Publications by authors named "Arpo Aromaa"

104 Publications

Does sauna bathing protect against dementia?

Prev Med Rep 2020 Dec 2;20:101221. Epub 2020 Oct 2.

Finnish Institute for Health and Welfare, Helsinki, Finland.

Repeated heat exposure like sauna bathing is suggested to beneficially affect against dementia development. The epidemiological evidence is, however, scarce. Therefore, we studied the association between heat exposure during sauna bathing (i.e., the frequency of sauna bathing, frequency of heat sessions, length of stay in heat, sauna temperature) and the subsequent risk of dementia. A prospective cohort study was conducted based on 13,994 men and women aged 30-69 and free from dementia diagnosis from the Finnish Mobile Clinic Follow-up Survey. During a follow-up of 39 years, a total of 1805 dementia patients were diagnosed. The sauna bathing data was gathered from a questionnaire. Analyses based on the Cox model included the sauna bathing variables and the potential confounding factors. Sauna bathing frequency was related to a reduced risk of dementia after adjustment for the potential sociodemographic, lifestyle, and metabolic risk factors of dementia considered. The hazard ratio of dementia between individuals sauna bathing 9-12 times per month in comparison with those not sauna bathing or sauna bathing less than four times per month was 0.47 (95% CI = 0.25-0.88) during the first 20 years of follow-up and 0.81 (95% CI = 0.69-0.97) during the whole follow-up. The results are in line with the hypothesis that sauna bathing provides protection against dementia. Further studies are required to verify the suggested benefits of sauna bathing.
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http://dx.doi.org/10.1016/j.pmedr.2020.101221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560162PMC
December 2020

Work-related risk factors for sciatica leading to hospitalization.

Sci Rep 2019 04 25;9(1):6562. Epub 2019 Apr 25.

Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

The aim of this study was to assess the effects of the general strenuousness of work and various physical exposures on the risk of hospitalization for sciatica. The study population consisted of Finns aged 30 to 59 who had participated in a national health examination survey in 1978-80 (N = 3891). The participants were followed up until the end of 2011 and information on work-related determinants was acquired by a questionnaire. After adjustment for confounders, sedentary work involving handling fairly heavy objects/physically light work (HR 1.57; 95% CI 1.05-2.34), lifting or carrying heavy objects (2.10; 1.35-3.26) and exposure to whole-body vibration (1.61; 0.95-2.72) predicted sciatica, whereas heavier workloads appeared to reduce its risk (0.48; 0.26-0.89). There was an interaction between body mass index and exposure to whole-body vibration for the risk of sciatica. Overweight (1.94; 0.96-3.93) and obese (3.50; 1.44-8.46) participants exposed to whole-body vibration were at an increased risk of sciatica. Individuals of normal weight who were exposed to vibration, and overweight and obese individuals who were not exposed to vibration were not at an increased risk. The risk of hospitalization for sciatica seems to be highest among obese individuals exposed to whole-body vibration and among those lifting or carrying heavy objects.
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http://dx.doi.org/10.1038/s41598-019-42597-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484005PMC
April 2019

Projecting long-term trends in mobility limitations: impact of excess weight, smoking and physical inactivity.

J Epidemiol Community Health 2019 05 18;73(5):443-450. Epub 2019 Feb 18.

National Institute for Health and Welfare, Helsinki, Finland.

Background: Policy makers need disability projections for planning adequate services and measures for health promotion. The aim of this study is to provide projections on severe mobility limitations up to year 2044 and illustrate how the projected prevalence and the number of persons with severe mobility limitations are affected by potential changes in the modifiable risk factors, namely excess weight, physical inactivity and smoking.

Methods: We analysed the nationally representative, repeated measures Health 2000 and 2011 Surveys (BRIF8901) with 8615 and 6740 participants, respectively, aged 18 years and older. Severe mobility limitations were defined as major difficulties or unable to walk about half a kilometre. We applied a multistate model on repeated measures to account for both individual risk factors and their changes over time.

Results: The number of people with severe mobility limitations was projected to double by the year 2044 in Finland, due to the rapid ageing of the population. Eliminating half of the excess weight would reduce their number by one-fifth, while reductions in the prevalence of smoking and physical inactivity would have a minor impact. Even if excess weight, smoking and physical inactivity were completely eliminated, the number of persons with severe mobility limitations is projected to increase.

Conclusions: Designing and implementing strategies to promote healthy weight are important to slow down the rapid increase in mobility limitations due to population ageing. Providing adequate health and social services for the increasing population with disabilities will nevertheless be an increasing national challenge.
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http://dx.doi.org/10.1136/jech-2017-210413DOI Listing
May 2019

Early quality-of-life and psychological predictors of disease-free time and survival in localized prostate cancer.

Qual Life Res 2019 Mar 3;28(3):677-686. Epub 2018 Dec 3.

Medical School, Oncology, University of Tampere, 33014, Tampere, Finland.

Purpose: The constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life (QOL) have shown contradictory results. We investigated the effect of socioeconomic and early QOL and psychological factors on disease-free time and survival in localized prostate cancer.

Methods: A consecutive sample of patients with localized prostate cancer (T1-3, N0, M0) treated with external beam radiotherapy completed validated questionnaires on coping with cancer (the Ways of Coping Questionnaire WOC-CA), anger expression (the Anger Expression Scale), life events (the Life Experience Survey), and various aspects of QOL (the Rotterdam Symptom Checklist, the Depression Scale DEPS, the EORTC QLQ-C30, the LENT-SOMA outcome measure) approximately 4.5 months after diagnosis. Cox regression analyses were used to determine the predictors of the disease-free and overall survival times measured from the date of diagnosis to the date of a PSA-relapse and date of death.

Results: After controlling for biological prognostic factors, age, and adjuvant hormonal therapies, moderate and high socioeconomic status and an increased level of pain predicted longer survival, whereas an increased level of prostate-area symptoms and fatigue and, especially, reports of no/few physical symptoms were predictors of a shorter survival time. A longer PSA-relapse-free time was predicted by Cognitive Avoidance/Denial coping, whereas problems in social functioning, hopelessness, and an excellent self-reported QOL predicted a shorter PSA-relapse-free time.

Conclusions: Higher socioeconomic status was prognostic for longer survival, as previously reported. Patients with a seemingly good QOL (few physical complaints, excellent self-reported QOL) had poorer prognoses. This association may due to the survival decreasing effect of emotional non-expression; patients with high emotional non-expression may over-report their wellbeing in simple measures, and thus actually be in need of extra attention and care.
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http://dx.doi.org/10.1007/s11136-018-2069-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394517PMC
March 2019

Risk factors for first hospitalization due to meniscal lesions - a population-based cohort study with 30 years of follow-up.

BMC Musculoskelet Disord 2017 Dec 13;18(1):528. Epub 2017 Dec 13.

Finnish Institute of Occupational Health, 40, 00251, Helsinki, PB, Finland.

Background: Meniscal lesions are among the most common injuries of the knee, yet limited epidemiologic data is available on their risk factors. We investigated the association of lifestyle factors and physical strenuousness of work on knee injuries with a focus on meniscal lesions.

Methods: We examined a nationally representative sample of persons aged 30 to 59 years, who participated in a comprehensive health examination (the Mini-Finland Health Survey). Subjects without any injury or osteoarthritis in the knee joint at baseline (n = 4713) were subsequently followed via the National Hospital Discharge Register up to 30 years.

Results: During the follow-up, 338 knee injuries were identified of which 224 were meniscal lesions. Obesity and regular leisure time physical exercise were associated with an increased risk of first hospitalization due to meniscal lesions (hazard ratio (HR) 1.62 and 95% confidence interval (CI) 1.06-2.48 and 1.53, 95% CI 1.05-2.23, respectively). The types of sports predicting the highest risk of meniscal lesions were ballgames, gymnastics and jogging. Physical strenuousness of work did not predict meniscal lesion. The hazard of other knee injury was increased among those reporting irregular or regular physical exercise at baseline (HR 1.64, 95% CI 1.03-2.64 and 1.88 CI 1.05-2.36, respectively). Smoking or alcohol intake were not associated with knee injuries.

Conclusions: Better safety measures in high-risk sports and weight control would likely improve the prevention of meniscal lesions in populations.
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http://dx.doi.org/10.1186/s12891-017-1886-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729412PMC
December 2017

International Differences in the Risk of Death from Smoking and Obesity: The Case of the United States and Finland.

SSM Popul Health 2017 Dec;3:141-152

National Institute for Health and Welfare (THL), Department of Health, Functional Capacity and Welfare, Turku / Helsinki, Finland.

Despite much interest in the health risks associated with behavioral factors, little is known about whether individuals residing in different countries experience a different set of risks. International comparisons of the death risks from major behavioral factors can shed light on whether features of health systems and epidemiological histories modify the health effects of risky behaviors. We used nationally representative samples and mortality linkages spanning the 1971-2014 period from the United States and Finland to examine cross-national differences in the risks of death from cigarette smoking and obesity. We evaluated both current and former smoking and current and prior obesity. In 1990, the approximate midpoint of our study, the death risks from current smoking were about 55% higher in U.S. women compared to Finnish women, but similar for men in the two countries. Death risks from smoking significantly increased over the period for women in both countries and there was no parallel increase in risks among men. Death risks from obesity did not significantly differ in the two countries and no significant trend in the risks were detected in either country. Reasons for the relatively high and increasing risks from smoking among American women warrant further evaluation.
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http://dx.doi.org/10.1016/j.ssmph.2016.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546741PMC
December 2017

Experiences and psychological distress of spouses of prostate cancer patients at time of diagnosis and primary treatment.

Eur J Cancer Care (Engl) 2018 Jan 21;27(1). Epub 2017 Jun 21.

Department of Surgery, Tampere University Hospital, Tampere, Finland.

We studied experiences and psychological distress of partners of prostate cancer patients at the time of diagnosis and primary treatment and investigated associates of their psychological wellbeing and the emotional social support they give to and receive from the patient. Using a quantitative questionnaire we studied the spouses' experiences (psychological response and sources of information and emotional support at diagnosis; impacts of prostate cancer on partnership and sex life; impact of side effects of treatment) and the emotional support given and received, and measured their psychological symptom distress. Many spouses reported distressing experiences and all psychological symptoms. Two thirds perceived no impact of the cancer on the partnership while 29% no change in sex life. Distress was associated with a shock, fear of the man's death and impact of side effects, whereas emotional support from a doctor predicted less distress. More support given to the patient was associated with information and emotional support received from a doctor and the patient's sexual dysfunction and pain, and less with experiences of depression, no impact on the partnership and the patient's irritableness. The spouses' distress was relieved by emotional support from a doctor, which along with received information also enhanced their capability to support the patient.
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http://dx.doi.org/10.1111/ecc.12729DOI Listing
January 2018

Patients' perceptions of the negative effects following different prostate cancer treatments and the impact on psychological well-being: a nationwide survey.

Br J Cancer 2017 Mar 21;116(7):864-873. Epub 2017 Feb 21.

National Institute for Health and Welfare THL, Health Monitoring Unit, Helsinki FI00271, Finland.

Background: Although the prognosis of localised prostate cancer is good, the negative effects of prostate cancer treatment often impair patient quality of life. A growing number of men experience these negative effects over a longer time because of the increased incidence of and prolonged survival in prostate cancer, and the ageing of the population. Only a few studies have investigated the adverse effects of different prostate cancer treatments using large population-based samples.

Methods: We conducted a nationwide survey (n=1239) to collect detailed information regarding the negative effects (i.e., the occurrence, perceived level and perceived bother since the beginning of the treatment) of prostate cancer treatments: radical prostatectomy, external beam radiotherapy, brachytherapy, hormone therapy and surveillance. Furthermore, we measured patient satisfaction with the outcome of the treatment and their psychological well-being (i.e., psychological symptoms and satisfaction with life) 5 years after diagnosis. The negative effects between the treatments were compared, and the determinants of satisfaction and psychological well-being were investigated.

Results: The negative effects of all types of active prostate cancer treatments were common and persistent (33-48% reported symptoms at 5 years) and showed the known differences between the treatments. Prostatectomy and the radiotherapies caused urinary leakage; radiotherapy also caused symptoms of urinary irritation; and external radiation also caused bowel dysfunction. Most symptoms were considered highly bothersome. Most respondents (81-93%) reported that their treatment negatively affected their sex lives; 70-92% reported sexual dysfunction; and 20-58% reported that their sex lives with their spouses had ended. Urinary symptoms were especially associated with poorer psychological outcomes. The perception of symptom level and bother had a greater effect on patient satisfaction and well-being than the symptoms per se.

Conclusion: Multiple and persistent negative effects follow active prostate cancer treatment, and these effects predict long-term patient satisfaction and psychological well-being. The harms and benefits associated with prostate cancer treatments should be considered when selecting whether and how to actively treat prostate cancer.
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http://dx.doi.org/10.1038/bjc.2017.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379142PMC
March 2017

Meta-analysis of 375,000 individuals identifies 38 susceptibility loci for migraine.

Nat Genet 2016 08 20;48(8):856-66. Epub 2016 Jun 20.

Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Migraine is a debilitating neurological disorder affecting around one in seven people worldwide, but its molecular mechanisms remain poorly understood. There is some debate about whether migraine is a disease of vascular dysfunction or a result of neuronal dysfunction with secondary vascular changes. Genome-wide association (GWA) studies have thus far identified 13 independent loci associated with migraine. To identify new susceptibility loci, we carried out a genetic study of migraine on 59,674 affected subjects and 316,078 controls from 22 GWA studies. We identified 44 independent single-nucleotide polymorphisms (SNPs) significantly associated with migraine risk (P < 5 × 10(-8)) that mapped to 38 distinct genomic loci, including 28 loci not previously reported and a locus that to our knowledge is the first to be identified on chromosome X. In subsequent computational analyses, the identified loci showed enrichment for genes expressed in vascular and smooth muscle tissues, consistent with a predominant theory of migraine that highlights vascular etiologies.
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http://dx.doi.org/10.1038/ng.3598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331903PMC
August 2016

Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform.

Acta Odontol Scand 2016 Jul 15;74(5):348-54. Epub 2016 Mar 15.

a University of Eastern Finland, Institute of Dentistry , Kuopio , Finland ;

Objectives In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. The aim of this study was to investigate income-related inequality in the perceived oral health and its determinants among adult Finns before and after the reform. Materials and methods Three identical cross-sectional nationally representative postal surveys, concerning perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2157), in 2004 (n = 1814) and in 2007 (n = 1671). Three measures of perceived oral health were used: toothache or oral discomfort during the past 12 months, current need for dental care and self-reported oral health status. Concentration index was used to analyse the income-related inequalities. Its decomposition was used to study factors related to the inequalities. Results The proportion of respondents reporting need for dental care decreased from 2001 to 2007, while no changes were seen in reports of toothache or self-reported oral health status. Income-related inequalities in reports of toothache and perceived need for care widened, while the inequality in self-reported oral health remained stable. Most of the inequalities were related to income itself, perceived general health and the time since the last visit to dental care. Conclusions It seems that the income-related inequalities in perceived oral health remained or even widened after the reform.
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http://dx.doi.org/10.3109/00016357.2016.1142113DOI Listing
July 2016

Inequality in oral health-related quality of life before and after a major subsidization reform.

Eur J Oral Sci 2015 Aug 25;123(4):267-75. Epub 2015 May 25.

Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.

In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. We investigated income-related inequality in oral health-related quality of life (OHRQoL) and its determinants among adult Finns before and after the reform. Three cross-sectional postal surveys, focusing on perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2,046), 2004 (n = 1,728), and 2007 (n = 1,560). Five measures, based on the Oral Health Impact Profile-14, were used as indicators of OHRQoL. Income-related inequality and associated factors were analysed using the concentration index and its decomposition. Prevalence, extent, and severity of oral health impacts were slightly lower in 2007 than in 2001. The oral health impacts were concentrated, at all study time points, among individuals with lower income. Most of the inequality was related to self-perceived general health, tooth loss, and income. Contributions of time since the last dental visit and satisfaction with the last treatment period to the inequality decreased from 2001 to 2007. However, the contributions of these factors were already small (10-20%) in 2001. In general, OHRQoL improved slightly; however, no clear or dramatic change in inequality in OHRQoL was seen after the reform.
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http://dx.doi.org/10.1111/eos.12192DOI Listing
August 2015

Social, lifestyle and demographic inequalities in hypertension care.

Scand J Public Health 2015 May 27;43(3):246-53. Epub 2015 Feb 27.

Department of Health, National Institute for Health and Welfare, Finland.

Aims: Recent nationwide in-depth analyses on inequalities in hypertension prevalence and care are scarce. This study assessed sociodemographic and lifestyle factors associated with the prevalence, awareness, treatment and control of hypertension in Finland.

Methods: A representative nationwide sample (participation rate 58%) of the Finnish adult population underwent a health examination and interview in 2011. After excluding participants with missing data, 4230 people were included in the analyses. Weighted regression modelling was used to explore the associations of sociodemographic and lifestyle factors with the prevalence, awareness, treatment and control of hypertension.

Results: The prevalence, awareness, treatment and control rates of hypertension (blood pressure ⩾140/90 mmHg or antihypertensive medication) in Finland were 47%, 57%, 51% and 48%, respectively. Older age, male sex, lower education, retirement, higher BMI, never-smoking and heavy alcohol use were associated with a higher prevalence of hypertension (p<0.05). In contrast, younger age, non-retirement, lower BMI, smoking and high physical activity were associated with lower awareness and treatment rates (p<0.05). In addition, male sex was associated with lower awareness rates (p<0.01). Hypertension control was better in younger participants (p<0.05).

Conclusions: In addition to high prevalence and moderate treatment rates of hypertension, serious sociodemographic and lifestyle inequities in hypertension care exist in Finland. Hypertension is more prevalent in older people of lower socio-economic status with adverse lifestyles. However, hypertension is more often unrecognised and untreated among people with low risk of hypertension.
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http://dx.doi.org/10.1177/1403494815571031DOI Listing
May 2015

Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform.

Community Dent Oral Epidemiol 2015 Jun 9;43(3):240-54. Epub 2015 Feb 9.

University of Eastern Finland, Kuopio, Finland.

Objectives: In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform.

Methods: Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them.

Results: Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years.

Conclusion: It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform.
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http://dx.doi.org/10.1111/cdoe.12148DOI Listing
June 2015

Patient experiences at diagnosis and psychological well-being in prostate cancer: A Finnish national survey.

Eur J Oncol Nurs 2015 Jun 24;19(3):220-9. Epub 2014 Dec 24.

National Institute for Health and Welfare, Helsinki, Finland.

Purpose: Most cases of prostate cancer are diagnosed at an early stage, and men live for many years after diagnosis. Thus, their well-being and quality of life are of great importance. This study investigated patient experiences and psychological well-being in a Finnish national sample of prostate cancer patients who received various types of treatment.

Method: In a national sample (50%) of prostate cancer patients diagnosed in Finland in 2004, information was collected on the patients' experiences at diagnosis and choice of treatment (e.g. treatment selection, patient satisfaction with care and information, psychological reactions). In 2009, participants were asked about their experiences, and psychological well-being (psychological symptoms, satisfaction with life) was measured. In total, 1239 completed questionnaires (73%) were accepted for the study. Differences between treatments and predictors of psychological well-being were investigated using descriptive statistics and regression analysis.

Results: Half of the respondents were satisfied with the care and information they received about the cancer and side effects of treatment. Experiences and psychological well-being were most positive among patients who received brachytherapy and poorest among patients who received hormonal therapy. Patients who underwent prostatectomy or brachytherapy were most likely to have been involved in treatment selection. Negative experiences, such as learning of the diagnosis in an impersonal way and dissatisfaction with the information and care received, were predictive of poorer well-being.

Conclusions: Unmet supportive care and informational needs were common. Experiences and well-being varied between treatments. Patients tended to prefer prostatectomy and brachytherapy. Unmet needs, which would probably be reduced by improvements in care, appear to have a long-lasting impact on patients' psychological well-being.
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http://dx.doi.org/10.1016/j.ejon.2014.10.018DOI Listing
June 2015

The role of behaviour in inequality in increments of dental caries among Finnish adults.

Caries Res 2015 11;49(1):34-40. Epub 2014 Nov 11.

Division of Population and Patient Health, King's College London Dental Institute, London, UK.

Background: Evidence from cross-sectional studies implies that dental behaviours partially explain inequalities in oral health.

Objective: To assess whether dental behaviours completely eliminate inequality in increments of dental caries in a sample of Finnish adults.

Methods: The baseline data were collected from the Health 2000 survey, a nationally representative survey of 8,028 individuals aged 30 years or older living in mainland Finland. Four years later, 1,248 subjects were invited for oral re-examination, and 1,049 agreed to participate (84% response rate). At baseline, participants provided information on demographics, education and dental behaviours (dental attendance, tooth brushing with fluoride toothpaste, sugar consumption and daily smoking). Oral examinations at baseline and follow-up were identical.

Results: Adults with basic education had significantly greater increments of DMFT (incidence rate ratio 1.41, 95% CI 1.07-1.85) and DT (incidence rate ratio 2.23, 95% CI 1.27-3.90) than those with high education. Adjusting for single behaviours attenuated but did not eliminate education inequality in DMFT and DT increments, tooth brushing having the greatest impact on inequality. Simultaneous adjustment for all behaviours eliminated the significant relationship between education and caries increment.

Conclusions: Accounting for important dental behaviours appears to explain all education inequality in dental caries in Finnish adults. The results should be interpreted with caution when applied to less egalitarian populations.
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http://dx.doi.org/10.1159/000366491DOI Listing
January 2016

Concordance of genetic risk across migraine subgroups: Impact on current and future genetic association studies.

Cephalalgia 2015 May 1;35(6):489-99. Epub 2014 Sep 1.

Department of Neurology, Leiden University Medical Centre, the Netherlands.

Background: There has been intensive debate whether migraine with aura (MA) and migraine without aura (MO) should be considered distinct subtypes or part of the same disease spectrum. There is also discussion to what extent migraine cases collected in specialised headache clinics differ from cases from population cohorts, and how female cases differ from male cases with respect to their migraine. To assess the genetic overlap between these migraine subgroups, we examined genome-wide association (GWA) results from analysis of 23,285 migraine cases and 95,425 population-matched controls.

Methods: Detailed heterogeneity analysis of single-nucleotide polymorphism (SNP) effects (odds ratios) between migraine subgroups was performed for the 12 independent SNP loci significantly associated (p < 5 × 10(-8); thus surpassing the threshold for genome-wide significance) with migraine susceptibility. Overall genetic overlap was assessed using SNP effect concordance analysis (SECA) at over 23,000 independent SNPs.

Results: Significant heterogeneity of SNP effects (p het < 1.4 × 10(-3)) was observed between the MA and MO subgroups (for SNP rs9349379), and between the clinic- and population-based subgroups (for SNPs rs10915437, rs6790925 and rs6478241). However, for all 12 SNPs the risk-increasing allele was the same, and SECA found the majority of genome-wide SNP effects to be in the same direction across the subgroups.

Conclusions: Any differences in common genetic risk across these subgroups are outweighed by the similarities. Meta-analysis of additional migraine GWA datasets, regardless of their major subgroup composition, will identify new susceptibility loci for migraine.
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http://dx.doi.org/10.1177/0333102414547784DOI Listing
May 2015

Weight histories and mortality among finnish adults: the role of duration and peak body mass index.

Epidemiology 2014 Sep;25(5):707-10

From the aEmory University, Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA; bNational Institute for Health and Welfare (THL), Department of Health, Functional Capacity and Welfare, Turku/Helsinki, Finland; cUniversity of Turku, Department of Public Health, Turku, Finland; and dUniversity of Pennsylvania, Population Studies Center, Philadelphia, PA.

Background: Many studies use information on weight histories to examine the association between body weight and mortality. A recent paper in Epidemiology (2013;25:707-710) developed a typology of the most common weight-history specifications.

Methods: We use data from a sample of Finnish adults to explore the associations of body weight and mortality, using existing specifications and also peak body mass index (BMI), a new specification.

Results: We confirm earlier findings that longer time in a high BMI state is predictive of mortality. Peak BMI (the highest BMI attained in life or available in the data) is also positively associated with mortality.

Conclusions: The specifications of duration in a high BMI state and peak BMI are both valuable for understanding the relationship between lifetime weight dynamics and mortality. The collection of information on peak body weight may be useful when collection of more detailed weight histories is not feasible.
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http://dx.doi.org/10.1097/EDE.0000000000000147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355397PMC
September 2014

Dental attendance among adult Finns after a major oral health care reform.

Community Dent Oral Epidemiol 2014 Dec 21;42(6):591-602. Epub 2014 Jun 21.

University of Eastern Finland, Kuopio, Finland.

Objectives: Between 2001 and 2002, all age limits restricting the availability of subsidized private dental care and Public Dental Services (PDS) were abolished in Finland. In addition, the reform aimed to address income- and residence-related disparities in access to subsidized oral health care services. The aim of this study was to analyse how dental attendance and factors associated with it changed after the reform.

Methods: We carried out three consecutive surveys on the use of oral health care services and perceived oral health. The surveys were conducted in 2001 (n = 2837), in 2004 (n = 2420) and in 2007 (n = 2296), and the study population comprised Finnish adults born in 1970 or earlier. Logistic regression analyses were used to examine factors associated with the use of the services.

Results: The percentage of respondents who attended dental care regularly or had used oral health care services over the past 12 months rose between 2001 and 2007. In particular, there was an increase in the proportion of subjects who used PDS. The average number of visits to a private dentist decreased between 2001 and 2007. In the regression analyses, the use of services was associated with older age, perceived lack of need for care, perceived toothache during the past 12 months, perceived good oral health, lower number of missing teeth and regular dental visiting habits. The use of private dental care services was associated with perceived good oral health and perceived lack of need for care, higher household income and older age in all three study years while the use of PDS was associated with younger age, perceived good oral health and perceived lack of need for care only in 2001.

Conclusions: The use of oral health care services rose and age did not seem to be a barrier to the use of oral health care services after the reform, as was the aim of the reform. No change in the association of household income with the use of oral health care services was seen after the OHCR.
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http://dx.doi.org/10.1111/cdoe.12117DOI Listing
December 2014

Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study.

J Dent 2014 Aug 9;42(8):952-8. Epub 2014 May 9.

National Institute for Health and Welfare, Helsinki, Finland; Department of Oral Public Health, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland; Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland.

Objectives: To explore the association between frequency of consumption of sugar-sweetened beverages (SSB) and caries increment over 4 years in adults. A second objective was to explore whether the association between frequency of SSB consumption and caries increment varied by socio-demographic characteristics and use of fluoride toothpaste.

Methods: Data from 939 dentate adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours, including two questions on frequency of SSB consumption. The 4-year net DMFT increment was calculated using data from baseline and follow-up clinical oral examinations. The association was tested in negative binomial regression models and the moderating role of sex, age, education and use of fluoride toothpaste was examined by adding their two-way interaction with SSB consumption to the main effects model.

Results: A positive association was found between frequency of SBS consumption and 4-year net DMFT increment, regardless of participants' socio-demographic and behavioural characteristics. Adults drinking 1-2 and 3+ SSB daily had, respectively, 31% (Incidence Rate Ratio: 1.31; 95%CI: 1.02-1.67) and 33% (IRR: 1.33; 95%CI; 1.03-1.72) greater net DMFT increments than those not drinking any SSB. None of the four two-way interaction terms was significant (all p>0.05).

Conclusion: There seems to be a dose-response relationship between frequency of SSB consumption and caries increment in adults. That association was consistent across socio-demographic characteristics, and more importantly, use of fluoride toothpaste.

Clinical Significance: Drinking sugar-sweetened beverages on a daily basis is related to greater caries risk in adults.
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http://dx.doi.org/10.1016/j.jdent.2014.04.011DOI Listing
August 2014

High risk population isolate reveals low frequency variants predisposing to intracranial aneurysms.

PLoS Genet 2014 Jan 30;10(1):e1004134. Epub 2014 Jan 30.

Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.

3% of the population develops saccular intracranial aneurysms (sIAs), a complex trait, with a sporadic and a familial form. Subarachnoid hemorrhage from sIA (sIA-SAH) is a devastating form of stroke. Certain rare genetic variants are enriched in the Finns, a population isolate with a small founder population and bottleneck events. As the sIA-SAH incidence in Finland is >2× increased, such variants may associate with sIA in the Finnish population. We tested 9.4 million variants for association in 760 Finnish sIA patients (enriched for familial sIA), and in 2,513 matched controls with case-control status and with the number of sIAs. The most promising loci (p<5E-6) were replicated in 858 Finnish sIA patients and 4,048 controls. The frequencies and effect sizes of the replicated variants were compared to a continental European population using 717 Dutch cases and 3,004 controls. We discovered four new high-risk loci with low frequency lead variants. Three were associated with the case-control status: 2q23.3 (MAF 2.1%, OR 1.89, p 1.42×10-9); 5q31.3 (MAF 2.7%, OR 1.66, p 3.17×10-8); 6q24.2 (MAF 2.6%, OR 1.87, p 1.87×10-11) and one with the number of sIAs: 7p22.1 (MAF 3.3%, RR 1.59, p 6.08×-9). Two of the associations (5q31.3, 6q24.2) replicated in the Dutch sample. The 7p22.1 locus was strongly differentiated; the lead variant was more frequent in Finland (4.6%) than in the Netherlands (0.3%). Additionally, we replicated a previously inconclusive locus on 2q33.1 in all samples tested (OR 1.27, p 1.87×10-12). The five loci explain 2.1% of the sIA heritability in Finland, and may relate to, but not explain, the increased incidence of sIA-SAH in Finland. This study illustrates the utility of population isolates, familial enrichment, dense genotype imputation and alternate phenotyping in search for variants associated with complex diseases.
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http://dx.doi.org/10.1371/journal.pgen.1004134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907358PMC
January 2014

Daily smoking and 4-year caries increment in Finnish adults.

Community Dent Oral Epidemiol 2014 Oct 29;42(5):428-34. Epub 2014 Jan 29.

Division of Population and Patient Health, King's College London Dental Institute, London, UK.

Objectives: Although the harmful effects of smoking on periodontal disease and oral cancer are now indisputable, its effect on dental caries is less well known. This study assessed whether daily smoking predicts caries increment in adults over 4 years.

Methods: Data from 955 adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours. The 4-year net increment in the numbers of decayed (DT), filled (FT) and missing (MT) teeth and the DMFT index were calculated using the data from baseline and follow-up clinical oral examinations.

Results: Daily smoking was not associated with net DMFT increment. In subsequent analysis by components, daily smoking was associated with net DT increment, but not with net FT or MT increments. When daily smokers were split into two groups by consumption level (1-19 and 20+ cigarettes/day) and compared to nondaily smokers, a significant dose-response relationship was additionally found between levels of tobacco consumption and net DT increment. Although daily smokers reported less favourable behaviours than nonsmokers, these associations only explained partially the effect of daily smoking on net DT increment.

Conclusions: Daily smoking was independently related to caries development (net DT increment) in adults over 4 years, but not to caries treatment (net FT and MT increments) or caries experience (net DMFT increment).
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http://dx.doi.org/10.1111/cdoe.12101DOI Listing
October 2014

Genome-wide meta-analysis identifies new susceptibility loci for migraine.

Nat Genet 2013 Aug 23;45(8):912-917. Epub 2013 Jun 23.

deCODE genetics, Reykjavik, Iceland.

Migraine is the most common brain disorder, affecting approximately 14% of the adult population, but its molecular mechanisms are poorly understood. We report the results of a meta-analysis across 29 genome-wide association studies, including a total of 23,285 individuals with migraine (cases) and 95,425 population-matched controls. We identified 12 loci associated with migraine susceptibility (P<5×10(-8)). Five loci are new: near AJAP1 at 1p36, near TSPAN2 at 1p13, within FHL5 at 6q16, within C7orf10 at 7p14 and near MMP16 at 8q21. Three of these loci were identified in disease subgroup analyses. Brain tissue expression quantitative trait locus analysis suggests potential functional candidate genes at four loci: APOA1BP, TBC1D7, FUT9, STAT6 and ATP5B.
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http://dx.doi.org/10.1038/ng.2676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041123PMC
August 2013

Public health indicators for the EU: the joint action for ECHIM (European Community Health Indicators & Monitoring).

Arch Public Health 2013 30;71(1):12. Epub 2013 May 30.

Ratakatu 1a, Helsinki, FI-00120, Finland.

Background: Public health policies aim to improve and maintain the health of citizens. Relevant data and indicators are needed for a health policy that is based on factual information. After 14 years of work (1998-2012), the multi-phase action on European Community Health Indicators (ECHI) has created a health monitoring and reporting system. It has generated EU added value by defining the ECHI shortlist with 88 common and comparable key health indicators for Europe.

Methods: In the 2009-2012 Joint Action for ECHIM project the ECHI shortlist was updated through consultation with Member State representatives. Guidelines for implementation of the ECHI Indicators at national level were developed and a pilot data collection was carried out.

Results: 67 of the ECHI Indicators are already part of regular international data collections and thus available for a majority of Member States, 14 are close to ready and 13 still need development work. By mid-2012 half of the countries have incorporated ECHI indicators in their national health information systems and the process is ongoing in the majority of the countries. Twenty-five countries were able to provide data in a Pilot Data Collection for 20 ECHI Indicators that were not yet (fully) available in the international databases.

Conclusions: The EU needs a permanent health monitoring and reporting system. The Joint Action for ECHIM has set an example for the implementation of a system that can develop and maintain the ECHI indicators,, and promote and encourage the use of ECHI in health reporting and health policy making. The aim for sustainable public health monitoring is also supported by a Eurostat regulation on public health statistics requiring that health statistics shall be provided according to the ECHI methodology. Further efforts at DG SANCO and Eurostat are needed towards a permanent health monitoring system.
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http://dx.doi.org/10.1186/0778-7367-71-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682857PMC
May 2014

Implementation of joint health indicators in Europe - Joint Action for ECHIM. Arpo Aromaa on behalf of the ECHIM core group.

Authors:
Arpo Aromaa

Arch Public Health 2012 Oct 8;70(1):22. Epub 2012 Oct 8.

Arpo Aromaa, National Institute for Health and Welfare, Helsinki, Finland.

The story of the implementation of the joint EU health indicators (ECHI indicators) began in the 1990s after the Amsterdam Treaty. The first concrete step in establishing a health monitoring capacity for EU was the Commission working group set up in 1997. Several consecutive and parallel projects, notably the health indicator projects ECHI-1 and ECHI-2 between the years 2000 and 2005 led to a preparedness to implement the jointly agreed health indicators (ECHI shortlist) in all European countries. ECHIM (2005 - 2008) and the Joint Action for ECHIM (2009 - ) laid the foundation for the implementation of health indicators, and initiated Europe wide implementation proper. After the European recession of 2008 the circumstances in different countries were not optimal. Also the collaboration with the Commission could have been better. Nevertheless, the implementation process of the ECHI indicators is now well underway in most countries. By June 2012 half of the Member States had incorporated the ECHI indicators into their national health information system, and, if work can continue, by 2014 most countries are likely to have done so. Unfortunately, a gap may occur between the current programme and the next public health programme. The current momentum must not be lost. Therefore, all those responsible need to urge that the Commission (DG SANCO) together with the Member States helps to bridge the gap from June 2012 to January 2014. The new Public Health Programme provides the necessary financial instruments for setting up a permanent EU health information and reporting system.
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http://dx.doi.org/10.1186/0778-7367-70-22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523025PMC
October 2012

Work-related exhaustion and telomere length: a population-based study.

PLoS One 2012 11;7(7):e40186. Epub 2012 Jul 11.

Work Organizations, Finnish Institute of Occupational Health, Helsinki, Finland.

Background: Psychological stress is suggested to accelerate the rate of biological aging. We investigated whether work-related exhaustion, an indicator of prolonged work stress, is associated with accelerated biological aging, as indicated by shorter leukocyte telomeres, that is, the DNA-protein complexes that cap chromosomal ends in cells.

Methods: We used data from a representative sample of the Finnish working-age population, the Health 2000 Study. Our sample consisted of 2911 men and women aged 30-64. Work-related exhaustion was assessed using the Maslach Burnout Inventory--General Survey. We determined relative leukocyte telomere length using a quantitative real-time polymerase chain reaction (PCR) -based method.

Results: After adjustment for age and sex, individuals with severe exhaustion had leukocyte telomeres on average 0.043 relative units shorter (standard error of the mean 0.016) than those with no exhaustion (p = 0.009). The association between exhaustion and relative telomere length remained significant after additional adjustment for marital and socioeconomic status, smoking, body mass index, and morbidities (adjusted difference 0.044 relative units, standard error of the mean 0.017, p = 0.008).

Conclusions: These data suggest that work-related exhaustion is related to the acceleration of the rate of biological aging. This hypothesis awaits confirmation in a prospective study measuring changes in relative telomere length over time.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0040186PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394788PMC
March 2013

Health indicators in Europe: availability and data needs.

Eur J Public Health 2012 Oct 31;22(5):716-21. Epub 2012 Jan 31.

National Institute for Health and Welfare THL, Department of Health, Functional Capacity and Welfare, PO Box 30, FI-00271 Helsinki, Finland.

Background: The European Union (EU) lacks adequate capacity for public health monitoring. The creation of a stable European Health Information System would help Member States to carry out evidence-based health policy. Such a system would also benefit EU health priorities by providing European wide comparable information. This study is the first comprehensive assessment of the availability of general health data in Europe.

Methods: The main aim was to assess the availability of the European Community Health Indicators (ECHI) in each EU Member State. This was done by means of a review of international health databases, an online survey and face-to-face discussions with experts in 31 European countries.

Results: The European average availability score for all ECHI indicators was 74% ranging from 56% to 84%. In most countries, about half of the ECHI indicators can be derived from routinely collected health information. This is true for demographic information, mortality and hospital discharge-based morbidity. However, many important ECHI indicators are lacking in most European countries. These include population representative data for health determinants, the provision and use of health care services, injuries, the quality of health care and health promotion.

Conclusion: Valid health information is essential for improving people's health across Europe. There is an urgent need to develop harmonized methods for gathering and disseminating representative health data. These methods should be developed jointly by DG Health and Consumers, Eurostat and EU Member States.
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http://dx.doi.org/10.1093/eurpub/ckr195DOI Listing
October 2012

Burnout and behavior-related health risk factors: results from the population-based Finnish Health 2000 study.

J Occup Environ Med 2012 Jan;54(1):17-22

Work Organizations, Finnish Institute of Occupational Health, Helsinki, Finland.

Objective: To explore the relationship between burnout and behavior-related health risk factors.

Methods: We collected data from a population-based sample (n = 3264) through interviews, questionnaires, and health examinations. Burnout was assessed using the Maslach Burnout Inventory-General Survey. Smoking, alcohol consumption, and leisure-time physical activity were self-reported. Obesity was based on measurements at screening.

Results: Burnout and exhaustion were associated with a higher likelihood of risk factors. More specifically, burnout syndrome was related to low physical activity and obesity, exhaustion dimension to low physical activity and heavy drinking, cynicism dimension to low physical activity, and diminished professional efficacy to low physical activity, obesity, and lower likelihood of heavy drinking.

Conclusions: Improving working conditions and psychoeducation on recommended ways of coping and recovery could help to prevent negative health consequences of chronic work stress.
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http://dx.doi.org/10.1097/JOM.0b013e31823ea9d9DOI Listing
January 2012

Psychomotor speed in a random sample of 7,979 subjects aged 30 years and over.

Aging Clin Exp Res 2011 Apr;23(2):135-44

GeroCenter Foundation for Research and Development, and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.

Background And Aims: Slowing of psychomotor speed among older individuals has been shown in numerous studies. However, in most cases these studies were based on small and selected groups of people and, in some cases, the test procedures did not allow separation of decision time and motor components of the overall performance. The purpose of the present study was to analyse in a large, randomly selected population sample the differences in decision and movement times in simple and multiple-choice test conditions. The association of educational background with psychomotor speed was also examined.

Methods: Data on psychomotor speed were collected from a representative nation- wide sample of the Finnish population aged 30 years and over (n=7979) with the help of a computerized device in simple and multiple-choice test conditions, with visual stimuli. Background information (education) was collected by a structured interview.

Results: Results showed a systematic and significant decline in both decision time and movement time when proceeding from the youngest (30-39-year-olds) to the oldest (80+ yrs) age groups. This decline was more pronounced in the multiple-choice test than in the simple test. In both test conditions, movement times were shorter in men than in women. In the young and middle-aged groups, participants with longer formal education were faster than the less educated subjects.

Conclusions: On the basis of the large representative random sample of this study, it may be concluded that decline in psychomotor speed during aging can already be seen at a quite young age. Decline accelerates after the age of about 70. Differences in socio-economic background factors, such as education, may modify the differences observed between younger and older individuals. These results emphasize the need for the separation of decision time and movement time in psychomotor speed tests, when differences between age groups as well as between men and women are analysed.
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http://dx.doi.org/10.1007/BF03351077DOI Listing
April 2011
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