Browsing by Subject "public health"

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  • Metiäinen, Tiia (Helsingfors universitet, 2015)
    Health related issues are largely regulated at EU Member State level, whereas areas such as internal market and competition fall mainly under the remit of European Union competence. This creates tension not only between legislation governing health and that concerning internal market but also between national and EU legislation. Here the Court of Justice of the European Union (CJEU) plays a key role in developing case-law through its judgments, defining further interpretation both on European and national level. An example of a sector operating at the interphase between public health and internal market interests is community pharmacy, which was chosen as the focus area of the study. The aim of this master's thesis was, through the case-study example of the regulation of pharmacy establishment, ownership and distribution in EU Member States, to perform a documentary analysis on related CJEU judgments, focusing on statements present in them referring to public health and internal market, discussing potential impacts on the community pharmacy sector as well as relating the outcomes to the broader context of European health policy with reference to existing literature. The study material consisted of publicly available documentation related to four judgments (Case C-531/06, Joined Cases C-171/07 and C-172/07, Joined Cases C-570/07 and C-571/07 and Case C-367/12) that were made between the years 2009 and 2014, the first proceedings initiating in 2006. The prevalence and variety of statements related to public health were found to be much higher in the documents analysed compared to those relating to internal market. The most common argumentation present in the judgments was related to the statement that regulation of ownership of community pharmacies can be justified by public health reasons, deriving from the professionalism inherent to pharmacists as well as ensuring balance between public health and economic interests. This transmits a clear message of the importance of public health and indeed the Court has been perceived as a balancing force to the union's liberalisation agenda. Following this it seems unlikely that the interpretation for national regulation would change in the near future, meaning that Member States should be able to maintain community pharmacy regulation, to the extent that it is implemented in a consistent manner. However, there has been indication of other routes being used to push for the liberalisation agenda and therefore it continues being a part of the debate both at European and national level. The findings of this study support literature suggesting that spillover is taking place in relation to the Court of Justice and health. Furthermore, it has been clearly demonstrated that even though officially the EU has very limited competence (authority) in health, its influence on European health policy is in fact highly significant, taking place to a large extent via routes other than those officially assigned to it in relation to health in particular. Whether this is intentional or unintentional, it does not change the fact that health policy is being influenced. When it happens without explicit intention, the processes lose transparency and are driven by other, potentially competing agendas. Therefore it would be important to assess whether the decision making processes and other processes currently shaping the European healthcare policy are in line with what was originally intended and re-evaluate whether this dynamic is the preferred way to proceed in the future.
  • Sama, Thomas Babila; Hiilamo, Heikki (2019)
    Aim:The aim of this study was to investigate the strategies used by the alcohol industry to influence the reform of the Alcohol Act in Finland during the preparation phase between 2016 and 2017. The study answers the following research question: what strategies were used by the alcohol industry to change the original purpose of the reform on alcohol in Finland?Method:Primary data were collected through 16 expert interviews with experts who had participated in the preparation of the alcohol reform in Finland, while secondary data were collected from prior literature, journal articles and Google databases.Results:The results identified three main political strategies used by the alcohol industry to influence the reform of the law on alcohol in Finland during the preparation phase between 2016 and 2017: ?information?, under which the alcohol industry lobbied politicians in Parliament through Members of Parliament of the National Coalition Party due to the close ties between the two; ?constituency building?, under which the alcohol industry formed alliances with interest groups in the grocery-retail business in Finland, to advocate for liberalisation of the law, as well as the use of social media ? specifically Twitter ? to lobby the public; and lastly, ?policy substitution? to promote self-regulation.Conclusions:The results suggest that the involvement of the alcohol industry in political decision-making following Finland?s EU membership has given the industry legitimacy and new opportunities to influence alcohol policy, while limiting policies to protect the public from alcohol-related harms. The results may be useful to alcohol policy-makers.
  • 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.
  • Seilo, Noora; Paldanius, Susanna; Autio, Reija; Kunttu, Kristina; Kaila, Minna (2020)
    Objective To evaluate the association between health and study-related factors measured by an Electronic Health Questionnaire (eHQ), participation in a health examination process and graduation in a university student population. Design Nationwide, retrospective, register-based cohort study with a 6-year follow-up. Setting Student health care in Finland. Finnish Student Health Service (FSHS) provides statutory student health services to university students in Finland. The health examination process of FSHS includes the eHQ provided annually to university entrants and a subsequent health check when necessary based on students' eHQ response. Participants A national cohort of university entrants from the 2011-2012 academic year (n=14 329, n (female)=8075, n (male)=6254). Outcome measures The primary outcome measure was graduation, measured based on whether a student had completed a bachelor's, licentiate or master's degree during the 6-year follow-up. Results Some 72% of the women and 60% of the men had graduated during the follow-up. The predictors in the eHQ associated with non-graduation differed by sex. Among the women's low enthusiasm about studies (OR 2.6, 95% CI 1.9 to 3.6), low engagement with studies (OR 2.5, 95% CI 1.8 to 3.4) and daily smoking (OR 1.9, 95% CI 1.4 to 2.6) were the strongest predictors to non-graduation. Among the men, low engagement with studies (OR 3.7, 95% CI 2.5 to 5.5) and obesity (body mass index >= 35) (OR 4.0, 95% CI 1.9 to 8.8) were the strongest predictors to non-graduation. Not attending the health check when referred was associated with non-graduation in both sexes: the OR for not graduating was 1.6 (95% CI 1.3 to 1.9) in women and 1.3 (95% CI 1.0 to 1.6) in men. Conclusions Engagement and enthusiasm about studying in the first year are important predictors of graduation and therefore a potential intervention target. Health promotion initiatives conducted early in the studies may have a positive effect on students' academic achievement.
  • Toffol, Elena; But, Anna; Heikinheimo, Oskari; Latvala, Antti; Partonen, Timo; Haukka, Jari (2020)
    Objectives Sociodemographic and mental health characteristics are associated with contraceptive choices. We aimed to describe the sociodemographic, reproductive and mental health characteristics of all fertile-aged women in Finland who used hormonal contraception (HC) in 2017. Design A nationwide, register-based study. Setting All women living in Finland in 2017; data from the Care Register of Health Care, Medical Birth Register, Population Register Centre, Prescription Centre, Register of Induced Abortions. Participants All women aged 15-49 with one redeemed HC prescription in 2017 (n=294 356), and a same-sized, age-matched and residence-matched, control group of non-users. Outcomes Rates of HC use; associations between HC use and mental disorders, sociodemographic and reproductive characteristics. Results 25.8% of women aged 15-49 years used HC. Women with the lowest socioeconomic levels had lower odds of using HC than women with upper-level statuses (OR, 95% CI students: 0.97, 0.94 to 0.99; entitled to pension: 0.66, 0.63 to 0.69; other: 0.87, 0.85 to 0.89; unknown: 0.90, 0.85 to 0.90). Women with the highest education (secondary: 1.46, 1.43 to 1.48; tertiary: 1.64, 1.58 to 1.70; academic: 1.60, 1.56 to 1.63) and income (second quarter: 1.57, 1.54 to 1.60; third quarter: 1.85, 1.82 to 1.89; fourth quarter: 2.01, 1.97 to 2.06), and unmarried women had higher odds of using HC than women with the lowest education and income levels, and married (0.61, 0.60 to 0.62), divorced (0.86, 0.84 to 0.88), widowed (0.73, 0.65 to 0.83) or other marital status women (0.26, 0.22 to 0.30). Parous women (0.70, 0.69 to 0.71), those with previous induced abortion(s) (0.91, 0.89 to 0.92) or recent eating (0.68, 0.62 to 0.75) or personality (0.89, 0.79 to 0.97) disorders had lower odds of HC use. Absolute risk differences between women with and without mental disorders ranged from 3.1% (anxiety disorders) to 10.1% (eating disorders). Conclusions A quarter of the fertile-aged women use HC in Finland. Sociodemographic disparities persist in relation to HC use, although of small effect size. HC use is less common among women suffering from severe to moderate psychiatric disorders, especially eating disorders.
  • Aivelo, Tuomas; Tschirren, Barbara (2020)
    Experimental field studies have demonstrated negative fitness consequences of Hen Flea Ceratophyllus gallinae infestations for bird hosts, yet it is currently unclear whether these negative effects are a direct consequence of flea-induced blood loss or a result of flea-borne pathogen transmission. Here we used a 16S rRNA gene sequencing approach to characterize the bacterial microbiota community of Hen Fleas collected from Great Tit Parus major nests and found that Brevibacterium (Actinobacteria), Staphylococcus (Firmicutes), Stenotrophomonas (Proteobacteria), Massilia (Proteobacteria), as well as the arthropod endosymbionts 'Candidatus Lariskella' and 'Candidatus Midichloria' were most abundant. We found evidence for the occurrence of Staphylococcus spp. in Hen Fleas, which may cause opportunistic infections in bird hosts, but not of other known pathogens commonly transmitted by other flea species, such as Bartonella spp. or Rickettsia spp. However, Hen Fleas might transmit other pathogens (e.g. viruses or bacteria that are not currently recognized as bird pathogens), which may contribute to the negative fitness consequences of Hen Flea infestations in addition to direct blood loss or secondary infections of wounds caused by biting fleas.
  • Idehen, Esther E.; Virtanen, Anni; Lilja, Eero; Tuomainen, Tomi-Pekka; Korhonen, Tellervo; Koponen, Päivikki (2020)
    Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008-2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010-2012 and Health 2011 Survey; aged 30-64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9-66.6), Somalis 19% (16.4-21.6), Kurds 69% (66.6-71.1), and Finns 67% (63.3-69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74-1.16), Somalis 0.16 (0.11-0.22), and Kurds 1.37 (1.02-1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27-2.35), gynecological 2.47 (1.65-3.68), or other reasons 1.53 (1.12-2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.
  • Suorsa, Kristin; Pulakka, Anna; Leskinen, Tuija; Pentti, Jaana; Vahtera, Jussi; Stenholm, Sari (2021)
    Background Prolonged sedentary behaviour is associated with a higher risk of cardiometabolic diseases. This longitudinal study examined changes in daily total, prolonged (>= 30 min) and highly prolonged (>= 60 min) sedentary time across the transition to retirement by gender and occupational status. Methods We included 689 aging workers (mean (SD) age before retirement 63.2 (1.6) years, 85% women) from the Finnish Retirement and Aging Study (FIREA). Sedentary time was measured annually using a wrist-worn triaxial ActiGraph accelerometer before and after retirement with on average 3.4 (range 2-4) measurement points. Results Women increased daily total sedentary time by 22 min (95% CI 13 to 31), prolonged sedentary time by 34 min (95% CI 27 to 42) and highly prolonged sedentary time by 15 min (95% CI 11 to 20) in the transition to retirement, and remained at the higher level of sedentary time years after retirement. The highest increase in total and prolonged sedentary time was observed among women retiring from manual occupations. Men had more total and prolonged sedentary time compared with women before and after retirement. Although no changes in men's sedentary time were observed during the retirement transition, there was a gradual increase of 33 min (95% CI 6 to 60) in prolonged sedentary time from pre-retirement years to post-retirement years. Conclusion The transition to retirement was accompanied by an abrupt increase in prolonged sedentary time in women but a more gradual increase in men. The retirement transition may be a suitable time period for interventions aiming to decrease sedentary behaviour.
  • Knaappila, Noora; Marttunen, Mauri; Fröjd, Sari; Kaltiala, Riittakerttu (2021)
    Background: Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland. Objective: To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents. Method: A time-trend school survey was conducted among 9th graders (15-year-olds) in Tampere, Finland, in three time periods: 2002-03, 2012-13 and 2018-19 (N = 4,162). Results: Compared to the period 2002-03, prevalence of externalizing symptoms decreased in the period 2012-13 and further in 2018-19. The prevalence of internalizing symptoms did not change significantly between 2002-03 and 2012-13; however, in 2018-19, depression, social anxiety, general anxiety, poor subjective health, stress symptoms among boys, and poor selfesteem increased compared to earlier time periods. The increases were more marked among girls. However, suicidal ideation did not increase in 2018-19 compared to earlier time periods. Conclusion: Whereas the prevalence of externalizing symptoms decreased among Finnish adolescents between 2002-03 and 2018-19, the prevalence of internalizing symptoms increased between 2012-13 and 2018-19. To help to understand the causes of these increases and to prevent internalizing problems, further research on the underlying causes is needed.
  • Halonen, Jaana; Pulakka, Anna; Pentti, Jaana; Kallio, Minna; Koskela, Sofia; Kivimäki, Mika; Kawachi, Ichiro; Vahtera, Jussi; Stenholm, Sari (2020)
    Objective Neighbourhood characteristics may affect the level of physical activity (PA) of the residents. Few studies have examined the combined effects of distinctive neighbourhood characteristics on PA using objective data or differentiated between activity during working or non-working days. We examined the associations of socioeconomic disadvantage and greenness with accelerometer-measured leisure-time PA during working and non-working days. Design Cross-sectional study. Setting Finnish Retirement and Aging (FIREA) study. Participants 708 workers (604 women, mean age 62.4 ranging from 58 to 64 years,) participating in the FIREA study who provided PA measurement data for at least 1 working and non-working day. Primary and secondary outcomes PA was measured with wrist-worn accelerometer on average of 4 working and 2 non-working days. Outcomes were total PA, light PA (LPA) and moderate-to-vigorous PA (MVPA). These measurements were linked to data on neighbourhood socioeconomic disadvantage and greenness within the home neighbourhood (750x750 m). Generalised linear models were adjusted for possible confounders. Results On non-working days, higher neighbourhood disadvantage associated with lower levels of total PA (p value=0.07) and higher level of neighbourhood greenness associated with higher level of total PA (p value=0.04). Neighbourhood disadvantage and greenness had an interaction (p value=0.02); in areas of low disadvantage higher greenness did not associate with the level of total PA. However, in areas of high disadvantage, 2 SD higher greenness associated with 46 min/day (95% CI 8.4 to 85) higher total PA. Slightly stronger interaction was observed for LPA (p=0.03) than for the MVPA (p=0.09). During working days, there were no associations between neighbourhood characteristics and leisure-time total PA. Conclusions Of the disadvantaged neighbourhoods, those characterised by high levels of greenness seem to associate with higher levels of leisure-time PA during non-working days. These findings suggest that efforts to add greenness to socioeconomically disadvantaged neighbourhoods might reduce inequalities in PA.
  • Lumme, Sonja; Manderbacka, Kristiina; Arffman, Martti; Karvonen, Sakari; Keskimaki, Ilmo (2020)
    Objectives To study the interplay between several indicators of social disadvantage and hospitalisations due to ambulatory care-sensitive conditions (ACSC) in 2011-2013. To evaluate whether the accumulation of preceding social disadvantage in one point of time or prolongation of social disadvantage had an effect on hospitalisations due to ACSCs. Four common indicators of disadvantage are examined: living alone, low level of education, poverty and unemployment. Design A population-based register study. Setting Nationwide individual-level register data on hospitalisations due to ACSCs for the years 2011-2013 and preceding data on social and socioeconomic factors for the years 2006-2010. Participants Finnish residents aged 45 or older on 1 January 2011. Outcome measure Hospitalisations due to ACSCs in 2011-2013. The effect of accumulation of preceding disadvantage in one point of time and its prolongation on ACSCs was studied using modified Poisson regression. Results People with preceding cumulative social disadvantage were more likely to be hospitalised due to ACSCs. The most hazardous combination was simultaneously living alone, low level of education and poverty among the middle-aged individuals (aged 45-64 years) and the elderly (over 64 years). Risk ratio (RR) of being hospitalised due to ACSC was 3.16 (95% CI 3.03-3.29) among middle-aged men and 3.54 (3.36-3.73) among middle-aged women compared with individuals without any of these risk factors when controlling for age and residential area. For the elderly, the RR was 1.61 (1.57-1.66) among men and 1.69 (1.64-1.74) among women. Conclusions To improve social equity in healthcare, it is important to recognise not only patients with cumulative disadvantage but also-as this study shows-patients with particular combinations of disadvantage who may be more susceptible. The identification of these vulnerable patient groups is also necessary to reduce the use of more expensive treatment in specialised healthcare.
  • KC, Prakash; Virtanen, Marianna; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi; Stenholm, Sari (2021)
    Objective This study aimed to compare the development of self-rated health, psychological distress and physical functioning between those retired on time and those who continued working beyond the individual retirement age. Methods The study population consisted of 2340 public sector employees from the Finnish Retirement and Aging study. Participants were categorised into no extension of employment (retired at the individual retirement date or = 12 months). Propensity score matching (1:1 ratio) was used to identify comparable group of participants in the no-extension (n=574) and extension (n=574) groups by taking into account preretirement characteristics and their interactions. Results The prevalence of suboptimal self-rated health and psychological distress changed a little among the extension group during the follow-up from 1 year before (T1) to 18 months (T2) and 30 months (T3) after individual pensionable date. Compared with no extension, the risk of having suboptimal self-rated health in the extension group was 0.89 (95% CI 0.68 to 1.17) at T1, 1.16 (95% CI 0.88 to 1.53) at T2 and 0.96 (95% CI 0.68 to 1.37) at T3. For psychological distress, the corresponding risk ratios were 0.93 (0.65 to 1.32), 1.15 (0.78 to 1.69) and 1.04 (0.61 to 1.79). The mean differences in the number of physical functioning difficulties between the extension and no-extension groups were 0.06 (-0.16 to 0.29) at T1, 0.05 (-0.18 to 0.27) at T2 and -0.11 (-0.39 to 0.17) at T3. Conclusions This study found no evidence that voluntarily extending the working career beyond retirement age would pose a risk to health and physical functioning among ageing workers.
  • Sormunen, Jani Jukka; Kulha, Niko; Klemola, Tero; Makela, Satu; Vesilahti, Ella-Maria; Vesterinen, Eero Juhani (2020)
    Most tick-related studies in Europe have been conducted in nonurban areas, but ticks and tick-borne pathogens also occur in urban green spaces. From a public health perspective, risks regarding tick-borne infections should be studied in these urban areas, where contacts between infected ticks and humans may be more frequent than elsewhere, due to high human activity. We examined the risk of encountering an infected tick in urban green spaces in Helsinki, Finland. We collected ticks at nine sites throughout Helsinki, recorded the prevalence of several pathogens and identified areas with a high potential for contacts between infected ticks and humans. Moreover, we explored the relationship between the density ofBorrelia burgdorferisensu lato-infected ticks and locally diagnosed cases of borreliosis and compared the potential for human-tick encounters in Helsinki to those in nonurban areas in south-western Finland. During 34.8 km of cloth dragging, 2,417Ixodes ricinuswere caught (402 adults, 1,399 nymphs and 616 larvae). From analysed nymphs, we found 11 distinct tick-borne pathogens, with 31.5% of nymphs carrying at least one pathogen. Tick activity was highest in August and September, leading to the density of nymphs infected withB. burgdorferis.l., and concurrently infection risk, to also be highest during this time. Nymph densities varied between the sampling sites, with obvious implications to spatial variation in infection risk. While ticks and tick-borne pathogens were found in both Helsinki and nonurban areas in south-western Finland, the estimates of human activity were generally higher in urban green spaces, leading to a higher potential for human-tick contacts therein. The presence of ticks and tick-borne pathogens and high local human activity in urban green spaces suggest that they form potential foci regarding the acquisition of tick-borne infections. Risk areas within cities should be identified and knowledge regarding urban ticks increased.
  • Mononen, Niina; Pohjanoksa-Mäntylä, Marika; Airaksinen, Marja S. A.; Hämeen-Anttila, Katri (2020)
    Objective Finland is one of the few countries that has established a national Medicines Information (MI) Strategy. The ultimate goal of the strategy is a well-implemented medication use process resulting in well-informed adherent patients. This study aimed at evaluating the implementation of the strategy 3years after its launch. Design The evaluation applied a pragmatic approach and was conducted by interviewing stakeholders involved in the National MI Network enhancing the MI Strategy's implementation. The network comprises national key stakeholders producing and using MI. Data were deductively analysed according to the medication use process of the MI Strategy using the framework method, complemented with inductively derived categories. Setting National implementation of the MI Strategy throughout the healthcare system after the first operational period (2012-2014) in 2015. Participants The members of the National MI Network (n=79/111, participation rate 71%, representing 42/53 stakeholder organisations). Outcome measures A new conceptual framework was developed based on stakeholders' views on well-implemented actions and actions needing development in the medication use process at (1) infrastructure (macro), (2) healthcare professionals (meso) and (3) patient (micro) levels. Results Medication counselling by community pharmacists was the primary implemented action, followed by physicians' actions while starting a new medication, and advice given by nurses. The major development needs concerned (1) poor access to patient information and its transfer in healthcare, particularly the lack of reconciled medication lists and electronic health records (macro); (2) poorly functioning medication use process in home care and social care units, such as nursing homes (meso); and (3) limited patient involvement in their care (micro). Conclusions Far more actions for development than well-established practices in the medication use process were identified. Major challenges found in this evaluation are considered in the ongoing Rational Pharmacotherapy Action Plan 2018-2022 by the Ministry of Social Affairs and Health.
  • Juhola, Juhani; Arokoski, J. P. A.; Ervasti, Jenni; Kivimaki, Mika; Vahtera, Jussi; Myllyntausta, Saana; Saltychev, M. (2021)
    Objectives To assess the internal consistency and construct validity of the Finnish translation of the Jenkins Sleep Scale (JSS) in a large healthy working-age population with diverse work characteristics. Design Survey-based cross-sectional cohort study. Setting Survey conducted by an institute of occupational health. Participants Employees of 10 towns and 6 hospital districts. Primary and secondary outcome measures The internal consistency defined by a Cronbach's alpha. Exploratory and confirmatory factor analyses to evaluate the construct structure of the JSS. Results Of 81 136 respondents, 14 890 (18%) were men and 66 246 (82%) were women. Their average age was 52.1 (13.2) years. Of the respondents, 41 823 (52%) were sleeping 7 or less hours per night. The mean JSS total score was 6.4 (4.8) points. The JSS demonstrated high internal consistency with an alpha of 0.80 (lower 95% confidence limit 0.80). Exploratory factor analysis supported a one-factor solution with eigenvalue of 1.94. Confirmatory factor analysis showed that all four items were positively correlated with a single common factor explaining 44%-61% of common factor's variance. Conclusions The Finnish translation of JSS was found to be a unidimensional scale with good internal consistency. As such, the scale may be recommended as a practicable questionnaire when studying sleep difficulties in a healthy working-age population.
  • Lahti, Jouni; Sabia, Severine; Singh-Manoux, Archana; Kivimäki, Mika; Tatsuse, Takashi; Yamada, Masaaki; Sekine, Michikazu; Lallukka, Tea (2016)
    OBJECTIVES: The aim of this study was to examine whether leisure time physical activity contributes to subsequent physical and mental health functioning among midlife employees. The associations were tested in three occupational cohorts from Finland, Britain and Japan. DESIGN: Cohort study. SETTING: Finland, Britain and Japan. PARTICIPANTS: Prospective employee cohorts from the Finnish Helsinki Health Study (2000-2002 and 2007, n=5958), British Whitehall II study (1997-1999 and 2003-2004, n=4142) and Japanese Civil Servants Study (1998-1999 and 2003, n=1768) were used. Leisure time physical activity was classified into three groups: inactive, moderately active and vigorously active. PRIMARY OUTCOME MEASURE: Mean scores of physical and mental health functioning (SF-36) at follow-up were examined. RESULTS: Physical activity was associated with better subsequent physical health functioning in all three cohorts, however, with varying magnitude and some gender differences. Differences were the clearest among Finnish women (inactive: 46.0, vigorously active: 49.5) and men (inactive: 47.8, active vigorous: 51.1) and British women (inactive: 47.3, active vigorous: 50.4). In mental health functioning, the differences were generally smaller and not that clearly related to the intensity of physical activity. Emerging differences in health functioning were relatively small. CONCLUSIONS: Vigorous physical activity was associated with better subsequent physical health functioning in all three cohorts with varying magnitude. For mental health functioning, the intensity of physical activity was less important. Promoting leisure time physical activity may prove useful for the maintenance of health functioning among midlife employees.
  • Fagerlund, Pi; Salmela, Jatta; Pietiläinen, Olli; Salonsalmi, Aino; Rahkonen, Ossi; Lallukka, Tea (Helsingin yliopisto, 2021)
    Abstract Background: Pain is known to be socio-economically patterned and associated with disability. However, knowledge is scarce concerning life-course socio-economic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socio-economic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees. Methods: We analyzed questionnaire data retrieved from the Young Helsinki Health Study (n=4683) covering 18–39-year-old employees of the City of Helsinki, Finland. We included a comprehensive set of indicators of childhood and current socio-economic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain–related disability was assessed by the Chronic Pain Grade Questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for socio-demographic, socio-economic and health-related covariates. Results: Childhood and current socio-economic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low education level (OR 3.38, 95% CI 2.18–5.24), manual occupation (OR 3.75, 95% CI 1.92–7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00–4.70). Conclusions: Pain is highly prevalent already among young employees and there is a socio-economic gradient in both pain chronicity and chronic pain–related disability. Life-course socio-economic determinants of pain should be considered in pain-preventing strategies and in clinical practice.
  • Jalanko, Eerika; Gyllenberg, Frida; Krstic, Nikolas; Gissler, Mika; Heikinheimo, Oskari (2021)
    Objectives Declining teenage pregnancy rates have been linked to improved access to youth-friendly contraceptive services, but information on the combined association of these services and socioeconomic factors with teenage pregnancy is lacking. Design and setting This retrospective longitudinal register-based study covers the annual teenage childbirth and induced abortion rates in the 100 largest municipalities in Finland in 2000-2018. We investigated the combined association of regional, socioeconomic (ie, education level and need for social assistance) and adolescent contraceptive service variables (ie, free-of-charge contraception, an adolescent-only clinic and availability of over-the-counter emergency contraception (OTC EC)) with teenage childbirth and induced abortion rates at the municipality level by using Poisson mixed-effects model. Primary outcome measures Annual teenage childbirth and induced abortion rates as numbers per 1000 teenage girls aged 15-19 years old in the 100 largest municipalities in Finland from 2000 to 2018. Results The following variables were significantly associated with both lower teenage childbirth and induced abortion rates when adjusted for all the other variables used in the model: providing free-of-charge contraception (rate ratio (RR) 0.82 (95% CI 0.73 to 0.92) and RR 0.87 (95% CI 0.79 to 0.96), respectively), availability of OTC EC without age limit (RR 0.70 (95% CI 0.67 to 0.75) and RR 0.74 (95% CI 0.71 to 0.78), respectively), and high education level of the municipality (RR 0.94 (95% CI 0.94 to 0.95) and RR 0.94 (95% CI 0.93 to 0.94), respectively). Conclusion Providing free-of-charge contraception and availability of OTC EC without age limit are associated with lower teenage pregnancy rates. These services combined with proper counselling are thus important contents of youth-friendly contraceptive services that should be provided equally for all teenagers in order to further reduce teenage pregnancy rates.
  • Abass, Khaled; Waits, Audrey; Emelyanova, Anastasia; Miettinen, Ilkka T.; Lavikainen, Antti; Rautio, Arja; Oksanen, Antti (Ruokavirasto, 2019)
    3/2019
    One Health takes a multidisciplinary approach to health risks and risk mitigation for humans, animals, plants and the environment, with the understanding that human health welfare is dependent on ecosystem health. The U.S. and Canada started the One Health project under the Sustainable Development Working Group (SDWG) of the Arctic Council in 2015, Finland joined the project as a colead in 2017. This report is a summary of the Finnish activities and achievements in the One Arctic - One Health project during the Finnish Chairmanship of the Arctic Council. The main actions included the One Arctic - One Health conference in Oulu, establishment of the TremArctic network, and two published Systematic Review papers and two manuscripts. There were also joint sessions and presentations in scientific conferences, seminars and workshops, and joint meetings and collaboration with the other Arctic Council Working Groups, the University of the Arctic, other organisations, and scientific projects. The report concludes with some updated proposals for further work, based on previous works and reflecting progress over the past two years. The Finnish One Arctic - One Health team consisted of scientists from the University of Oulu, National Institute for Health and Welfare (THL), University of Helsinki and the Finnish Food Authority. This work was supported by the grant of the Ministry for Foreign Affairs of Finland.
  • Haukka, Anna; Heikkinen, Anna Maria; Haukka, Jari; Kaila, Minna (2020)
    Objectives: The individualised recall interval (IRI) is part of the oral health examination. This observational, register-based study aimed to explore how oral health indices DMFT (decayed, missing, filled teeth), DT (decayed teeth), CPI (Community Periodontal Index, maximum value of individual was used) and number of teeth are associated with IRI for adults. Methods: Oral health examination includes an assessment of all oral tissues, diagnosis, a treatment plan and assessment and a determination of the interval before the next assessment. It is called the IRI. This cross-sectional study population included 42,533 adults (age range 18-89 years), who had visited for an oral health examination during 2009, provided by the Helsinki City Social Services and Health Care. The recall interval was categorised into an ordinal scale (0-12, 13-24, 25-36 and 37-60 months) and was modelled using a proportional odds model. ORs less than one indicated a shorter recall interval. Results: Recall interval categories in the study population were 0-12 months (n = 4,569; 11%), 13-24 months (n = 23,732; 56%), 25-36 months (n = 12,049; 28%), and 37-60 months (n = 2,183; 5%). The results of statistical models clearly showed an association between the length of recall intervals and oral health indices. In all models, higher values of DMFT, DT and CPI indicated a shorter recall interval. The number of teeth were not so relevant. The association was not influenced when different combinations of other predictors (age, gender, socioeconomic status, chronic diseases) were included in the model. The severity of periodontitis predicted a short recall interval, for example, in the Model 1, CPI maximum value 4 was OR = 0.35 (95% confidence interval 0.31-0.40). Conclusions: The oral health indices showed a clear association with the length of the IRI. Poor oral health reduced IRI. The indices provide information about the amount of oral health prevention required and are useful to health organisations.