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.
  • Saltychev, Mikhail; Juhola, Juhani; Ervasti, Jenni; Kivimäki, Mika; Pentti, Jaana; Myllyntausta, Saana; Vahtera, Jussi (2021)
    Objectives To investigate the association between changes in lifestyle risk factors and changes is sleep difficulties. Design Longitudinal repeated measures cohort study. Setting University and national institute of occupational health. Participants Participants of the Finnish Public Sector study with information on sleep and lifestyle-related risk factors collected in five repeat surveys with 4-year intervals from 2000 to 2017. The participants were those, who had responded at least twice and had a change in sleep difficulties (having sleep difficulties vs not) (142 969 observations from 38 400 respondents (mean age 45.5 (SD 9.2) years, 83% women). Primary and secondary outcome measures Changes in sleep quality over time. Longitudinal fixed effects analysis, a method that accounts for time-invariant confounders by design, was used. Results At first available response, sleep difficulties were experienced by 13 998 (36%) of the respondents. Respectively, the mean age was 44.3 (10.0) years, 7526 (20%) were obese, 13 487 (35%) reported low physical activity, 3338 (9%) extensively drinking and 6547 (17%) were smoking. Except for smoking, the changes in the studied modifiable risks were associated with changes in sleep difficulties. The ORs for having sleep difficulties were 1.41 (95% CI 1.35 to 1.48) for obesity, 1.10 (95% CI 1.06 to 1.13) for low physical activity and 1.43 (95% CI 1.35 to 1.51) for heavy drinking. For smoking, the association was negative with OR 0.81 (95% CI 0.76 to 0.86). Including all four modifiable risks into model changed the estimates only little. Conclusions The results of this longitudinal study suggest that changes in sleep quality are interconnected with changes in lifestyle.
  • Elovainio, Marko; Lahti, Jari; Pirinen, Matti; Pulkki-Raback, Laura; Malmberg, Anni; Lipsanen, Jari; Virtanen, Marianna; Kivimaki, Mika; Hakulinen, Christian (2022)
    Background Social isolation and loneliness have been associated with increased risk of dementia, but it is not known whether this risk is modified or confounded by genetic risk of dementia. Methods We used the prospective UK Biobank study with 155 070 participants (mean age 64.1 years), including self-reported social isolation and loneliness. Genetic risk was indicated using the polygenic risk score for Alzheimer's disease and the incident dementia ascertained using electronic health records. Results Overall, 8.6% of participants reported that they were socially isolated and 5.5% were lonely. During a mean follow-up of 8.8 years (1.36 million person years), 1444 (0.9% of the total sample) were diagnosed with dementia. Social isolation, but not loneliness, was associated with increased risk of dementia (HR 1.62, 95% CI 1.38 to 1.90). There were no interaction effects between genetic risk and social isolation or between genetic risk and loneliness predicting incident dementia. Of the participants who were socially isolated and had high genetic risk, 4.4% (95% CI 3.4% to 5.5%) were estimated to developed dementia compared with 2.9% (95% CI 2.6% to 3.2%) of those who were not socially isolated but had high genetic risk. Comparable differences were also in those with intermediate and low genetic risk levels. Conclusions Socially isolated individuals are at increased risk of dementia at all levels of genetic risk.
  • 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.
  • Toffol, Elena; Partonen, Timo; Heikinheimo, Oskari; But, Anna; Latvala, Antti; Haukka, Jari (2022)
    Objectives The relationship between the use of contraception and of psychiatric medications is understudied. We examined whether the current and past use of psychotropic medications is associated with the use and type of hormonal contraception (HC). Design Nationwide register-based matched case-control study. Settings All fertile-aged (15-49 years) girls and women living in Finland in 2017; data from several national registers. Participants 294 356 girls and women with a redeemed prescription of HC in 2017, and their same-sized control group of non-users (n=294 356) identified through the Prescription Centre. Main outcome measures Associations between the use of psychotropic medications and the use of HC, and the type of HC tested in logistic regression models. Results Altogether 19.5% of the HC users, and 18% of the HC non-users received at least one prescription for a psychotropic medication in 2017. Among HC users, the proportions of occasional and regular users of psychotropic medications in 2013-2016 were 4.5% and 14.8%, while among HC non-users the respective figures were 4.3% and 14.6%, respectively. In multivariable logistic regression models both the use of psychotropic medications in 2017, and their occasional or regular use between 2013-2016 were associated with higher odds of HC use, although with small to very small effect sizes (ORs between 1.37 and 1.06 and 95% CIs 1.22 to 1.53, and 1.03 to 1.09, respectively). After adjustment for covariates, when fixed combinations of progestogens and oestrogens for systemic use was the reference category, women using almost any class of psychotropic medications had higher odds of using other types of HC. Conclusions Fertile-aged girls and women with current and past use of psychotropic medications have higher odds of using HC, with a specific pattern in the type of contraceptives used. Further research is warranted to examine whether our observations indicate a reduction of unwanted pregnancies in women with psychiatric disorders.
  • Kumar, Mukkesh; Ang, Li Ting; Png, Hang; Ng, Maisie; Tan, Karen; Loy, See Ling; Tan, Kok Hian; Chan, Jerry Kok Yen; Godfrey, Keith M.; Chan, Shiao-yng; Chong, Yap Seng; Eriksson, Johan G.; Feng, Mengling; Karnani, Neerja (2022)
    The increasing prevalence of gestational diabetes mellitus (GDM) is contributing to the rising global burden of type 2 diabetes (T2D) and intergenerational cycle of chronic metabolic disorders. Primary lifestyle interventions to manage GDM, including second trimester dietary and exercise guidance, have met with limited success due to late implementation, poor adherence and generic guidelines. In this study, we aimed to build a preconception-based GDM predictor to enable early intervention. We also assessed the associations of top predictors with GDM and adverse birth outcomes. Our evolutionary algorithm-based automated machine learning (AutoML) model was implemented with data from 222 Asian multi-ethnic women in a preconception cohort study, Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO). A stacked ensemble model with a gradient boosting classifier and linear support vector machine classifier (stochastic gradient descent training) was derived using genetic programming, achieving an excellent AUC of 0.93 based on four features (glycated hemoglobin A(1c) (HbA(1c)), mean arterial blood pressure, fasting insulin, triglycerides/HDL ratio). The results of multivariate logistic regression model showed that each 1 mmol/mol increase in preconception HbA(1c) was positively associated with increased risks of GDM (p = 0.001, odds ratio (95% CI) 1.34 (1.13-1.60)) and preterm birth (p = 0.011, odds ratio 1.63 (1.12-2.38)). Optimal control of preconception HbA(1c) may aid in preventing GDM and reducing the incidence of preterm birth. Our trained predictor has been deployed as a web application that can be easily employed in GDM intervention programs, prior to conception.
  • 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.
  • Bronnum-Hansen, Henrik; Ostergren, Olof; Tarkiainen, Lasse; Hermansen, Åsmund; Martikainen, Pekka; van der Wel, Kjetil A.; Lundberg, Olle (2021)
    Objectives Levels, trends or changes in socioeconomic mortality differentials are typically described in terms of means, for example, life expectancies, but studies have suggested that there also are systematic social disparities in the dispersion around those means, in other words there are inequalities in lifespan variation. This study investigates changes in income inequalities in mean and distributional measures of mortality in Denmark, Finland, Norway, and Sweden over two decades. Design Nationwide register-based study. Setting The Danish, Finnish, Norwegian and Swedish populations aged 30 years or over in 1997 and 2017. Main outcome measures Income-specific changes in life expectancy, lifespan variation and the contribution of 'early' and 'late' deaths to increasing life expectancy. Results Increases in life expectancy has taken place in all four countries, but there are systematic differences across income groups. In general, the largest gains in life expectancy were observed in Denmark, and the smallest increase among low-income women in Sweden and Norway. Overall, life expectancy increased and lifespan variation decreased with increasing income level. These differences grew larger over time. In all countries, a marked postponement of early deaths led to a compression of mortality in the top three income quartiles for both genders. This did not occur for the lowest income quartile. Conclusion Increasing life expectancy is typically accompanied by postponement of early deaths and reduction of lifespan inequality in the higher-income groups. However, Nordic welfare societies are challenged by the fact that postponing premature deaths among people in the lowest-income groups is not taking place.
  • 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.
  • Tiusanen, Roosa; Saltychev, Mikhail; Ervasti, Jenni; Kivimäki, Mika; Pentti, Jaana; Stenholm, Sari; Vahtera, Jussi (2022)
    Objectives To identify concurrent developmental trajectories of physical activity and body mass index (BMI) over time. Design Prospective cohort study, repeated survey. Setting Cohort study in Finland. Participants 66 852 public sector employees, who have been followed up for 16 years. Outcome measures Shapes of trajectories of changes in physical activity and BMI. Results At baseline, mean age was 44.7 (SD 9.4) years, BMI 25.1 (SD 4.1) kg/m(2) and physical activity 27.7 (SD 24.8) MET hours/week. Four clusters of concurrent BMI and physical activity trajectories were identified: (1) normal weight (BMI 35 kg/m(2)) and low level of physical activity (
  • Pasanen, Sanna; Halonen, Jaana I.; Pulakka, Anna; Kestens, Yan; Thierry, Benoit; Brondeel, Ruben; Pentti, Jaana; Vahtera, Jussi; Leskinen, Tuija; Stenholm, Sari (2021)
    Objectives We examined sedentary time and physical activity in different contexts among ageing workers, between their workdays and days off, and recent retirees, between their weekdays and weekend days. Design Cross-sectional study. Setting Finnish Retirement and Aging study and Enhancing physical activity and healthy ageing among recent retirees - Randomised controlled in-home physical activity trial. Participants 137 workers (544 measurement days) and 53 retirees (323 days), who provided data for at least 1 workday/weekday and 1 day off/weekend day. Primary and secondary outcome measures Physical activity behaviour was measured with a combined Global Positioning System and accelerometer device (SenseDoc V.2.0), providing information on sedentary time, light physical activity and moderate-to-vigorous physical activity (MVPA) by locations (home or non-home) and trips (active travel, ie, speed <20 km/hour and passive travel, ie, speed ≥20 km/hour). Results Workers accumulated more sedentary time and physical activity at non-home locations than at home on workdays, while the opposite was confirmed for days off (p<0.01). Workers accrued more MVPA on days off than on workdays (34 vs 28 min, p<0.05), of which 9 min on workdays and 14 min on days off was accrued during active travel. Retirees' physical activity behaviour did not differ between weekdays and weekend days (p>0.05). Regardless of the day, retirees accumulated 33 min of daily MVPA, of which 14 min was accrued during active travel. Conclusions Workers accumulated more MVPA on days off than on workdays, and their activity behaviour varied between workdays and days off at different locations. Our results showed that a large proportion of the MVPA was accumulated during travel at slower speeds, which suggests that active travel could be a feasible way to increase MVPA among older adults. Trial registration number NCT03320746.
  • Halonen, Jaana I.; Pulakka, Anna; Pentti, Jaana; Kallio, Minna; Koskela, Sofia; Kivimäki, Mika; Kawachi, Ichiro; Vahtera, Jussi; Stenholm, Sari (BMJ, 2020)
    BMJ Open 10 8 (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 (750×750 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.
  • 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.
  • Okely, Anthony D.; Reilly, John J.; Tremblay, Mark S.; Kariippanon, Katharina E.; Draper, Catherine E.; El Hamdouchi, Asmaa; Florindo, Alex A.; Green, Janette P.; Guan, Hongyan; Katzmarzyk, Peter T.; Lubree, Himangi; Bang Nguyen Pham; Suesse, Thomas; Willumsen, Juana; Basheer, Mohamed; Calleia, Rebecca; Chong, Kar Hau; Cross, Penny L.; Nacher, Maria; Smeets, Laura; Taylor, Ellie; Abdeta, Chalchisa; Aguilar-Farias, Nicolas; Baig, Aqsa; Bayasgalan, Jambaldori; Chan, Cecilia H. S.; Chathurangana, P. W. Prasad; Chia, Michael; Ghofranipour, Fazlollah; Ha, Amy S.; Hossain, Mohammad Sorowar; Janssen, Xanne; Jauregui, Alejandra; Katewongsa, Piyawat; Kim, Dong Hoon; Thanh Van Kim; Koh, Denise; Kontsevaya, Anna; Leyna, Germana H.; Lof, M.; Munambah, Nyaradzai; Mwase-Vuma, Tawonga; Nusurupia, Jackline; Oluwayomi, Aoko; del Pozo-Cruz, Borja; del Pozo-Cruz, Jesus; Roos, Eva; Shirazi, Asima; Singh, Pragya; Staiano, Amanda; Suherman, Adang; Tanaka, Chiaki; Tang, Hong Kim; Teo, Wei-Peng; Tiongco, Marites M.; Tladi, Dawn; Turab, Ali; Veldman, Sanne L. C.; Webster, E. Kipling; Wickramasinghe, Pujitha; Widyastari, Dyah Anantalia (2021)
    Introduction 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. Methods and analysis SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. Ethics and dissemination The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions.
  • 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.