Hjelt Institute

Helsinki, Finland

Hjelt Institute

Helsinki, Finland

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Tuominen U.,Social Insurance Institution | Sintonen H.,Hjelt Institute | Aronen P.,Hjelt Institute | Hirvonen J.,University of Helsinki | And 4 more authors.
International Journal of Technology Assessment in Health Care | Year: 2013

In many Western countries, long waiting times for elective surgery are a concern. Major joint replacement is an example of a type of surgery with a high volume of demand and relatively long waiting periods for patients. As populations get older, the prevalence of slowly progressive diseases, such as osteoarthritis (OA) in hip and knee joints, is increasing. Over three-quarters of a million total hip and knee replacement surgeries are done in the United States annually (1). Furthermore, according to March et al. (1997), the costs of OA have been estimated to account for up to 1-2.5 percent of the Gross National Product (GNP) in several developed countries (2). In Finland, a total of 11,104 total joint replacements (TJRs) were performed in 2004 (hip 6,600 and knee 5,905), with the median waiting time of 181 days for the surgery (hip 153 and knee 209 days). Until 2007, the number of TJRs was 17,334 (hip 7,698 and knee 9,636), with a median waiting time of 120 and 142 days, respectively (3;4). The mean waiting time for elective surgical procedures is approximately 3 months in several countries and the maximum waiting times can stretch into years. Copyright © Cambridge University Press 2013.


Joutsenniemi K.,Finnish National Institute for Health and Welfare | Joutsenniemi K.,Hospital District of Helsinki and Uusimaa | Laaksonen M.A.,Finnish National Institute for Health and Welfare | Knekt P.,Finnish National Institute for Health and Welfare | And 4 more authors.
Journal of Affective Disorders | Year: 2012

Background: Socio-demographic factors predict the outcome of short-term psychotherapy (STT) in the treatment of mood and anxiety disorders, but information on the prediction for long long-term therapy (LPP) is lacking. We aimed to compare the prediction of changes in psychiatric symptoms afforded by socio-demographic factors across two treatment conditions, short- versus long-term psychotherapy. Methods: In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorders, aged 20-46 years, were randomly assigned to STT or LPP. Socio-demographic factors (i.e. age, gender, education, employment status, marital status, and living arrangement) were self-reported. Psychiatric symptoms were measured by the Symptom Check List, Global Severity Index (SCL-90-GSI) and Anxiety scale (SCL-90-Anx), and the Beck Depression Inventory (BDI) at baseline and seven times during a three-year follow-up period. Results: Socio-demographic factors were found to predict symptom development during follow-up irrespective of the baseline symptom level. Patients in a relatively good position, i.e. married and highly educated patients benefited from STT, whereas patients in less advantaged positions, i.e. homemakers, lone parents, and divorced patients needed LPP or did not benefit from either therapy. In several categories of socio-demographic factors, the extent to which a patient's background predicted the outcome of the psychotherapy varied according to whether general, anxiety or depressive symptoms were studied. Limitations: We were unable to assess widows and pensioners. For ethical reasons, a no-treatment control group with a long follow-up could not be included in the study design. Conclusions: Socio-demographic factors may need to be considered in the selection of patients for short- and long-term therapy. © 2012 Elsevier B.V.


Ngandu T.,Karolinska Institutet | Lehtisalo J.,Karolinska Institutet | Solomon A.,Karolinska Institutet | Solomon A.,Institute of Clinical Medicine Neurology | And 29 more authors.
The Lancet | Year: 2015

Background Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a proof-of-concept randomised controlled trial, we aimed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population. Methods In a double-blind randomised controlled trial we enrolled individuals aged 60-77 years recruited from previous national surveys. Inclusion criteria were CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age. We randomly assigned participants in a 1:1 ratio to a 2 year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice). Computer-generated allocation was done in blocks of four (two individuals randomly allocated to each group) at each site. Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation. The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery (NTB) Z score. Analysis was by modified intention to treat (all participants with at least one post-baseline observation). This trial is registered at ClinicalTrials.gov, number NCT01041989. Findings Between Sept 7, 2009, and Nov 24, 2011, we screened 2654 individuals and randomly assigned 1260 to the intervention group (n=631) or control group (n=629). 591 (94%) participants in the intervention group and 599 (95%) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis. Estimated mean change in NTB total Z score at 2 years was 0·20 (SE 0·02, SD 0·51) in the intervention group and 0·16 (0·01, 0·51) in the control group. Between-group difference in the change of NTB total score per year was 0·022 (95% CI 0·002-0·042, p=0·030). 153 (12%) individuals dropped out overall. Adverse events occurred in 46 (7%) participants in the intervention group compared with six (1%) participants in the control group; the most common adverse event was musculoskeletal pain (32 [5%] individuals for intervention vs no individuals for control). Interpretation Findings from this large, long-term, randomised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population. Funding Academy of Finland, La Carita Foundation, Alzheimer Association, Alzheimer's Research and Prevention Foundation, Juho Vainio Foundation, Novo Nordisk Foundation, Finnish Social Insurance Institution, Ministry of Education and Culture, Salama bint Hamdan Al Nahyan Foundation, Axa Research Fund, EVO funding for University Hospitals of Kuopio, Oulu, and Turku and for Seinäjoki Central Hospital and Oulu City Hospital, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and af Jochnick Foundation. © 2015 Elsevier Ltd.


Makinen T.E.,Finnish National Institute for Health and Welfare | Sippola R.,Finnish National Institute for Health and Welfare | Borodulin K.,Finnish National Institute for Health and Welfare | Rahkonen O.,Hjelt Institute | And 7 more authors.
Scandinavian Journal of Medicine and Science in Sports | Year: 2012

Although educational differences in leisure-time physical activity (LTPA) exist across Europe, the independent effect of educational level on leisure-time physical activity has rarely been explored. This study examines the relative contribution of occupational class, employment status, and educational level to LTPA across 12 European countries. The data were obtained from 12 European health surveys conducted at the turn of the century and identified in the EUROTHINE project. All information was self-reported. Logistic regression was applied and relative inequality index (RII) was calculated. Analyses were limited to those in the prime working-age (age 30-59; total N=137646) men and women. In all 12 European countries, LTPA was more common in the high-educated than in the low-educated. The association between education and LTPA remained mostly unchanged after adjusting for marital status, urbanization, and self-rated health. After further adjusting for occupational class and employment status, the educational differences in LTPA were only slightly attenuated. An inverse association was found between educational level and LTPA across almost all 12 European countries. Occupational class and employment status had only a modest effect on educational differences in LTPA in most of the examined countries, suggesting that education remains an important predictor of LTPA. © 2010 John Wiley & Sons A/S.


Alastalo H.,Finnish National Institute for Health and Welfare | Alastalo H.,Institute of Behavioural science | Raikkonen K.,Hjelt Institute | Pesonen A.-K.,Hjelt Institute | And 10 more authors.
Psychosomatic Medicine | Year: 2012

Objective: Early-life stress may influence health later in life. We examined morbidity and mortality from cardiovascular disease over 60 years in individuals separated temporarily from their parents in childhood due to World War II. Methods: We studied 12,915 members of the Helsinki Birth Cohort Study born from 1934 to 1944, of whom 1726 (13.4%) had been evacuated aboard without their parents to temporary foster families for an average of 1.8 (standard deviation = 1.1) years at an average age of 4.6 (standard deviation = 2.4) years. Data on parental separations were extracted from the Finnish National Archives. Information on use of medication for coronary heart disease and hypertension was derived from the National Register of Medication Reimbursement, and information on coronary events, stroke, and cardiovascular deaths was derived from Finnish Hospital Discharge Register and Causes of Death Register between Years 1971 and 2003. Results: Participants who were separated in childhood used medications for coronary heart disease more frequently than those who were not separated (7.2% versus 4.5%, respectively; hazard ratio [HR] = 1.29, 95% confidence interval [CI] = 1.04-1.59; p = .02). No associations between separation and all-cause mortality (HR = 1.04, 95% CI = 0.90-1.20) or cardiovascular mortality (HR = 0.94, 95% CI = 0.72-1.21) or hospitalizations for cardiovascular disease or stroke were observed. Conclusions: Early-life stress may possibly be a factor predisposing to coronary heart disease decades later, but no evidence was found for increased risk of hospitalizations or mortality. © 2012 by the American Psychosomatic Society.


Louhiala P.,University of Helsinki | Enkovaara H.,University of Helsinki | Halila H.,Hjelt Institute | Palve H.,Hjelt Institute | Vanska J.,Hjelt Institute
Journal of Medical Ethics | Year: 2015

Introduction Most physicians are against active euthanasia. Very little is known about the possible changes in the attitudes of physicians. Methods A questionnaire was sent to a random sample of 1003 Finnish physicians of working age. A similar questionnaire had been sent to a random sample of Finnish physicians also in 1993 and 2003. The questionnaire consisted of statements about euthanasia, for which the participants were asked to express their agreement or disagreement on a 5-point Likert scale. Results In general, Finnish physicians' attitudes towards active euthanasia have become considerably more positive. In 2003, 61% of the respondents were against the legalisation of euthanasia and 29% supported it. In 2013, both groups were of equal size (46%). The willingness to perform active euthanasia has not, however, increased significantly, even in a legalised setting. Conclusions The attitudes of Finnish physicians towards active euthanasia became considerably more positive between 2003 and 2013. There was no significant change, however, in the willingness topractice euthanasia if it became legal.


Lahti R.A.,Hjelt Institute | Sajantila A.,Hjelt Institute | Korpi H.,Statistics Finland | Poikolainen K.,Finnish Foundation for Alcohol Studies and Hjelt Institute | Vuori E.,Hjelt Institute
Forensic Science International | Year: 2011

In the present study we examined how consistently and completely the role of acute alcohol (ethanol) intake as a cause of death is reported on death certificates, how complete and specific the statistical recording of cause-of-death data on acute alcohol-induced deaths is, and how the information ultimately appears in the national mortality statistics.Data on all alcohol-positive deaths with blood alcohol concentration of ≥0.5‰ (g/kg) in Finland in 2005 (N= 2348) were reviewed.Overall, a concentration-dependent association was found between forensic-toxicologically determined blood alcohol concentrations and acute alcohol-specific cause-of-death diagnoses. Based on a medico-legal re-evaluation of death certificates, acute alcohol-specific causes were found to be underreported nationally at a rate of 8%. For accidental alcohol poisonings alone, the figure was about 1%. This underreporting was not corrected during recording of the cause-of-death data, though individual corrections and changes were observed. Especially, recording of multiple causes suffers from this underreporting of acute alcohol-specific causes.ICD-10 seems to do well in fulfilling the demands for a specific classification of uncomplicated alcohol poisoning. In combined alcohol-drug poisonings, however, ICD-10 shows a bias towards drugs over alcohol, even when alcohol has been specified and reported as the most toxic component by the medico-legal pathologist. Since the national statistics is based on the underlying causes, this state of affairs is likely to result in the underestimation of the role of acute alcohol intake as a cause of death. This observation of underreporting of acute alcohol-specific causes on death certificates should result in a harmonisation of education and principles and practices used in death certification. To increase the coverage and specificity of mortality statistics, based on the underlying causes of death, the coding of all components of alcohol-drug combinations and their classification according to the most important intoxicant or combination of intoxicants is recommended. © 2011 Elsevier Ireland Ltd.


King J.L.,University of North Texas Health Science Center | Larue B.L.,University of North Texas Health Science Center | Novroski N.M.,University of North Texas Health Science Center | Stoljarova M.,University of North Texas Health Science Center | And 10 more authors.
Forensic Science International: Genetics | Year: 2014

Mitochondrial DNA typing in forensic genetics has been performed traditionally using Sanger-type sequencing. Consequently sequencing of a relatively-large target such as the mitochondrial genome (mtGenome) is laborious and time consuming. Thus, sequencing typically focuses on the control region due to its high concentration of variation. Massively parallel sequencing (MPS) has become more accessible in recent years allowing for high-throughput processing of large target areas. In this study, Nextera® XT DNA Sample Preparation Kit and the Illumina MiSeq™ were utilized to generate quality whole genome mitochondrial haplotypes from 283 individuals in a both cost-effective and rapid manner. Results showed that haplotypes can be generated at a high depth of coverage with limited strand bias. The distribution of variants across the mitochondrial genome was described and demonstrated greater variation within the coding region than the non-coding region. Haplotype and haplogroup diversity were described with respect to whole mtGenome and HVI/HVII. An overall increase in haplotype or genetic diversity and random match probability, as well as better haplogroup assignment demonstrates that MPS of the mtGenome using the Illumina MiSeq system is a viable and reliable methodology. © 2014 Elsevier Ireland Ltd.


Mustelin L.,University of Helsinki | Mustelin L.,Hjelt Institute | Latvala A.,University of Helsinki | Latvala A.,Finnish National Institute for Health and Welfare | And 7 more authors.
Journal of Applied Physiology | Year: 2011

Mustelin L, Latvala A, Pietiläinen KH, Piirilä P, Sovijärvi AR, Kujala UM, Rissanen A, Kaprio J. Associations between sports participation, cardiorespiratory fitness, and adiposity in young adult twins. J Appl Physiol 110: 681-686, 2011. First published December 30, 2010; doi:10.1152/japplphysiol. 00753.2010.-Exercise behavior, cardiorespiratory fitness, and obesity are strongly influenced by genetic factors. By studying young adult twins, we examined to what extent these interrelated traits have shared genetic and environmental etiologies. We studied 304 twin individuals selected from the population- based FinnTwin16 study. Physical activity was assessed with the Baecke questionnaire, yielding three indexes: sport index, leisuretime index, and work index. In this study, we focused on sport index, which describes sports participation. Body composition was determined using dual-energy X-ray absorptiometry and cardiorespiratory fitness using a bicycle ergometer exercise test with gas exchange analysis. The Baecke sport index was associated with high maximal oxygen uptake adjusted for lean body mass (V O2max[adj]) (r = 0.40), with low body fat percentage (BF%) (r = -0.44) and low waist circumference (WC) (r = - f0.29). Heritability estimates for the key traits were as follows: 56% for sport index, 71% for V O2max[adj], 77% for body mass index, 66% for WC, and 68% for BF%. The association between sport index and V O2max was mostly explained by genetic factors (70%), as were both the association between sport index and BF% (71%) and that between sport index and WC (59%). Our results suggest that genetic factors explain a considerable part of the associations between sports participation, cardiorespiratory fitness, and obesity. © 2011 the American Physiological Society.


Hannus S.,Vantaa Social Welfare and Health Care | Kauppila T.,Vantaa Social Welfare and Health Care | Pitkaniemi J.,Hjelt Institute | Launonen K.,University of Helsinki
Folia Phoniatrica et Logopaedica | Year: 2013

Objective: To evaluate the ability of language tests to identify children with specific language impairment (SLI) in primary health care. All the language tests presently in clinical use in Finland were applied. Method: All the children with SLI living in one city in Finland constituted the cohort. Test scores were collected from 83 subjects drawn from a birth cohort of 4,553 children. Finally 31 case-control pairs were studied. All SLI diagnoses were set in secondary health care. Test scores of 14 language tests were examined that, together with subtests, included 39 different tasks. Results: Out of 39 performed tests, the difference in test scores between children with SLI and their matched controls was statistically significant in 26 tests. A group of six tests had good sensitivity and moderate specificity for SLI diagnosis and they correctly classified children with SLI to either F80.1 or F80.2 diagnosis category. Conclusion: The results suggest that most of the language tests in Finnish identify children with SLI and, furthermore, that these tests identify language deficits that are consistent with those found in other studies. More studies with larger age-matched populations are needed. Copyright © 2013 S. Karger AG, Basel.

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