Browsing by Subject "public Health"

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  • Whipp, Alyce (Helsingin yliopisto, 2021)
    Problems of aggressive behavior affect as many as one in every six children and are associated with negative outcomes for not only the individual themselves, but also their family, friends, and community. Aggressive behavior includes a variety of different behaviors (e.g., yelling, hitting, bullying) and has been notoriously difficult to treat. In assessing aggression, researchers and clinicians have repeatedly been recommended to utilize reports from multiple informants (e.g., parents, teachers, the child him/herself) in order to obtain the most complete picture of the problem. In studying aggressive behavior, early research was initially focused on males only and severe outcomes, but now investigates gender similarities and differences and a broad range of behaviors related to aggression. While much has been learned from research thus far, new biological mechanisms and detailed phenotypic information are still important to continue clarifying the heterogenous nature of aggression and to improve ideas for personalized treatment. Thus, this thesis aimed to contribute to those efforts. Study I and II showed that aggressive behavior (as rated by all raters) often co-occurred with other externalizing behaviors and low prosocial behavior, and also co-occurred with internalizing problems but not as often. Patterns were similar across cohorts and genders, however, parents indicated more co-occurrence with internalizing problems and less co-occurrence with other externalizing behaviors than teachers did. Study III showed teacher and self ratings were able to predict ASPD, both in separate models and when both ratings were in the same model. Additionally, the direct aggression subtype (e.g., hitting, yelling) was able to predict ASPD well, for both genders. Furthermore, when the co-occurring influence of hyperactivity was removed from the aggression ratings (using a residual aggression variable with hyperactivity co-occurrence removed), aggressive behavior was still able to predict ASPD. Study IV showed the ketone body 3-hydroxybutyrate to be negatively associated with aggressive behavior in initial analyses. In more detailed modeling, nearly all raters of aggression showed the same trend with 3-hydroxybutyrate, including in fully adjusted models. In a model including both teacher and self ratings, 3-hydroxybutyrate was significantly associated with both aggressive behavior ratings. A replication dataset of young adult Dutch twins (N=960) showed support for the association found in FinnTwin12, however, the issue of whether there are gender differences of the association of 3-hydroxybutyrate with aggressive behavior remains to be clarified by future research. These findings help to clarify the co-occurrence of aggressive behavior with other behaviors across raters and countries, to show how common the co-occurrence is and that it should be taken into consideration when studying aggressive behavior, including from (epi)genetic or biological perspectives. Additionally, aggressive behavior, in particular direct aggression, can inform future ASPD risk, and obtaining behavior data from teachers and the child are of high importance. Furthermore, the new association of 3-hydroxybutyrate with aggressive behavior suggests new biological pathways to investigate to improve our understanding of aggressive behavior, including potential treatments. This thesis provides refinements to the aggressive behavior phenotype, new avenues for aggression biology investigations, and ideas for where to improve or personalize treatment options.
  • Berntzen, Bram (Helsingin yliopisto, 2021)
    Obesity is a complex global health concern, associated with biological, social, psychological, and environmental factors. Obesity increases the risk of comorbidities, such as cardiovascular diseases, type 2 diabetes, and forms of cancer. To reduce the global burden of obesity, we require further understanding of its determinants. Physical inactivity, unhealthy eating behaviors, and curtailed sleep have been associated with higher body weight. However, most studies have been unable to control for the confounding influences of genotype and early life environmental factors. This research project aimed to understand how physical activity (PA), eating, and sleep behaviors were associated with body mass index (BMI), adiposity, and metabolic health, independent of genotype and early environmental factors (together “familial” influences). I, together with the research group I belong to, secondarily tested how sleep associated with PA and eating behaviors, because an interconnection between these behaviors is plausible. To overcome confounding by familial factors, we investigated healthy (except for obesity) Finnish monozygotic (MZ) twin pairs (Studies I, II, III) who share personal factors (e.g., age, sex, and 100% of the DNA sequence) and have shared environmental factors during early life (e.g., in utero, family, and neighborhood environment). We also investigated same-sex dizygotic (DZ) twin pairs who share the same factors, except their segregating genes (only ~50% overlap). This thesis focused on twin pairs who varied strongly in BMI within pairs (BMI difference of at least 3 kg/m²). We screened 5,417 young adult (22–36 y) twin pairs from ten full birth cohorts to acquire 36 MZ and 46 same-sex DZ twin pairs discordant for BMI (∆BMI ≥ 3 kg/m²). A random sample of twin pairs (38 MZ and 31 same-sex DZ twin pairs) participated as BMI-concordant twin pairs (∆BMI < 3 kg/m²). This thesis incorporated three cross-sectional studies performed under natural conditions. Study I addressed the twins’ PA derived from self-reports and hip-worn actigraphy and cardiorespiratory fitness from spiroergometry, Study II investigated self-reported eating behaviors, and Study III assessed sleep behaviors acquired with questionnaires and wrist-worn actigraphy. All studies included clinical measurements of BMI, adiposity (e.g., adipose tissue mass and location), and metabolic health variables (e.g., insulin sensitivity, cholesterol, and inflammation). Study I found that in the MZ BMI-discordant twin pairs, the heavier co-twins took fewer steps daily, performed shorter daily moderate-to-vigorous intensity PA (MVPA), and reported less activity through sports, but no considerable differences appeared in other subjective and objective PA intensities (e.g., sedentary time, light PA) and categories (e.g., work, domestic PA). Higher daily steps and longer time spent in MVPA correlated with lower whole-body adipose tissue percentage, leptin concentration, and less insulin resistance, regardless of familial influences. MVPA further linked with lower low-density lipoprotein (LDL) cholesterol, and light PA negatively associated with high-sensitivity C-reactive protein concentration, indicating lower low-grade inflammation. Study II uncovered in MZ and DZ BMI-discordant twins that the heavier co-twins displayed higher disinhibited eating, binge-eating scores, body dissatisfaction, ate less frequently according to their needs (most ate more than they needed), and exhibited less flexible control, independent of DNA and shared environment. Leaner and heavier co-twins agreed frequently that heavier co-twins have unhealthier eating behaviors in general, and especially eat more food and fatty food. Negligible differences arose for feelings of hunger, eating restraint, eating due to external or emotional triggers, or self-reported dietary intake. Overeating behaviors and lack of control over eating associated with larger subcutaneous fat – and binge eating with intra-abdominal fat – but the strongest positive linear link was between body dissatisfaction and subcutaneous fat, regardless of familial effects. Optimal regulation of food intake correlated with lower subcutaneous fat and better insulin sensitivity, and flexible control linked with lower intra-abdominal and liver fat and LDL cholesterol. Study III observed in MZ BMI-discordant twins that the heavier co-twins reported shorter sleep, greater tiredness, more frequent and severe snoring, and a chronotype closer to eveningness, regardless of genotype and early life environment. Trivial differences emerged for sleep quality, insomnia, and sleep schedule, and for objectively measured sleep duration, latency, efficiency, and fragmentation. The larger the self-reported sleep debt (sleep duration minus sleep need), the higher the disinhibited eating and binge-eating scores. More snoring correlated with larger subcutaneous, intra-abdominal, and liver fat, whole-body adipose tissue proportion, LDL, and triglycerides. In all three studies, none of the behaviors (besides flexible control) differed substantially within BMI-concordant twin pairs. In conclusion, lower PA, a lack of control over eating, and detrimental sleep characteristics were associated with a higher BMI, larger adipose tissue storage, and poorer metabolic health, regardless of age, sex, and familial influences. The uncovered behaviors might be keys for interventions to prevent weight gain, promote weight loss, and benefit metabolic health.
  • Ning, Feng (Helsingin yliopisto, 2013)
    The objectives of this study were to investigate: 1) what the major risk factors are that have contributed to the rise in prevalence of type 2 diabetes in Chinese adults, and whether the joint effect of a family history of diabetes along with obesity on the risk of diabetes in the Chinese differs from that in the Finns; 2) the impact of the homeostasis model assessment of insulin resistance and beta cell function on glucose metabolism in relation to aging in people of Asian origin; 3) the relative risk for cardiovascular disease (CVD) mortality and morbidity associated with fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) within the normoglycemic range in European populations. This study was based on datasets of the Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Asia (DECODA) and in Europe (DECODE) studies comprising 10307 men and 13429 women aged 30 to 74 years from 11 Asian cohorts, and 12566 men and 10874 women aged 25 to 90 years from 19 European cohorts. Type 2 diabetes and intermediate hyperglycemia in this study were determined by a 2-h 75g oral glucose tolerance test according to the World Health Organization/International Diabetes Federation criteria of 2006. The odds ratios for the prevalence of type 2 diabetes and intermediate hyperglycemia were estimated using logistic regression analysis. Cox proportional hazards analysis was performed to estimate the association between plasma glucose and CVD mortality and morbidity, adjusting for conventional cardiovascular risk factors. Between 2001 and 2006, the age-standardized prevalence of type 2 diabetes increased from 5.2% to 14.2% in men and from 7.2% to 14.5% in women in rural areas, from 12.6% to 19.4% in men and from 10.2% to 16.6% in women in urban areas in Qingdao, China. Age, family history of diabetes and waist circumference was independent risk factors for diabetes in both sexes and in both urban and rural areas (P less than 0.01 for all). A high level of education and a high income were inversely associated with the increased prevalence in all populations except in rural men (P less than 0.05). Obesity and a family history of diabetes were major risk factors for type 2 diabetes in men and women from China and Finland. Their synergetic effect on type 2 diabetes was significant in Finnish men, but not in Finnish women or the Chinese. The prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) increased with age in populations of Asian origin except IFG in the Indians living in India and in African men living in Mauritius. The age-related increase was more prominent for IGT than for IFG in both men and women. Adjustment for insulin resistance and beta cell function reduced the differences among age groups for all ethnic groups, but the risk gradient between age groups still remained significant for IGT. Within normoglycemic range, individuals whose baseline 2hPG did not return to FPG levels (Group II, 2hPG > FPG) were older and had higher baseline body mass index (BMI), blood pressure and fasting insulin levels compared with those whose baseline 2hPG did (Group I, 2hPG ≤ FPG) in Europeans. Hazard ratios (95% confidence intervals) for CVD mortality were 1.22 (1.05-1.41) in men, and 1.40 (1.03-1.89) in women for Group II versus Group I, adjusting for age, study cohort, BMI, FPG, total serum cholesterol, smoking status and hypertension status. The corresponding hazard ratios for the incidence of coronary heart disease, ischemic stroke and composite CVD events were 1.13 (0.93-1.37), 1.40 (1.06-1.85) and 1.20 (1.01-1.42) in men, and 1.33 (0.83-2.13), 0.94 (0.59-1.51) and 1.11 (0.79-1.54) in women, respectively. The increasing trends for CVD mortality and morbidity did not change substantially after additional adjustment for fasting insulin concentrations. In conclusion, this study confirmed the impact of established risk factors of age, obesity and a family history of diabetes on the risk of diabetes among the Chinese, which is consistent with literature, but the interaction between the risk factors might be different between ethnicities and requires further investigation. This study also disclosed the deleterious effect of high normal 2hPG levels on CVD mortality and morbidity, which has not been widely investigated previously. The findings further support the view that the CVD risk extends well below the diabetes diagnostic value based on the post-challenge glucose levels, and may have certain clinical implications regarding diabetes diagnosis and glycemic management targets.
  • Simonsen, Nina (Helsingin yliopisto, 2013)
    Municipalities are important arenas in health promotion as many of the determinants of health relate to, and exert their influence in, local contexts. Accordingly, one key question in public-health work is how to support health promotion on the local level. The present study explores and compares health promotion actions in four medium-sized municipalities, with an emphasis on factors influencing engagement. The point of departure is the health promotion strategies described in the Ottawa Charter (WHO 1986) – the focus being on community action for health, health-promoting health services and healthy public policy – and the multilevel health promotion model (Rütten et al. 2000). The overall aim is to further enhance understanding of health promotion action in local contexts. The specific aims are to explore the role of local voluntary associations in health promotion, to compare the emphasis on health promotion in four municipalities with different forms of primary healthcare service production, and, especially, to identify factors associated with comprehensive health promotion action and with health policy impact (effective health promotion actions). The study – part of an evaluation of the production model of primary healthcare in four municipalities in the southern part of Finland – is based on cross-sectional surveys conducted in the four municipalities in 2000, 2002 and 2004 and including all registered local voluntary associations (LVAs), primary healthcare (PHC) personnel (including services for older people) and local politicians. The data were analysed by means of descriptive statistics as well as logistic and linear regression analysis. The findings suggest that a fair proportion of LVAs are interested in action for community health and could be seen as a resource for health promotion in local contexts. There was agreement that the promotion of residents’ health requires cooperation between municipal agencies and LVAs, although cooperation was not particularly strongly emphasized in municipal budget and action plans according to the politicians. Cooperation with municipal agencies was independently associated with LVA engagement in health promotion. PHC personnel appear to be engaged in health promotion primarily on an individual basis. On all three levels (individual, group and population) it was most prevalent in ambulatory care. This was also true in the case of comprehensive action, as well as when health promotion was conceptualized as addressing risk behaviour. There were some differences between the municipalities in terms of level of engagement; the respondents' focus in health promotion and varying opportunities for cooperation are two potential explanations for these differences. Moreover, variables reflecting all the proposed determinants (organizational values, competence and opportunities) were independently associated with the PHC personnel’s engagement in comprehensive health promotion action. These included working conditions that are conducive to health promotion such as being able to use one’s skills and knowledge, and having possibilities for reflection and learning as well as collegial support; knowledge about residents’ health and living conditions; and opportunities to cooperate with partners outside the organization. Similarly, perceived competence and a value orientation towards health as well as opportunities for community participation were independently associated with LVA engagement in comprehensive health promotion action. In addition to the determinants in the theoretical model, the municipality had an influence. There were no inter-municipality differences in the politicians’ evaluations of health promotion actions and their effectiveness (health policy impact). In terms of impact, an emphasis on promoting health and quality of life among older people and the resources (in the form of capacity of PHC and care for older people) were among the most significant elements of health promotion policy on the local level. Contrary to expectations, opportunities for community participation were not associated with the evaluations. The findings reinforce the value of empowerment, community participation and intersectoral cooperation – in other words the principles of health promotion – in the context of Finnish municipalities, providing further evidence as well as highlighting their significance for engagement in health promotion action. The study also provides novel empirical confirmation concerning the applicability of the multilevel health promotion model to the actions of different actors in municipalities, in other words in local contexts. In support of action on the local level, the findings – the equally strong associations of organizational values, competence and opportunities with engagement in health promotion – suggest the need for a multilevel approach. However, local policy makers may need more evidence concerning the impact of cooperation and community participation.
  • Masip, Guiomar (Helsingin yliopisto, 2021)
    Background: Obesity prevalence has dramatically increased during the past decades and is currently a major global public health challenge. Both genes and environmental factors influence weight gain, but our understanding of how these factors impact body weight is still incomplete. Unhealthy diet is a key risk factor in the development of obesity and eating behaviors have been described as predictors of weight gain. Genes identified so far are likely to influence weight partly through appetite traits, representing one behavioral pathway of the genetic susceptibility to obesity. However, some genes are expressed in the adipose tissue, suggesting that there might be other pathways that could lead to weight gain and increased appetite in genetically susceptible individuals. Aims: This dissertation aims to 1) examine whether a diet quality score derived from a food frequency questionnaire is a valid brief instrument to estimate diet quality by comparing it with obesity measures, nutrient intakes and eating styles (eating behaviors and dietary patterns) (Study I); 2) examine whether eating behavior patterns (diet quality, eating behaviors and dietary patterns) are related to obesity measures in a cross-sectional setting of young adults (Study II) and a prospective setting of children (III); and 3) examine the relationship between genetic susceptibility to obesity, eating behaviors and obesity cross-sectionally in adulthood (Study II) and longitudinally in childhood (Study III). Materials and methods: This thesis was based on data from the FinnTwin16 study (FT16) at wave 5 (n = 4,407), a representative national longitudinal cohort of young adult Finnish twins (Studies I and II), and the IDEFICS/I.Family cohort (n = 21,293), a European multicenter study of children and adolescents (Study III). Both datasets include obesity measures [body mass index (BMI) and waist circumference], eating-related traits questionnaires (eating behaviors, dietary patterns, food frequency questionnaires, and food diaries), and family-level factors. For 1,055 twin individuals and 2,656 children with genome-wide data (Studies II and III, respectively), two polygenic risk scores for BMI were constructed using ~1 million (Study II) and 2.1 million (Study III) single nucleotide polymorphisms irrespective of genome-wide significance. Linear regression models and logistic regression models were calculated to test the associations between the diet quality score and obesity measures and eating styles in Study I (n = 3,592 twin individuals, n = 764 dizygotic twin pairs and n = 430 monozygotic twin pairs). Pearson’s correlations were calculated between the diet quality score and nutrient intakes in a subsample of 249 twin individuals and in n = 45 same-sex dizygotic twin pairs and n = 60 monozygotic twin pairs, who provided food diaries in Study I. Principal component analyses were used to derive eating behavior patterns in Studies II and III. To examine the relationship between eating behavior patterns and obesity measures, heritability estimates and Cholesky decomposition were estimated in 1,500 twin pairs (Study II) and cross-lagged path models were calculated in 2,355 children (Study III). Structural equation modeling (Study II) and causal mediation analyses (Study III) were used to identify the potential mediation models between the polygenic risk scores for BMI, eating behavior patterns and obesity measures. Results: A higher diet quality score was inversely associated with obesity measures, a lower risk of being overweight or abdominally obese and was associated with healthier eating styles (Study I). Further, the diet quality score was associated with key nutrient intakes, such as lower intakes of sucrose and total fat and higher intakes of magnesium; it can thus be used to rank individuals and twins according to diet quality (Study I). Analyses of twin pairs showed that the co-twin with a higher diet quality score tended to have healthier eating styles and nutrient intakes compared to their twin sibling (Study I). Eating behavior patterns were moderately heritable in adults (Study II). The cross-sectional associations between snacking and emotional and external eating behavior patterns with obesity measures were largely explained by genetic factors in young adults (Study II). The prospective associations between parental concern of overeating and obesity measures in children were bi-directional (Study III). The genetic susceptibility to obesity was partly mediated by the snacking eating behavior pattern, and to a lesser extent by the infrequent and unhealthy and the emotional and external eating behavior patterns during adulthood (Study II) and by parental concern of overeating during childhood (Study III). Futhermore, obesity was also tested as a mediator in the association between the polygenic risk score for BMI and parental concern of overeating, and obesity measures partly mediated the prospective association between genetic susceptibility and parental concern of overeating during childhood (Study III). Conclusions: This thesis provides new evidence that diet quality, eating behaviors and dietary patterns are important determinants of obesity during childhood and young adulthood. It provides a detailed picture of the complex associations between obesity, dietary risk factors and genetic susceptibility, by showing how eating behavior patterns and obesity measures are temporarily associated and share a common genetic liability. Moreover, it confirms that eating behavior patterns partly mediate the genetic susceptibility to obesity in both children and adults. Further, it suggests that there might be pathways other than eating behaviors by which the genetic susceptibility may lead to weight gain and the increased weight might subsequently increase appetite. A better understanding of the pathways that lead to weight gain and their impact and influences on early- and long-term health will be beneficial for future research and health professionals.
  • Peña, Sebastián (Helsingin yliopisto, 2021)
    Harmful alcohol use is a global public health challenge. Socioeconomic differences in alcohol-attributable harm are higher than in all-cause mortality and Finland has one of the highest socioeconomic differences in alcohol-attributable harm in European countries. Lower socioeconomic groups typically experience greater alcohol-attributable harm, despite reporting lower levels of alcohol use. This “alcohol harm paradox” can be the result of differential biases in the measurement of alcohol use, differential vulnerability to the effects of alcohol or reverse causality. What explains the alcohol harm paradox remains largely unknown. This study investigated the existence and patterns of socioeconomic differences in volume of alcohol use and drinking patterns in Finland and Chile (two countries with high alcohol use and harm); examined changes in the prevalence and socioeconomic correlates of alcohol use disorders (AUD) in Finland between 2000 and 2011; and examined whether differential biases in the measurement of volume of alcohol use (using alcohol biomarkers as objective measures of alcohol use) and behavioural risk factors and their joint effects with each other and with socioeconomic status (SES) could explain the alcohol harm paradox. We used data from national health surveys in Finland and also Chile in Sub-study I. The study population were adults residing permanently in Finland. Income and education were used as indicators of SES. Central measurements included alcohol use (volume and heavy episodic drinking), alcohol biomarkers (GGT, CDT, ALT and AST), smoking, body mass index as well as sociodemographic factors. We used structured interviews to assess 12-month and lifetime AUD and linked data from population surveys to mortality data. Outcomes were indicators of alcohol use, 12-month and lifetime prevalence of AUD and alcohol-attributable mortality. Statistical methods included the concentration index, logistic and Cox proportional hazards models and causal mediation analysis. Abstinence was higher among lower socioeconomic groups than in higher socioeconomic groups in Finland and Chile, while heavy episodic drinking was modestly higher among people with lower SES in Finland. Estimated prevalence of 12-month AUD in Finland decreased from 4.6% in 2000 to 2.0% in 2011. We did not find evidence to support the existence of educational differences in AUD in 2000 or 2011. Participants in the lowest income quintile experienced 2.1 times higher risk of alcohol-attributable mortality, despite reporting lower levels of alcohol use. Alcohol biomarkers explained a very small fraction of the socioeconomic differences in alcohol-attributable mortality. We found strong joint (or interactive) effects for SES and alcohol use and SES and smoking. However, smoking, body mass index and their joint effects with income explained a relatively small proportion (18%) of the effect of income on alcohol-attributable mortality. Our findings confirm the existence of the alcohol harm paradox in Finland and support the need for targeted alcohol policies for lower socioeconomic groups and a broader policy agenda for tackling structural determinants of health.