National Institute for Health and Welfare
News Article | April 17, 2017
It's been claimed that Finland's baby boxes, given to every newborn in the country, help reduce cot deaths. But what evidence is there that they lower infant mortality rates, asks Elizabeth Cassin. In June 2013, the BBC News website published an article entitled Why Finnish babies sleep in cardboard boxes. It's been viewed over 13 million times and sparked global interest in the idea. The article explained Finland's 75-year-old policy of giving every pregnant mother a cardboard box filled with baby products, such as clothes, sleeping bag, nappies, bedding and a mattress, and how the box itself could be used as a bed. One reason it attracted such attention is that Finland has one of the lowest infant mortality rates in the world - two deaths per 1,000 live births, compared with a global rate of 32 in 1,000, according to the UN. Over the past three years, companies selling the boxes have popped up in the US, Finland and the UK. And they're incredibly popular not just with individuals but - more significantly - with governments. The promise of lower infant mortality rates is something to aim for. But if you stop and think about it for a minute, this is a bold claim. How does getting a baby to sleep in a box and a few baby items bring down infant mortality rates? In theory, the boxes offer a safe sleep space for babies. There are lots of reasons why babies die, from health problems to accidents. But there's one in particular that these boxes have been thought to help reduce - sudden infant death syndrome (Sids), also referred to as "cot death", is the unexpected and unexplained death of an apparently healthy baby. Although it's difficult to always understand what causes these deaths, there are environmental factors that increase the risk - including being around tobacco smoke, getting tangled in bedding, or sleeping alongside parents - especially if parents have been drinking. In the early 90s, many Western countries introduced Back to Sleep campaigns, when it was discovered that babies who sleep on their tummies are more vulnerable to Sids. This led to the last significant reduction in countries like the US and UK. "Since we had the dramatic decline of Sids in the 90s, we're now in a situation where the remaining Sids is much harder to try to alleviate," says Prof Helen Ball, director of the Parent-Infant Sleep Lab in the UK. "And so people are looking for new interventions, new changes to social care practices that might specifically help some of the more vulnerable families." Putting a baby in a box, and keeping the box near a parent, could prevent some of the hazardous scenarios. But it's important to understand that nearly all countries have seen a dramatic reduction in infant mortality over the last century. In 1900, about 15% of babies in Europe would have died in their first year. Now it's less than 0.4%. And Finnish academics and health professionals have been keen to point out that there is some misunderstanding about the box scheme. To understand how policy changed in Finland, we need to go back to 1938. Although infant mortality rates had been falling across Europe, Finland's rate was higher than their Nordic neighbours. The government decided to offer baby boxes to low-income women. But the women didn't just get a box. The boxes were introduced "at the same time that the pre-natal care was started", says Prof Mika Gissler, a statistician at the National Institute for Health and Welfare in Finland. Women had to attend clinics early on in their pregnancy to qualify for the maternity package. Their health could then be monitored throughout and after the pregnancy. Legislation in 1944 made it a legal obligation for municipalities to provide maternity and child health clinics. That year, only 31% of pregnant mothers had received prenatal care. The figure jumped to 86% the following year. In 1949, the care package, including the baby boxes, was offered to all women. "Then there was a big change from home birth to hospital birth," says Gissler. "We had the national health insurance system introduced very late in the 60s." One of Gissler's colleagues, Prof Tuovi Hakulinen, says that to her knowledge, there is no direct link between the baby box and infant mortality rates. And that if you look at the decline in infant mortality, the thing that's driving it more than anything else is a combination of advancement in medicine, vaccinations, nutrition, hygiene and increased prosperity. Finland has reliable Sids data for the past three decades - and the rate is low. But the significant reduction in deaths has been in congenital anomalies and other diseases. And yet one of the leading baby box companies sells its products as an essential gift for new parents, claiming studies have proven the link. I asked the company if I could see these studies, but they said that studies showing positive results had not been published yet. Experts say that there are no studies showing the efficacy of baby boxes. Countries across the world have been trialling variations on the Finnish box, including Canada, Ireland, and Scotland - with many tying in additional education for parents. And while looking at the possibilities the baby box is interesting, there are bigger factors at play. One country where the baby box idea has received a lot of attention is the United States - because they are struggling with poor infant mortality rates - six per 1,000 births, which makes them comparable to Poland and Hungary, below the level you'd expect based on their income. Prof Emily Oster, an economist at Brown University, compared data from the US with various European countries, primarily Finland and Austria. She says the US does fairly well in the first month of life - but from a month to a year, "you can see the mortality rate in the US kind of accelerating away from the other countries in that period". When looking at women with a college degree - a marker for relatively high income - infant mortality rates were low and similar to the same groups in Finland and Austria. "What we see is that well-off women in Finland, well off women in the US, are very, very similar," she says. "The difference is well-off women in Finland and less-educated women in Finland have very similar infant mortality profiles. Whereas that is not true in the US." But it's not clear from their research what specifically causes these deaths - because there are many things which make the US different, such as their health system. Also, most countries in Europe have a pretty robust home visiting programme after birth. That's not something that has uniformly been true in the US. "What often comes along with the boxes is some additional contact with somebody," says Oster. "It may be the healthcare assistant, a nurse, a social worker. "The box alone doesn't seem likely to matter." The baby boxes are hugely popular in Finland, but they are emblematic of a wider health care system. Governments and individuals should not see the box as solely effective, without improving care and education for parents also. After all, there are countries with the same infant mortality rate as Finland, such as Iceland, Estonia and Japan, that do not have baby box schemes. Join the conversation - find us on Facebook, Instagram, Snapchat and Twitter
PubMed | University of Tampere, GSK, National Institute for Health and Welfare and GSK Vaccines
Type: Journal Article | Journal: Journal of the Pediatric Infectious Diseases Society | Year: 2016
After administering the 10-valent pneumococcal polysaccharide nontypeable Haemophilus influenzae protein D-conjugated vaccine (PHiD-CV) to children aged 2-18 months, we observed a reduction in vaccine-type nasopharyngeal carriage, resulting in a reduction of overall pneumococcal nasopharyngeal carriage, which may be important for indirect vaccine effects. We noted a trend toward reduction of acute otitis media.This trial (ClinicalTrials.gov identifier NCT00839254), nested within a cluster-randomized double-blind invasive pneumococcal disease effectiveness study in Finland (ClinicalTrials.gov identifier NCT00861380), assessed the effectiveness of the 10-valent pneumococcal polysaccharide nontypeable Haemophilus influenzae protein D-conjugated vaccine (PHiD-CV or PCV10) against bacterial nasopharyngeal carriage and acute otitis media (AOM).Infants (aged 6 weeks to 6 months) received the PHiD-CV or a control vaccine (hepatitis B) (schedule 3+1 or 2+1). Nasopharyngeal swabs were collected at 4 time points post-vaccination from all of the infants and at pre-vaccination from a subset. Parent-reported physician-diagnosed AOM was assessed from first vaccination until last contact (mean follow-up, 18 months). Vaccine effectiveness (VE) was derived as (1 - relative risk)*100, accounting for cluster design in AOM analysis. Significant VE was assessed descriptively (positive lower limit of the non-adjusted 95% confidence interval [CI]).The vaccinated cohort included 5093 infants for carriage assessment and 4117 infants for AOM assessment. Both schedules decreased vaccine-serotype carriage, with a trend toward a lesser effect from the 2+1 schedule ( VE across timpoints 19%-56% [3+1] and 1%-38% [2+1]). Trends toward reduced pneumococcal carriage (predominantly vaccine serotypes 6B, 14, 19F, and 23F), decreased carriage of vaccine-related serotype 19A, and small increases at later time points (ages 14-15 months) in non-vaccine-serotype carriage were observed. No effects on nontypeable Haemophilus influenzae, Staphylococcus aureus, or Moraxella catarrhalis carriage were observed. There were non-significant trends toward a reduction in the number of infants reporting AOM episodes (VE 3+1: 6.1% [95% CI, -2.7% to 14.1%] and 2+1: 7.4% [-2.8% to 16.6%]) and all AOM episodes (VE 3+1: 2.8% [-9.5% to 13.9%] and 2+1: 10.2% [-4.1% to 22.9%]). PHiD-CV was immunogenic and had an acceptable safety profile.We observed reduced vaccine-type pneumococcal carriage, a limited increase in non-vaccine-type carriage, and a trend toward AOM reduction.
Levola J.,National Institute for Health and Welfare |
Holopainen A.,Jarvenpaa Addiction Hospital |
Aalto M.,National Institute for Health and Welfare
Addictive Behaviors | Year: 2011
The purpose of this study was to assess the association between depression and heavy drinking occasions in the Finnish general population. A subsample (2086/4020, response rate 51.9%) of the National FINRISK 2007 Study was used. Depression was assessed with a modified Beck Depression Inventory (short form) and alcohol problems with the Alcohol Use Disorders Identification Test. Total alcohol intake and number of heavy drinking occasions (≥ 7 drinks for men, ≥ 5 drinks for women) were evaluated using the Timeline Followback. Of the sample, 13.0% (123/946) of men and 17.4% (198/1140) of women were classified as being depressed. Further, 7.5% (71/946) of men and 3.5% (40/1140) of women reported having at least four heavy drinking occasions in the previous 28. days. In an adjusted logistic regression model, these men had a 2.6-fold risk (95% C.I. 1.2-5.3) of depression, as compared to men with less than four heavy drinking occasions. The association was found irrespective of total alcohol consumption and alcohol problems. This association was not found in women. © 2010 Elsevier Ltd.
News Article | February 23, 2017
New Study First to Link Internal Clock to What and When People Eat SILVER SPRING, MD--(Marketwired - February 23, 2017) - Benjamin Franklin famously extolled the virtues of early risers saying, "early to bed, early to rise, makes a man healthy, wealthy and wise" -- and a new study out today adds scientific data to the claim that morning people may in fact be healthier. By comparing "morning type" people with "evening type" people, researchers found that morning people ate more balanced foods overall and ate earlier in the day. Published in Obesity, the scientific journal of The Obesity Society (TOS), this is the first study of its kind to examine what and when people with different internal time clocks eat, including macronutrients like carbohydrates, protein and fat. "Early birds may have an extra advantage over night owls when it comes to fighting obesity as they are instinctively choosing to eat healthier foods earlier in the day," said TOS spokesperson Courtney Peterson, PhD, of the University of Alabama at Birmingham. "Previous studies have shown that eating earlier in the day may help with weight loss and lower the risk of developing diabetes and heart disease. What this new study shows is that our biological clocks not only affect our metabolism but also what we choose to eat." Researchers looked at data from nearly 2,000 randomly chosen people to determine if their circadian or biological clock rhythm (chronotype) affected what they ate and at what time. Clear differences in both energy and macronutrients between the two chronotypes abound, with morning people making healthier choices throughout the day. Evening types ate less protein overall and ate more sucrose, a type of sugar, in the morning. In the evening, they ate more sucrose, fat and saturated fatty acids. On weekends, the differences between the morning and evening type people was even more pronounced, with evening types having more irregular meal times and twice as many eating occasions. The evening types also slept worse and were less physically active overall. "Linking what and when people eat to their biological clock type provides a fresh perspective on why certain people are more likely to make unhealthy food decisions," said Mirkka Maukonen, who led the study out of the National Institute for Health and Welfare at the Department of Public Health Solutions in Helsinki, Finland, using data from the national FINRISK 2007 study. "This study shows that evening type people have less favorable eating habits, which may put them at a higher risk for obesity, diabetes and heart disease." For people working to lose weight, this new research may provide a compelling window into why they choose to make certain food choices throughout the day, say researchers. "Clinicians can help steer people to healthier options -- and suggest the optimal time to eat these foods -- based on what we now know about our biological clocks," said Dr. Peterson. This press release can be published in full or in part with attribution to The Obesity Society. The Obesity Society (TOS) is the leading professional society dedicated to better understanding, preventing and treating obesity. Through research, education and advocacy, TOS is committed to improving the lives of those affected by the disease. For more information visit: www.Obesity.org. Connect with us on social media Facebook, Twitter and LinkedIn. Find information about industry relationships here.
Jarvelin J.,National Institute for Health and Welfare
Journal of Patient Safety | Year: 2016
OBJECTIVES: If patients experience health care–related adverse events, they may claim for compensation. Adverse events of claimants are generally more severe and presumably involve higher health care costs than those of nonclaimants. The aim of this study was to estimate the cost differential between claimants and nonclaimants in the no-fault system in Finland. METHODS: We compiled register data on patients having had coronary artery bypass grafting (CABG, n = 20,500), total hip arthroplasty (n = 17,506), or knee arthroplasty (TKA, n = 18,512) and calculated risk-adjusted cost differentials by using a gamma distributed, log-linked generalized linear model. The explained variable comprised costs, whereas the main explanatory variables were whether the patient filed a claim and whether he or she received compensation. RESULTS: Uncompensated claimants had higher admission costs (CABG, &OV0556;3660, 29%; total hip arthroplasty, &OV0556;418, 5%; TKA, &OV0556;359, 4%) compared with nonclaimants, whereas the differential between compensated claimants and uncompensated claimants was statistically insignificant. Significant associations emerged concerning CABG 1-year costs: uncompensated claimants had &OV0556;12,990 (71%) higher costs than nonclaimants, whereas compensated claimants had &OV0556;6388 (20%) higher costs than uncompensated claimants. CONCLUSIONS: Although the precise cost differentials may be specific to Finland, the implications may apply also to other countries. (1) Excess costs of claimants should motivate efforts to reduce adverse events. (2) Analyses of claims to improve patient safety should not be restricted to compensated claims only but should equally concern uncompensated claims. A further implication regarding Finland is that additional approaches to identify and report adverse events are necessary. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved
Aromaa A.,National Institute for Health and Welfare |
Haverinen-Shaughnessy U.,National Institute for Health and Welfare
10th International Conference on Healthy Buildings 2012 | Year: 2012
The aim of the study was to assess the business potential related to energy efficiency of buildings for Finnish companies or companies operating in Finland. A literature review on the topic was performed and thirteen experts from companies of different sizes, operating in different business fields related to buildings, were interviewed. More specifically, the business fields were construction, real estate, building products, and services. The semistructured interviews were conducted mainly in Eastern Finland. Business potential was expected to arise from specialization of companies, increased specialized design and computational work, increased awareness among customers, increased level of automation in buildings, and increased supply of services to customers. In general, companies expected that Heating, Ventilation and Air Conditioning (HVAC) technology brings the most benefits to business through promoting energy efficiency. Real estate owners and landlords estimated that the business potential related to energy efficiency of buildings will be focused in tenements and not in housing association owned (private) buildings. Many of the companies felt that international market was a major possibility. Russia, Eastern- and Northern-Europe were thought to be the areas with the most potential for export.
Karki J.,National Institute for Health and Welfare |
Ailio E.,National Institute for Health and Welfare
Studies in Health Technology and Informatics | Year: 2014
A client data model for social welfare was gradually developed in the National Project of IT in Social Services in Finland. The client data model describes the nationally uniformed data structures and relationships between the data elements needed in production of social services. It contains the structures of social care client records, unique core components and distinct classifications. The modeling method guaranteed the coverage, integrity, flexibility and device independency of the model. The model is maintained and developed by the National Institute for Health and Welfare (THL) together with the social workers and other experts of social welfare. It forms the basis of the electronic information management of the social services. Implementation of the data model in information systems enables the availability of the client data where and when ever a client has to be helped. © 2014 European Federation for Medical Informatics and IOS Press.
PubMed | McGill University, National Institute for Health and Welfare, Epidemiology Research Program and National Cancer Institute
Type: | Journal: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology | Year: 2017
Studies examining associations between circulating concentrations of C-peptide and total adiponectin, two biomarkers related to obesity and insulin secretion and sensitivity and pancreatic ductal adenocarcinoma (PDA) risk have shown inconsistent results and included limited numbers of smokers.We examined associations of these biomarkers and high molecular weight (HMW) adiponectin with PDA, overall, and by smoking status. We conducted a pooled nested case-control analysis in 3 cohorts (Prostate, Lung, Colorectal, and Ovarian Cancer Trial, Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, and Cancer Prevention Study-II), with 758 cases (435 current smokers) and 1052 controls (531 smokers) matched by cohort, age, sex, race, blood draw date and follow-up time. We used conditional logistic regression adjusted for age, smoking, diabetes, and body mass index to calculate odds ratios (OR) and 95% confidence intervals (CI).Circulating C-peptide concentration was not associated with PDA in never or former smokers, but was inversely associated with PDA in current smokers (per standard deviation OR=0.67, 95% CI 0.54, 0.84, p-interaction=0.005). HMW adiponectin was inversely associated with PDA in never smokers (OR=0.43, 95% CI 0.23, 0.81), not associated in former smokers, and positively associated in smokers (OR=1.23, 95% CI 1.04, 1.45, p-interaction=0.009). Total adiponectin was not associated with PDA in nonsmokers or current smokers.Associations of biomarkers of insulin secretion and sensitivity with PDA differ by smoking status. Smoking-induced pancreatic damage may explain the associations in smokers while mechanisms related to insulin resistance associations in non-smokers.Future studies of these biomarkers and PDA should examine results by smoking status.
News Article | November 4, 2016
Some people adapt easily to shift work, but not everyone can handle constant disruptions to their daily rhythm. Finnish researchers have now found that a melatonin receptor gene influences tolerance to shift work. Published in the journal Sleep, the new study is the first time the genetic factors underlying poor tolerance to shift work were systematically examined. Covering the entire genome, the study discovered that a common variation in the melatonin receptor 1A (MTNR1A) gene is linked to the job-related exhaustion experienced by shift workers. Shift work often disrupts the circadian rhythm, which can lead to sleep disorders and daytime fatigue. The study was led by Professor Tiina Paunio, University of Helsinki, and involved Finnish shift workers from many different lines of work. The differences in the job-related exhaustion reported by employees were contrasted with genetic differences in their entire genome. The link to the melatonin receptor gene was discovered in a group of 176 shift workers included in the national Health 2000 survey. The connection was also found in a group of 577 shift workers covering rest of the shift workers from the Health 2000 survey as well as shift workers in care work and aviation. The study also established that the risk variation of the melatonin receptor 1A (MTNR1A) gene is probably related to the methylation of DNA in the regulatory sequence of the MTNR1A gene as well as the weaker expression of the MTNR1A gene. The methylation of DNA is one of the epigenetic mechanisms regulating the functioning of the genome, influenced by not only by variations in DNA sequence, but also environmental factors such as fluctuations in the circadian rhythm. As it results in a smaller number of melatonin receptors, the risk variant of the gene can cause weaker natural melatonin signalling, one of the regulatory mechanisms in stabilising the circadian rhythm. The influence of the risk variant of the MTNR1A gene may explain the degree to which light exposure at night disrupts the circadian rhythm of shift workers. "The variant we have now discovered can only explain a small part of the variation between individuals, and it cannot be used as a basis to determine a person's tolerance to shift work," Paunio points out. The study was conducted at the National Institute for Health and Welfare (THL) in cooperation with the University of Helsinki, the Finnish Institute of Occupational Health as well as the occupational health care provider for Finnair.
News Article | February 7, 2017
Published in the American Journal of Epidemiology, the study showed that the candy and the natural sweetener it contains, glycyrrhizin, can lead to long-term harmful effects on fetal development. The results support Finnish food recommendations for families with children, with pregnant women being advised to avoid eating large quantities of licorice although a safe consumption limit was not established. The study was carried out by the Helsinki and Uusimaa hospital districts, Finland's National Institute for Health and Welfare, and the University of Helsinki. It involved 378 children, each about 13 years of age. Their mothers consumed licorice while carrying them to term, either eating little to no licorice or large quantities of the candy during their pregnancy. Katri Räikkönen and colleagues defined "little to no" as no more than 249mg glycyrrhizin a week while "large quantities" was established as over 500mg of the natural sweetener. Consuming 500mg of glycyrrhizin is equivalent to eating 250g of licorice on average. The researchers discovered that youths exposed to large quantities of licorice while they were in the womb performed poorly in cognitive reasoning tests administered by a psychologist compared to those who were exposed to safer levels of the candy while developing as fetuses. According to their findings, the researchers saw a difference in IQ levels by about 7 points. Additionally, study subjects who were exposed to high levels of licorice did worse in tasks designed to measure memory capacity and, based on estimates provided by parents, had more ADHD-type of problems. Girls from the group also experienced puberty earlier. Animal models made it possible to understand the biological mechanism behind how licorice affects pregnant women. For starters, glycyrrhizin increases the effects of cortisol by inhibiting an enzyme responsible for deactivating the stress hormone. Cortisol plays a role in fetal development but only in appropriate levels. In large amounts, the hormone becomes detrimental instead. Glycyrrhizin also elevates blood pressure, which can lead to pregnancy complications, although it has been shown as well to be a direct cause of shorter pregnancies. According to the researchers, it is important that those pregnant and women planning on getting pregnant should be notified of the harmful effects of licorice and other products containing glycyrrhizin on a developing fetus. In Finland, food recommendations from the country's National Institute for Health and Welfare already reflect this, what with licorice falling under the "not recommended" category for pregnant women. However, the researchers also noted that occasionally consuming the sweet, such as a few portions or as added to ice cream, should not be a cause for concern, highlighting the importance of proportion. The Finns are a step ahead with food recommendations for licorice because a large number of Finland's population have been exposed to the candy's natural sweetener in the womb. Glycyrrhizin has been established to be one of the many possible factors that can affect fetal development but the researchers can't say for a fact that the licorice ingredient is the cause of a developmental issue in a particular individual. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.