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Suominen M.H.,University of Helsinki | Jyvakorpi S.K.,University of Helsinki | Pitkala K.H.,University of Helsinki | Finne-Soveri H.,Finnish National Institute for Health and Welfare | And 3 more authors.
Journal of Nutrition, Health and Aging | Year: 2014

Background: Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people’s health, functional capacity and quality of life.Objective: To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland.Design: A review of the existing literature on older people’s nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland.Results: The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4.The use of a vitamin D supplement (20 μg per day) recommended. 5.The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted.Conclusions: Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population. © 2014, Serdi and Springer-Verlag France.


Koskenvuo K.,University of Helsinki | Koskenvuo K.,The Social Insurance Institution | Hublin C.,Finnish Institute of Occupational Health | Partinen M.,Rinnekoti Foundation | And 2 more authors.
Sleep Medicine | Year: 2010

Objective: To find out if childhood adversities predict poor sleep quality in working age. Methods: Survey data from the Health and Social Support (HeSSup) study was used (N = 25,605, 59% women). Negative childhood adversities and quality of sleep in adulthood were assessed by the questionnaire in 1998. Multinomial regression models were used. Results: A graded association between childhood adversities and the quality of sleep in adulthood was found. Odds ratio (OR) of poor quality of sleep for those with multiple childhood adversities (3-6) was 3.64 (95% CI 2.94-4.50). The association between childhood adversities and the quality of sleep remained significant after adjustments for work status, use of psychotropic drugs, health behaviours, recent life events and child-parent relationships. Poor quality of sleep was clearly increased among those with both poor child-mother (OR 10.4, 95% CI 6.73-16.07) or poor child-father (OR 5.4, 95% CI 3.89-7.50) relationships and multiple childhood adversities. In the analyses of specific childhood adversities, frequent fear of a family member and serious conflicts in the family showed the strongest associations. Conclusions: The strong association between childhood adversities and the quality of sleep in adulthood highlights the importance of early life circumstances on adult health. Early stage recognition, prevention and supportive measures against childhood adversities and serious family conflicts should be promoted. © 2009.


Jaakkola J.,University of Turku | Hakala P.,The Social Insurance Institution | Isolauri E.,University of Turku | Poussa T.,Nokia Inc. | Laitinen K.,University of Turku
Nutrition | Year: 2013

Objective: The aim of this study was to explore whether type of eating behavior is related to diet and overweight in women after childbirth. Methods: In a prospective mother-infant study, women's (N = 189) eating behavior, dietary intake from food diaries, weight, and waist circumference (WC) were measured at 6, 12, 24, and 48 mo after giving birth. Three aspects of eating behavior were measured by the validated Three Factor Eating Questionnaire-18: cognitive restraint (CR; restricting of eating without associated hunger or fullness), emotional eating (EE; overeating due to negative feelings), and uncontrolled eating (UE; overeating irrespective of physiologic need). Results: High scores in CR associated with the lowest tertile of fat intake (% of energy [E%], P = 0.045). High UE scores associated with the highest tertiles of intakes of energy (kcal; P < 0.001), fiber (g; P < 0.001) and sucrose (E%; P < 0.001). High EE scores (P = 0.003) linked with overweight (body mass index ≥ 25 kg/m2), whereas UE (P < 0.001) linked with central obesity (WC ≥ 80 cm). Conclusions: We demonstrated that certain types of eating behavior related to both energy-dense diet and weight and central adiposity. We propose that measuring eating behavior by the simple questionnaire could be a helpful tool in dietary counseling that aids in identifying women who are likely at risk for unhealthy dietary patterns and for developing overweight. © 2013 Elsevier Inc.


Autti-Ramo I.,The Social Insurance Institution | Sourander A.,University of Turku | Seppanen J.,Finnish Institute of Occupational Health | Martikainen J.E.,The Social Insurance Institution
European Journal of Psychiatry | Year: 2011

Background and Objectives: The use of antidepressants has increased in many Western countries among children, adolescents and young adults. The objective of this study was to analyse changes in incidence and prevalence of antidepressant use among patients aged 0 to 26 years from year 1997 to 2007. Methods: This is an observational population-based drug utilization study using a nationwide prescription register including data on reimbursed purchases of antidepressants for outpatient use. Results: The incidence and prevalence of antidepressant use increased about three fold during the study period. Among children less than 14 years of age both incidence and prevalence were low during the study period. In the age group 14-26 years, the incidence increased from 6.4 to 16.1 (per 1000 person-years) among men and from 9.7 to 28.3 among women, while the prevalence went up from 10.4 to 30.4 among men and from 15.5 to 56.8 among women. By the age of 26 years, 11.6% of men and 17.8% of women had purchased antidepressants at least once. The first antidepressant prescriptions were mainly prescribed by a specialist for children aged 7 to 15 years and by a non-specialist for the older age groups. Conclusions: Use of antidepressants has increased remarkably among adolescents and young adults during recent years. Further studies are warranted to analyse whether the increase in use is due to an increase in depression incidence, a lower threshold of prescribing medications or a lack of psychosocial treatment resources.


Rikala M.,University of Eastern Finland | Hartikainen S.,University of Eastern Finland | Hartikainen S.,Leppavirta Health Center | Saastamoinen L.K.,The Social Insurance Institution | Korhonen M.J.,University of Turku
International Journal of Methods in Psychiatric Research | Year: 2013

Pharmacoepidemiological studies provide valuable information on the relationships between psychotropic drug use and adverse outcomes in older people. To minimize the influence of misclassification bias in pharmacoepidemiological studies, more emphasis should be given to methodological aspects of exposure assessment. This study evaluated the validity of a dosage assumption of one unit per day for measuring legend duration of psychotropic drug exposures among older people. Using data from the Finnish Prescription Register, the study analysed 62,320 psychotropic drug prescriptions dispensed for people aged≥75 years (n = 52,729) in September 2009. The proportions of prescriptions in which the prescribed dose deviated from one unit per day were assessed for categories and subcategories of psychotropic drugs. The prescription was considered misclassified (a) if the prescribed drug was intended for "as needed" use, (b) if the prescription included a dose range, or (c) if the prescribed dose was below or above one unit per day. Among antidepressants, less than every fourth (23.7%) prescription was misclassified. The proportions of misclassification varied substantially across subcategories, being 13.1% for selective serotonin reuptake inhibitors (SSRIs), 25.3% for other antidepressants and 53.8% for tricyclic antidepressants. Of the benzodiazepine and antipsychotic prescriptions, 79.9% and 57.6%, respectively, were misclassified. In conclusion, the dosage assumption of one unit per day is valid for measuring the legend duration of SSRI and other antidepressant exposures among older people. Among other psychotropic drugs, the dosage assumption is likely to lead to severe exposure misclassification. © 2013 John Wiley & Sons, Ltd.


PubMed | The Social Insurance Institution, Karolinska Institutet, Reykjavik University, University of Southern Denmark and Norwegian Institute of Public Health
Type: Journal Article | Journal: European journal of clinical pharmacology | Year: 2016

The use of ADHD drugs among adults is controversial and has until recently not been approved for use in adults in most countries. The aim was to investigate use of ADHD drugs (stimulants and atomoxetine) among the entire adult population in the Nordic countries.We conducted a multinational population-based prescription register study based on the entire adult population in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). All users of ADHD drugs aged 18-64years during 2008-2012 were included, which for 2012 comprised 76,896 drug users among 15.8 million adult inhabitants.Annual prevalence of drug use increased during the study period for both genders and all age groups. The overall prevalence increased from 2.4 to 5.3 per 1000 men and 1.8 to 4.4 per 1000 women. Incidence also increased, but to a lesser extent in the last part of the study period. Methylphenidate was used by 88% of drug users. Treatment was discontinued within the first year by 21% of new drug users. Among all users of ADHD drugs, 53% of men and 64% of women concurrently used other psychotropic drugs, most frequently antidepressants and hypnotics. Psychotropic co-medication increased with age and was more pronounced among women than men.Use of ADHD drug among adults more than doubled over a 5-year period, and a majority were concurrently treated with other psychotropics. Adults constitute a substantial proportion of persons treated with ADHD drugs. Thus, evidence for long-term efficacy and safety in adults is urgently needed.


Ilus T.,University of Tampere | Kaukinen K.,University of Tampere | Virta L.J.,The Social Insurance Institution | Pukkala E.,University of Tampere | Collin P.,University of Tampere
The American journal of gastroenterology | Year: 2014

The association between celiac disease and malignancies is well recognized. In Finland, the prevalence of clinically diagnosed adult celiac disease is 0.6%. In this large, population-based cohort, we aimed at a realistic projection of the cancer risk. In the period 2002-2011, the register comprised 32,439 adult celiac patients. This was linked with the Finnish Cancer Registry, which covers over 98% of diagnosed malignancies. The standardized incidence ratio (SIR) was calculated for the malignancies, on the basis of incidence figures for the whole population. A time-stratified analysis was made in celiac patients diagnosed after 2004 (n=11,991). Lifestyle factors, including smoking habits and obesity, were not obtainable. The overall incidence ratio of malignant diseases was not increased (SIR 0.94; 95% confidence intervals 0.89-0.98), but it was ≥5 years from the diagnosis of celiac disease (1.31, 1.04-1.63). The SIRs for non-Hodgkin lymphoma (NHL; 1.94; 1.62-2.29), small-intestinal cancer (4.29; 2.83-6.24), colon cancer (1.35; 1.13-1.58), and basal cell carcinoma of the skin (1.13; 1.03-1.22) were increased, whereas those for lung cancer (0.60; 0.48-0.74), pancreatic cancer (0.73; 0.53-0.97), bladder cancer (0.53; 0.35-0.77), renal cancer (0.72; 0.51-0.99), and breast cancer (0.70; 0.62-0.79) were decreased. SIR for NHL immediately after the diagnosis of celiac disease was 2.56 (1.37-4.38). There was no increased SIR of cancer in the whole series, but SIR was increased after 5 years from the diagnosis of celiac disease. The risk of breast and lung cancers was decreased. The risk of small-intestinal cancer and NHL was increased, but to a lesser extent than previously described.


Saastamoinen L.K.,The Social Insurance Institution | Verho J.,The Social Insurance Institution
Pharmacoepidemiology and Drug Safety | Year: 2015

Background: Excessive polypharmacy is often associated with inappropriate drug use. Because drug expenditures are heavily skewed and a considerable share of patients in the top 5% of the cost distribution have excessive polypharmacy, the appropriateness of their drug use should be reviewed. Objectives: The aim of this study was to review the quality of drug use in patients with extremely high costs and excessive polypharmacy and to compare them with all drug users. Research Design: This is a nationwide register study. Subjects: The subjects of this study were all drug users in Finland over 15years of age, n=3303813. Measures: The measures used were annual total costs, average costs, and number of patients. The background characteristics used included gender, age, morbidity, number of prescribers, active substances, and indicators of potentially inappropriate drug use, for example, Beers criteria. Results: The patients with high costs and excessive polypharmacy accounted for 22% of the total pharmaceutical expenditures but only 3% of drug users. One-third of them were elderly, compared with 11.3% of all drug users (p<0.001). Almost all of them, 93.6%, had chronic disease compared with 34.0% of all the drug users (p<0.001). The high-cost polypharmacy patients used more potentially inappropriate (28.0% vs 19.9%, p<0.001) and anticholinergic drugs (26.7% vs. 9.6%, p<0.001) and psychotropics more often simultaneously (20.4% vs. 3.8%, p<0.001) than all drug users. Conclusions: Excessive polypharmacy with inappropriate medication use should be prevented using all the methods. The patients with excessive polypharmacy and high-drug costs provide a most interesting group for containing pharmaceutical costs via medication reviews. Copyright © 2015 John Wiley & Sons, Ltd.


Jeglinsky I.,Arcada University of Applied Sciences | Jeglinsky I.,Karolinska Institutet | Autti-Ramo I.,The Social Insurance Institution | Brogren Carlberg E.,Karolinska Institutet
Child: Care, Health and Development | Year: 2012

Background In order to best meet the needs of both families and their children with cerebral palsy, many rehabilitation service providers have adopted a family-centred service (FCS) approach. In FCS parents are seen as experts on their child's needs, and the family and professionals collaborate in the rehabilitation process. However, parents and service providers might look at FCS from different points of view, i.e. look into the mirror from two different sides. The objective of this study was to explore the degree to which parents experience the service as being family-centred and to which extent the service providers experience their service provision as family-centred. Methods A translated version of The Measure of Processes of Care 20 (MPOC-20) questionnaire was used to evaluate parents' experience of FCS, and a Measures of Processes of Care for Service Providers (MPOC-SP) questionnaire was used to evaluate the FCS provided by professionals. Parents visiting two university hospital neuropediatric wards (n= 67) during a 2-month period and who were willing to participate received the questionnaire. Also the service providers working on the same wards (n= 49) were invited to participate. Results A total of 53 families and 29 service providers completed the questionnaires. Both parents and professionals generally rated the FCS positively. General information was rated lowest and respectful treatment the highest by both parents and professionals. The results revealed that written information about the child's condition, the possibility to choose when to receive information, and contact with other families in the same situation are areas in need of improvement. Conclusions The possibility to regularly evaluate services both from the families' and the professionals' perspectives should be part of quality development. Providing general information is a challenge for all service providers. The MPOC questionnaires can be used to highlight important areas of improvement in FCS. © 2011 Blackwell Publishing Ltd.


Jeglinsky I.,Arcada University of Applied Sciences | Jeglinsky I.,Karolinska Institutet | Autti-Ramo I.,The Social Insurance Institution | Brogren Carlberg E.,Karolinska Institutet | Brogren Carlberg E.,Astrid Lindgren Childrens Hospital
Child: Care, Health and Development | Year: 2012

Background Children with cerebral palsy have difficulties in several areas of functioning, and they need long-lasting rehabilitation with a clear focus on the individual's needs. Finnish guidelines emphasize family-centred service. The values of family-centred service are widely known, but how the principles of family-centred service are adopted in clinical practice is not well documented. The objective of this study was to analyse the family-centred behaviour of professionals working with children and adolescents with cerebral palsy. Methods A translated version of the Measure of Processes of Care for Service Providers (MPOC-SP) questionnaire was used to evaluate the family-centred service. The questionnaire was sent to all the professionals in the multidisciplinary rehabilitation teams at all the hospitals and governmental special schools treating children and adolescents with cerebral palsy in Finland (n= 327). Furthermore, 438 physiotherapy service providers working in the children's home region were invited to participate. Results A total of 201 multidisciplinary team members and 311 physiotherapy service providers completed the questionnaire. Both the team members and the service providers generally rated their family-centred behaviour positively. There was statistically significant difference in how the team members in the multidisciplinary teams self-assessed their family-centred service. Physiotherapists working in multidisciplinary teams rated their family-centred service higher than physiotherapy service providers. The professional's apprehension of family-centred service increased with work experience. Conclusions Professional background and professional context seem to affect the apprehension of family-centred service. Also work experience and being part of a multidisciplinary team have an influence on how the professionals embrace the family-centred service delivered. The MPOC-SP can be used to identify areas for improvement. © 2011 Blackwell Publishing Ltd.

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