 1.56-2.63) groups. Being overweight regardless of activity level was associated with poor physical functioning. Poor physical functioning was practically equally common among the highly active overweight group and the inactive normal-weight group. After adjustments, for mental functioning, only inactivity among the overweight was associated with poor mental functioning (OR 1.39, 95% CI 1.08-1.80). CONCLUSIONS: Physical activity is likely to be beneficial for physical and mental functioning among both those with overweight and normal weight. However, maintaining normal weight is also important for good physical functioning. Therefore, efforts should be made to recommend people to engage in physical activity regardless of weight.
  • Ray, Carola; Campbell, Karen; Hesketh, Kylie D. (2019)
    Knowledge of the impact of health messages as an intervention strategy is sparse. The aim of this study was to explore recall and use of health behaviour messages among mothers, and whether recall is associated with child health behaviours. Intervention group data from the 15 months Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) were used (n = 127, children 4 months at commencement). Mothers recalled (unprompted then prompted) at 2 and 3.5 years post-intervention six key messages used in the program, and reported whether they had used them. Children's food intake was measured by three days of 24-h recall; physical activity by accelerometers; and television viewing by parent report. Unprompted recall ranged between 1-56% across messages and follow-up points, and 37-90% for prompted recall. The most commonly recalled messages "tap into water", "parents provide, kids decide" and "color every meal with fruit and veg" were also most commonly used. There were few associations between recall and children's health behaviours. Given the association between recall and reported use, it is important to plan messages so they resonate well with the target group and its needs. Messages should be used as one of multiple strategies within health promotion programs.
  • Kjaer, Maj-Brit N.; Meyhoff, Tine S.; Madsen, Martin B.; Hjortrup, Peter B.; Moller, Morten Hylander; Egerod, Ingrid; Wetterslev, Jorn; Lange, Theis; Cronhjort, Maria; Laake, Jon H.; Jakob, Stephan M.; Nalos, Marek; Pettilä, Ville; van der Horst, Iwan C. C.; Ostermann, Marlies; Mouncey, Paul; Cecconi, Maurizio; Ferrer, Ricard; Malbrain, Manu L. N. G.; Ahlstedt, Christian; Hoffmann, Soren; Bestle, Morten H.; Gyldensted, Louise; Nebrich, Lars; Russell, Lene; Vang, Marianne; Solling, Christoffer; Brochner, Anne C.; Rasmussen, Bodil S.; Perner, Anders (2020)
    BackgroundIn patients with septic shock, mortality is high, and survivors experience long-term physical, mental and social impairments. The ongoing Conservative vs Liberal Approach to fluid therapy of Septic Shock in Intensive Care (CLASSIC) trial assesses the benefits and harms of a restrictive vs standard-care intravenous (IV) fluid therapy. The hypothesis is that IV fluid restriction improves patient-important long-term outcomes. AimTo assess the predefined patient-important long-term outcomes in patients randomised into the CLASSIC trial. MethodsIn this pre-planned follow-up study of the CLASSIC trial, we will assess all-cause mortality, health-related quality of life (HRQoL) and cognitive function 1 year after randomisation in the two intervention groups. The 1-year mortality will be collected from electronic patient records or central national registries in most participating countries. We will contact survivors and assess EuroQol 5-Dimension, -5-Level (EQ-5D-5L) and EuroQol-Visual Analogue Scale and Montreal Cognitive Assessment 5-minute protocol score. We will analyse mortality by logistic regression and use general linear models to assess HRQoL and cognitive function. DiscussionWith this pre-planned follow-up study of the CLASSIC trial, we will provide patient-important data on long-term survival, HRQoL and cognitive function of restrictive vs standard-care IV fluid therapy in patients with septic shock.
  • Hublin, Chister; Lehtovirta, Mikko; Partinen, Markku; Koskenvuo, Markku; Kaprio, Jaakko (2016)
    OBJECTIVE: Some studies indicate an association between napping and increased risk of type 2 diabetes. We studied this prospectively in a sample representative of general population. METHODS: A questionnaire was administered to the Finnish Twin Cohort in 1990 (response rate 77%, age 33-60 years). The study population included 12,244 subjects who replied to the question "Do you sleep during the daytime (take naps)?" with five response alternatives ranging from "no need" to "every or almost every day." Information on incident cases of diabetes was obtained by linkage to nationwide registers. Logistic regression models were used to obtain odds ratios (ORs) (95% confidence intervals) for incident type 2 diabetes risk in 1991-2004 by napping category. Adjustments were made for 11 socio-demographic and lifestyle covariates. For subjects aged 33-45 years at baseline, a questionnaire in 2011 provided information on prevalent diabetes. RESULTS: Thirty-four per cent had no need for napping, and 15% did so on ≥3 days weekly. There were 356 incident type 2 diabetes cases during the follow-up. Using the 'no need' category as the reference, the risk of type 2 diabetes was significantly increased only among those napping most frequently [OR 1.86 (1.29-2.67), age- and sex-adjusted]. After adjusting for other covariates, the results were essentially the same, but when adjusted for body mass index, the association decreased (to about 1.3) and was statistically non-significant. Analysis of 2011 self-reported type 2 diabetes was in line with the register data. CONCLUSIONS: Frequent napping is associated with future risk of type 2 diabetes. This association is largely explained by obesity.
  • Lindgren, Maija; Holm, Minna; Kieseppä, Tuula; Suvisaari, Jaana (2020)
    Cognitive performance at illness onset may predict outcomes in first-episode psychosis (FEP), and the change in cognition may associate with clinical changes. Cognitive testing was administered to 54 FEP participants 2 months after entering treatment and to 39 participants after 1 year. We investigated whether baseline cognition predicted 1-year outcomes beyond positive, negative, and affective symptoms and whether the trajectory of cognition associated with clinical change. Baseline overall neurocognitive performance predicted the 1-year social and occupational level, occupational status, and maintaining of life goals. The domain of processing speed associated with the 1-year remission, occupational status, and maintaining of life goals. Baseline social cognition associated with occupational status a year later and the need for hospital treatment during the 1st year after FEP. Most of the associations were retained beyond baseline positive and affective symptom levels, but when accounting for negative symptoms, cognition no longer predicted 1-year outcomes, highlighting how negative symptoms overlap with cognition. The trajectory of neurocognitive performance over the year did not associate with changes in symptoms or functioning. Cognitive testing at the beginning of treatment provided information on the 1-year outcome in FEP beyond positive and affective symptom levels. In particular, the domains of processing speed and social cognition could be targets for interventions that aim to improve the outcome after FEP.
  • Farkkila, Anniina; Haltia, Ulla-Maija; Tapper, Johanna; McConechy, Melissa K.; Huntsman, David G.; Heikinheimo, Markku (2017)
    Adult-type granulosa cell tumor is a clinically and molecularly unique subtype of ovarian cancer. These tumors originate from the sex cord stromal cells of the ovary and represent 3-5% of all ovarian cancers. The majority of adult-type granulosa cell tumors are diagnosed at an early stage with an indolent prognosis. Surgery is the cornerstone for the treatment of both primary and relapsed tumor, while chemotherapy is applied only for advanced or non-resectable cases. Tumor stage is the only factor consistently associated with prognosis. However, every third of the patients relapse, typically in 4-7 years from diagnosis, leading to death in 50% of these patients. Anti-Mullerian Hormone and inhibin B are currently the most accurate circulating biomarkers. Adult-type granulosa cell tumors are molecularly characterized by a pathognomonic somatic missense point mutation 402C->G (C134W) in the transcription factor FOXL2. The FOXL2 402C->G mutation leads to increased proliferation and survival of granulosa cells, and promotes hormonal changes. Histological diagnosis of adult-type granulosa cell tumor is challenging, therefore testing for the FOXL2 mutation is crucial for differential diagnosis. Large international collaborations utilizing molecularly defined cohorts are essential to improve and validate new treatment strategies for patients with high-risk or relapsed adult-type granulosa cell tumor.Key Messages:Adult-type granulosa cell tumor is a unique ovarian cancer with an indolent, albeit unpredictable disease course.Adult-type granulosa cell tumors harbor a pathognomonic somatic missense mutation in transcription factor FOXL2.The key challenges in the treatment of patients with adult-type granulosa cell tumor lie in the identification and management of patients with high-risk or relapsed disease.
  • Lind, Annika; Nyman, Anna; Lehtonen, Liisa; Haataja, Leena (2020)
    The aims of this study were to 1) assess the predictive value of psychological assessment at five years of age on the need for educational support in very preterm children, and 2) report the neuropsychological profile of very preterm children at eleven years of age and risk factors for poorer neuropsychological functions. A cohort of 167 very preterm children was included (birth weight???1500?g and/or gestational age <32?weeks). At five years of age, intellectual functioning was assessed with Wechsler Preschool and Primary Scale of Intelligence-Revised and neuropsychological performance with NEPSY II. At eleven years of age, neuropsychological functions were assessed using NEPSY II and data on educational support services collected using a questionnaire. Lower full-scale intelligence quotient and poorer performance in subtests inhibition, comprehension of instructions, memory for designs, visuomotor precision and design copying at five years of age were associated with a need for educational support. Neuropsychological performance at eleven years of age was overall within the average range but below the mean, with the poorest performance in tasks assessing visual memory and visuospatial functions. The results offer a novel perspective to timing and measures of follow-up of very preterm children, since they show that need for long-term educational support can be identified at five years of age. The findings also highlight the clinical value of psychological assessments including evaluation of both intellectual functioning and neuropsychological performance, covering detailed information about non-verbal functions, in the follow-up of very preterm children up to eleven years of age.
  • Kowlessur, Sudhirsen; Hu, Zhibin; Heecharan, Jaysing; Wang, Jianming; Dai, Juncheng; Tuomilehto, Jaakko O.; Soderberg, Stefan; Zimmet, Paul; Barengo, Noel C. (2018)
    Information on the predictors of future hypertension in Mauritians with prehypertension is scant. The aim of this study was to analyze the 5-year and 11-year risk of hypertension and its predictors in people with normotension and prehypertension at baseline in Mauritius in 1987. This was a retrospective cohort study of 883 men and 1194 women of Mauritian Indian and Mauritian Creole ethnicity, aged 25-74 years old, free of hypertension at baseline in 1987 with follow-up examinations in 1992 and 1998 using the same methodology. The main outcome was 5- and 11-year risk of hypertension. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated. The 5-year risk of hypertension was 5.4-times higher in people with prehypertension compared with normotensive individuals at baseline. The corresponding odds for prehypertensive people at baseline regarding 11-year hypertension risk was 3.39 (95% CI 2.67-4.29) in the adjusted logistic regression models. Being of Creole ethnicity (OR 1.42; 95% CI 1.09-1.86) increased the 11-year odds of hypertension compared with the Indian population. It is of importance to screen for people with prehypertension and implement strategies to reduce their systolic blood pressure levels to the recommended levels of 120/80 mmHg. Special attention needs to be given to Mauritians of Creole ethnicity.
  • Heinonen, Annu; Jakobsson, Maija; Kiviharju, Mari; Virtanen, Seppo; Aro, Karoliina; Kyrgiou, Maria; Nieminen, Pekka; Kalliala, Ilkka (2020)
    Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and cone margin status. Altogether, 419 women treated for histological high-grade lesion (HSIL) with large loop excision of the transformation zone (LLETZ) attended colposcopy with cytology and hrHPV test at six months. Follow-up for recurrence of HSIL continued for 24 months. Colposcopy was considered positive if colposcopic impression was recorded as high grade and cytology if HSIL, ASC-H (atypical squamous cells, cannot exclude HSIL), or AGC-FN (atypical glandular cells, favor neoplasia) were present. Overall, 10 (10/419, 2.4%) recurrent HSIL cases were detected, 5 at 6 months and 5 at 12 months. Colposcopic impression was recorded at 407/419 6-month visits and was positive for 11/407 (2.7%). None of them had recurrent lesions, resulting in 0% sensitivity and 97% specificity for colposcopy. Sensitivity for the hrHPV test at 6 months was 100% and specificity 85%, for cytology 40% and 99%, and for margin status at treatment 60% and 82%, respectively. While the hrHPV test is highly sensitive in predicting recurrence after local treatment for CIN, colposcopy in an unselected population is not useful in follow-up after treatment of CIN.
  • Sares-Jäske, L.; Knekt, P.; Männistö, S.; Lindfors, O.; Heliövaara, M. (2019)
    Objective This prospective study explores whether dieting attempts and previous changes in weight predict changes in body mass index (BMI) and waist circumference (WC). Methods The study was based on the representative Finnish Health 2000 Survey and on its follow-up examination 11 years later. The sample included 2,785 participants, aged 30-69. BMI and WC were determined at health examinations. Information on dieting attempts and previous changes in weight was collected using a questionnaire including questions on whether participant had tried to lose weight (no/yes), gained weight (no/yes) or lost weight (no/yes) during the previous year. Results At baseline, 32.8% were dieters. Of these, 28.4% had lost weight during the previous year. Dieters had higher BMI and WC than non-dieters. During the follow-up, the measures increased more in dieters and in persons with previous weight loss. The mean BMI changes in non-dieters versus dieters were 0.74 (standard deviation [SD] 2.13) kg/m(2) and 1.06 (SD 2.77) kg/m(2) (P = 0.002), respectively. The corresponding numbers for those with no previous weight change versus those who had lost weight were 0.65 (SD 2.07) kg/m(2) and 1.52 (SD 2.61) kg/m(2). The increases in BMI and WC were most notable in dieters with initially normal weight. Conclusions The increases in BMI and WC were greater in dieters than in non-dieters, suggesting dieting attempts to be non-functional in the long term in the general population.
  • Suokas, Frans (Helsingfors universitet, 2017)
    Objectives: The present study tests the hypothesis of the association of an asphyxic insult, as defined by a low perinatal Apgar score to cognitive performance on adulthood, which has not been the objective in previous studies. The study questions are whether the low Apgar score without other symptoms predisposes one to a lower educational attainment, lower speech production capabilities and other cognitive impairments in adulthood. Based on previous studies conducted on younger individuals, the hypotheses were that individuals with a low Apgar score 1) have lower educational attainment and 2) perform worse on tasks that stress speech production than controls. Additionally, it was analyzed whether the individuals with a low Apgar score have lower 3) general intelligence, 4) verbal intelligence, 5) perceptual organization, 6) attentional skills and executive functions and 7) memory functions than controls. Methods: The participants were selected from a birth cohort of 22359 deliveries during 1971–1974 that had been followed-up until the latest measurements in 2014–2016, when the participants were aged 40–45 years of age. Asphyxia group consisted of participants with an Apgar score below 7 at least two times at 1, 5, and 15 minutes after delivery without other perinatal risk conditions (N = 80). Control group consisted of participants without any perinatal risk conditions (N = 83). It was analyzed whether the asphyxia group had an increased risk for attaining maximally a secondary level education. Measures of cognition were conducted with standardized neuropsychological tests. Childhood maladaptive living environment was included in the analyses as a covariate. Logistic regression was used in the analyses of educational attainment. In the neuropsychological tests, t-tests were conducted for the unadjusted analyses and analyses of covariance for the adjusted analyses with the covariate. Results and conclusions: The individuals who had suffered asphyxia had higher likelihood to remain in the secondary level education. They performed worse on reading speed, semantic verbal fluency, semantic abstract reasoning and on a task of processing and psychomotor speed. After adjustment for the childhood living environment, their general intelligence was also lower than controls. It was confirmed that the consequences of perinatal asphyxia extend to adulthood. Based on the results, it was assumed that the temporal cortex and basal ganglia are especially sensitive to asphyxic insults. It is suggested that the individuals, who have suffered from perinatal asphyxia, will be followed-up at the onset of their studies and provided with environmental support to avoid academic underachievement.
  • Silvo, Jenni (Helsingin yliopisto, 2018)
    Objectives: Low birth weight has been associated with impaired cognitive abilities especially in childhood and young adulthood. However, the role of a low Apgar score on cognitive functions remains unclear. Apoliprotein E (APOE) gene allele ε4 has been linked to older people’s cognition, but the influence of APOE alleles on cognition of children or middle-aged is not well understood. The present study investigated the effects of low birth weight (< 2000 g) and low Apgar scores (< 7) on later cognitive performance and on the stability of cognitive functions from childhood to middle age. In addition, the influence of APOE ε2 and ε4 alleles on risk group subjects’ cognitive performance was evaluated. It was hypothesized that the groups with perinatal risk factors have impaired cognitive abilities in all the domains and have lower stability within these abilities compared to controls. Low birth weight was hypothesized to contribute lower cognitive abilities more than a low Apgar score. It was also assumed that APOE ε4 allele impairs cognitive performance only at midlife, not in childhood. Methods: The subjects with low birth weight (n = 66) and/or a low Apgar score (n = 60) were selected from a birth cohort born during 1971–1974. The control subjects (n = 95) were free from perinatal risk factors. Cognitive performance was evaluated using Wechsler’s intelligence test. All the subjects completed the test at the age of 40 (n = 221) and some also at the age of 9 (n = 190). The differences between the groups were computed with the analysis of covariance, where family socioeconomic status was controlled. Differences in the stability of cognitive abilities were evaluated with repeated measures ANOVA and correlation analysis. The effect of APOE ε2 and ε4 alleles on cognitive performance was computed with t-test. Results and conclusions: The subjects with low birth weight reached lower scores in all the cognitive domains compared to controls. At midlife, there was also a trend towards lower general intelligence in individuals with a low Apgar score. The lowest stability in cognitive performance between childhood and middle-age was observed among those born with a low birth weight. However, the difference in the stability was not significant between the groups. APOE ε4 allele was related to lower ability of perceptual reasoning in childhood and middle age. According to the results, the effects of low birth weight on cognitive functions seem to extend to middle age. However, it is assumed that environmental factors have an important role in later development in people with low birth weight. Based on the results, the APOE ε4 allele might impact already on early cognitive development. In the future, it is important to examine if this initial impairment in perceptual reasoning is related to abnormal aging among those with APOE ε4 allele.
  • Mikkonen, Janne; Moustgaard, Heta; Remes, Hanna; Martikainen, Pekka (2018)
    Objectives To quantify how large a part of educational dropout is due to adverse childhood health conditions and to estimate the risk of dropout across various physical and mental health conditions. Study design A registry-based cohort study was conducted on a 20% random sample of Finns born in 1988-1995 (n = 101 284) followed for school dropout at ages 17 and 21. Four broad groups of health conditions (any, somatic, mental, and injury) and 25 specific health conditions were assessed from inpatient and outpatient care records at ages 10-16 years. We estimated the immediate and more persistent risks of dropout due to health conditions and calculated population-attributable fractions to quantify the population impact of childhood health on educational dropout, while accounting for a wide array of sociodemographic confounders and comorbidity. Results Children with any health condition requiring inpatient or outpatient care at ages 10-16 years were more likely to be dropouts at ages 17 years (risk ratio 1.71, 95% CI 1.61-1.81) and 21 years (1.46, 1.37-1.54) following adjustment for individual and family sociodemographic factors. A total of 30% of school dropout was attributable to health conditions at age 17 years and 21% at age 21 years. Mental disorders alone had an attributable fraction of 11% at age 21 years, compared with 5% for both somatic conditions and injuries. Adjusting for the presence of mental disorders reduced the effects of somatic conditions. Conclusions More than one fifth of educational dropout is attributable to childhood health conditions. Early-onset mental disorders emerge as key targets in reducing dropout.
  • Hailikari, Telle; Sund, Reijo; Haarala-Muhonen, Anne; Lindblom-Ylänne, Sari (2020)
    Despite vast research on transitioning to higher education and student diversity, little longitudinal evidence exists of how individual differences of first-year students predict their graduation times. The present study explored the relation between first-year students' study profiles and graduation times in two different disciplines, by following the same students' (N = 65) study progress for six years using student records data. Profiling students was based on student interviews. Statistical analysis of time to degree completion was conducted using event history analysis. The results revealed that first-study-year study profiles clearly predict graduation times and degree completion. Disciplinary differences existed between graduation times, which may be explained by the different structures of the disciplines. The results imply that individual students need tailored support at different phases of their studies.