Finnish Adult Population Research Articles

Nightmares: risk factors among the Finnish general adult population.

To identify risk factors for experiencing nightmares among the Finnish general adult population. The study aimed to both test whether previously reported correlates of frequent nightmares could be reproduced in a large population sample and to explore previously unreported associations. Two independent cross-sectional population surveys of the National FINRISK Study. Age- and sex-stratified random samples of the Finnish population in 2007 and 2012. A total of 13,922 participants (6,515 men and 7,407 women) aged 25-74 y. N/A. Nightmare frequency as well as several items related to socioeconomic status, sleep, mental well-being, life satisfaction, alcohol use, medication, and physical well-being were recorded with a questionnaire. In multinomial logistic regression analysis, a depression-related negative attitude toward the self (odds ratio [OR] 1.32 per 1-point increase), insomnia (OR 6.90), and exhaustion and fatigue (OR 6.86) were the strongest risk factors for experiencing frequent nightmares (P < 0.001 for all). Sex, age, a self-reported impaired ability to work, low life satisfaction, the use of antidepressants or hypnotics, and frequent heavy use of alcohol were also strongly associated with frequent nightmares (P < 0.001 for all). Symptoms of depression and insomnia were the strongest predictors of frequent nightmares in this dataset. Additionally, a wide variety of factors related to psychological and physical well-being were associated with nightmare frequency with modest effect sizes. Hence, nightmare frequency appears to have a strong connection with sleep and mood problems, but is also associated with a variety of measures of psychological and physical well-being.

Social, lifestyle and demographic inequalities in hypertension care.

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. 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. 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). 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.

National diabetes prevention program (DEHKO): awareness and self-reported lifestyle changes in Finnish middle-aged population

ObjectivesThe national development programme for the prevention and care of diabetes was carried out in Finland during 2000–2010. One of the programme goals was to raise awareness of diabetes and its risk factors in the whole population through various activities, e.g. media campaigns and health fares. In addition, a targeted implementation project on the prevention of type 2 diabetes, FIN-D2D, was carried out in selected districts during 2003–2008. The aim of this analysis was to examine the changes in overall awareness of the programme and its association with self-reported lifestyle changes within the adult population during the FIN-D2D project period in the FIN-D2D area compared with the area not participating in the FIN-D2D (the control area). Study designHealth behaviour and health among the Finnish Adult Population –postal survey. MethodsThe structured questionnaire mailed to a random population sample included questions on participants' sociodemographic background, medical history, health habits, and recent lifestyle changes. Awareness of the national diabetes programme was also enquired. Data (n = 10 831) from the 2004–2008 postal surveys were used for this investigation. ResultsIn the FIN-D2D area, 25% (347/1384) of men and 48% (797/1674) of women reported being aware of the programme. In the control area, the proportions were 20% (702/3551) and 36% (1514/4222), respectively. The overall awareness increased among both genders and in all areas during the project period, but the level of awareness was consistently higher in the FIN-D2D area. Female gender and higher age were associated with increasing awareness of the programme in both areas. Self-reported lifestyle changes were more common among women, but associated with the level of awareness of the programme more often among men than women. ConclusionsThe awareness of diabetes and its risk factors increased among men and women in both implementation and control areas during the FIN-D2D project period. The activities of the implementation project may at least partly explain the differences in lifestyle changes between areas, especially among men. The results suggest that health promotion campaigns increase the population awareness about the prevention of chronic diseases and as a result, especially men may be prompted to make beneficial lifestyle changes.

Abstract 15714: Prediction of Sudden Cardiac Death With Automated High-Throughput Analysis of T-Wave Heterogeneity in Standard 12-Lead Electrocardiogram

Introduction: Noninvasive identification of patients at risk for sudden cardiac death (SCD) remains a major clinical challenge. Abnormal ventricular repolarization is associated with increased risk of lethal ventricular arrhythmias and SCD. Hypothesis: We investigated the hypothesis that spatial repolarization heterogeneity can identify patients at risk for SCD in general population. Methods: Spatial R-, J- and T-wave heterogeneities (RWH, JWH and TWH, respectively) were automatically analyzed with second central moment technique from standard digital 12-lead ECGs in 5618 adults (46% men; age 50.9±12.5 yrs.) who took part in Health 2000 Study, an epidemiological survey representative of the entire Finnish adult population. During average follow-up of 7.7±1.4 years, a total of 72 SCDs occurred. Thresholds of RWH, JWH and TWH were based on optimal cutoff points from ROC curves. Results: Increased RWH, JWH and TWH (Fig.1) in left precordial leads (V4-V6) were univariately associated with SCD (P&lt;0.001, each). When adjusted with clinical risk markers (age, gender, BMI, systolic blood pressure, cholesterol, heart rate, left ventricular hypertrophy, QRS duration, arterial hypertension, diabetes, coronary heart disease and previous myocardial infarction) JWH and TWH remained as independent predictors of SCD. Increased TWH (≥102μV) was associated with a 1.9-fold adjusted relative risk (95% confidence interval [CI]: 1.2 - 3.1; P=0.011) and increased JWH (≥123μV) with a 2.0-fold adjusted relative risk for SCD (95% CI: 1.2 - 3.3; P=0.004). When both TWH and JWH were above threshold, the adjusted relative risk for SCD was 3.2-fold (95% CI: 1.7 - 6.2; P&lt;0.001). When all heterogeneity measures (RWH, JWH and TWH) were above threshold, the risk for SCD was 3.7-fold (95% CI: 1.6 - 8.6; P=0.003). Conclusions: Automated measurement of spatial J- and T-wave heterogeneity enables analysis of high patient volumes and is able to stratify SCD risk in general population.

Genetic variation in the hTAS2R38 taste receptor and food consumption among Finnish adults.

Genetic variation in bitter taste receptors, such as hTAS2R38, may affect food preferences and intake. The aim of the present study was to investigate the association between bitter taste receptor haplotypes and the consumption of vegetables, fruits, berries and sweet foods among an adult Finnish population. A cross-sectional design utilizing data from the Cardiovascular Risk in Young Finns cohort from 2007, which consisted of 1,903 men and women who were 30–45 years of age from five different regions in Finland, was employed. DNA was extracted from blood samples, and hTAS2R38 polymorphisms were determined based on three SNPs (rs713598, rs1726866 and rs10246939). Food consumption was assessed with a validated food frequency questionnaire. The prevalence of the bitter taste-sensitive (PAV/PAV) haplotype was 11.3 % and that of the insensitive (AVI/AVI) haplotype was 39.5 % among this Finnish population. PAV homozygotic women consumed fewer vegetables than did the AVI homozygotic women, 269 g/day (SD 131) versus 301 g/day (SD 187), respectively, p = 0.03 (multivariate ANOVA). Furthermore, the intake of sweet foods was higher among the PAV homozygotes of both genders. Fruit and berry consumption did not differ significantly between the haplotypes in either gender. Individuals perceive foods differently, and this may influence their patterns of food consumption. This study showed that the hTAS2R38 taste receptor gene variation was associated with vegetable and sweet food consumption among adults in a Finnish population.

The incidence and triggers of adult-onset Guillain-Barré syndrome in southwestern Finland 2004-2013.

A Swiss study recently reported surgery as a potential risk factor for developing Guillain-Barré syndrome (GBS). It was sought to establish this in the Finnish adult population. Persons over 16 years of age who received a diagnosis of GBS in 2004-2013 were identified from the patient register of Turku University Hospital and their patient records were analyzed to identify possible triggers. A cohort of 69 adult patients with GBS (63.8% men) was identified giving an annual incidence of 1.82/100,000. Of these, four (5.8%) had experienced a surgical procedure during the preceding 6 weeks with a relative risk of 6.28 (95% confidence interval 4.15-9.47, P < 0.001) compared with the general study population or a risk of 1.25/100,000 operations. No difference between genders was found. Only two (2.9%) patients had received a vaccination [one against seasonal influenza (P = 0.888) and one against pandemic influenza (Pandemrix(®), GlaxoSmithKline Biologicals, Rixensart, Belgium, relative risk 2.85, 95% confidence interval 1.27-6.38, P = 0.011)] during the preceding 6 weeks. The most common GBS triggers identified were respiratory tract infections in 30 cases (43.5%) and gastroenteritis in 16 cases (23.2%) whilst two patients (2.9%) had had both. The overall incidence of GBS in the adult population of southwestern Finland was similar to previous studies worldwide and the most common triggers were respiratory tract infections and gastroenteritis. Surgery was a rare risk factor and of vaccinations only the one against pandemic influenza raised the risk of GBS.

Oscillometric and auscultatory blood pressure measurement in the assessment of blood pressure and target organ damage

The objective of this study was to elucidate the usefulness of both the oscillometric blood pressure (OBP) and auscultatory blood pressure (ABP) measurement technique in the assessment of blood pressure (BP) and target organ damage in the general population. We studied a sample of the Finnish adult population aged 25-74 years. Four hundred and eighty-four study participants underwent a health examination including measurements of 24-h urine albumin, echocardiographic variables of the left ventricle, intima media thickness and pulse wave velocity. OBP and ABP were measured simultaneously four times by beginning the OBP measurements in random order from the right or left arm and by switching the devices between hands after two measurements. The mean OBP was 126.7/77.4 mmHg and the mean ABP was 124.5/78.0 mmHg. Systolic difference between OBP compared with ABP was large in men. Male sex, higher arm circumference and lower systolic BP were independent determinants explaining the greater difference between systolic OBP compared with ABP. Diabetes, higher arm circumference and higher pulse wave velocity were independent determinants explaining greater difference between diastolic OBP compared with ABP. The correlations of target organ damage between OBP and ABP were equally good. At population level OBP and ABP measurements yielded similar results in relation to BP level and the indicators of target organ damage, probably due to the simultaneous and controlled measurement protocol, and to the sample of participants from the general population. It is, however, recommendable to use either OBP or ABP measurements for individual patients to avoid unnecessary interdevice variability.

Interarm blood pressure difference and target organ damage in the general population

The objective of the study was to investigate interarm differences of blood pressure (BP) and its determinants, and to clarify whether both arms are equally good in assessing BP and target organ damage in the general population. We studied a representative sample of Finnish adult population with 484 study participants, ages 25-74 years. BP was measured twice by an oscillometric monitor simultaneously on both arms. Study participants underwent a clinical examination including measurements of serum lipids, glucose and indicators of target organ damage. BP was 2.3/0.2 mmHg higher on right than on left arm (P < 0.001/P = 0.15 for SBP/DBP differences). SBP and DBP measured on right and left arms correlated equally with left ventricular mass index (LVMI), interventricular septal thickness (IVST), posterior wall thickness (PWT), pulse wave velocity (PWV) and albuminuria. Higher SBP level was an independent determinant of both greater systolic and diastolic interarm BP difference. Exaggerated absolute diastolic interarm BP difference (>5 mmHg) was associated with higher BMI, arm circumference, LVMI, IVST and PWT, whereas exaggerated absolute systolic interarm BP difference (>10 mmHg) was not associated with any clinical variables. There was only a small difference in BP between arms in a healthy general population. Both arms are equally good determinants of target organ damage. BP should be measured at least once on both arms and prefer the arm with higher BP readings in the future BP measurements.

Food choices, perceptions of healthiness, and eating motives of self-identified followers of a low-carbohydrate diet

BackgroundLow-carbohydrate (LC) diets have gained substantial media coverage in many Western countries. Little is, however, known about the characteristics of their followers.ObjectiveThe article analyses how those who report following an LC diet differ from the rest of the population in their background, food choices, weight reduction status, as well as food-related perceptions and motives. The data are a part of the Health Behaviour and Health among the Finnish Adult Population survey collected in spring 2012 (n=2,601), covering 15- to 64-year-old Finns.ResultsSeven per cent of the respondents identified themselves as followers of the LC diet. Gender and education were not associated with following an LC diet. The youngest respondents were the least likely to follow such a diet. The LC diet group preferred butter but also vegetables more commonly than the other respondents and were less likely to use vegetable bread spreads. The followers of the LC diet and the other respondents agreed about the healthiness of whole grain, vegetable oils, vegetables, and fruits and berries, and of the harmfulness of white wheat. Compared to the other respondents, the LC diet group was less likely to regard eating vegetable/low-fat products as important, more likely to regard eating healthy carbohydrates, and the health and weight-managing aspects of foods, as important and placed less value on sociability and pleasures connected to food. The results showed varying food choices among the followers of the LC diet: some even reported that they were not avoiding carbohydrates, sugars, and white wheat in their diet.ConclusionsPlanners of nutrition policies should follow-up on new diets as they emerge and explore the food choices and motives of their followers and how these diets affect the food choices of the whole population.

Thyroid-stimulating hormone reference range and factors affecting it in a nationwide random sample.

Previous studies with mainly selected populations have proposed contradicting reference ranges for thyroid-stimulating hormone (TSH) and have disagreed on how screening, age and gender affect them. This study aimed to determine a TSH reference range on the Abbott Architect ci8200 integrated system in a large, nationwide, stratified random sample. To our knowledge this is the only study apart from the NHANES III that has addressed this issue in a similar nationwide setting. The effects of age, gender, thyroid peroxidase antibody (TPOAb)-positivity and medications on TSH reference range were also assessed. TSH was measured from 6247 participants randomly drawn from the population register to represent the Finnish adult population. TSH reference ranges were established of a thyroid-healthy population and its subpopulations with increasing and cumulative rigour of screening: screening for overt thyroid disease (thyroid-healthy population, n=5709); screening for TPOAb-positivity (risk factor-free subpopulation, n=4586); and screening for use of any medications (reference subpopulation, n=1849). The TSH reference ranges of the thyroid-healthy population, and the risk factor-free and reference subpopulations were 0.4-4.4, 0.4-3.7 and 0.4-3.4 mU/L (2.5th-97.5th percentiles), respectively. Although the differences in TSH between subgroups for age (p=0.002) and gender (p=0.005) reached statistical significance, the TSH distribution curves of the subgroups were practically superimposed. We propose 0.4-3.4 mU/L as a TSH reference range for adults for this platform, which is lower than those presently used in most laboratories. Our findings suggest that intensive screening for thyroid risk factors, especially for TPOAb-positivity, decreases the TSH upper reference limit.

Prevalence of nightmares among the general finnish adult population and veterans of the second world war

Introduction Nightmares are emotionally negative intense dreams and a relatively common phenomenon. Most people experience occasional idiopathic nightmares which are completely benign, but frequent nightmares are associated with mental health problems and increased suicide risk and can be a serious mental health issue. The current research investigates the prevalence of nightmares among the Finnish general adult population as well as veterans of the Second World War. Specifically, we were interested how sex, age and war experiences affect the nightmare prevalence and how the prevalence has changed during the 35year study period. We also investigated the associations between nightmares and various factors including other sleep problems, mental and physical health and lifestyle. Materials and methods The current research is based on the National FINRISK Study which includes health surveys conducted every 5years from 1972 to 2012. The surveys consist of independent random population samples of Finnish adults aged 25–74 ( N =75,647). The question about nightmares is self-assessment of frequency during the last 30days. The surveys also contain questions about various topics related to mental and physical health. The statistical methods used include Pearson and Mantel–Haenszel χ 2 , Cramer's V and Logistic regression. Results In the whole sample, 3.5% of men and 4.8% of women report frequent nightmares, but the prevalence and the sex difference is significantly affected by the age of participants. Occasional nightmares have increased in Finland from 1972 to 2007 and the effect of the Second World War can be seen in nightmare prevalence still decades after the war in the surveys of 1972–1987. Among war veterans the prevalence of nightmares is significantly higher at 7.0% than among their peers without war experience. Significant correlates of nightmares include depression, insomnia and stress. Conclusion Nightmares are not uncommon among Finnish adults and their prevalence is affected by sex, age, historical time and war experiences. They are also associated with other sleep problems and poor mental health. Our research leads to better understanding of the interindividual variation in nightmare frequency. Acknowledgements This work has received financial support from Jenny and Antti Wihuri Foundation, Sigrid Juselius foundation and Turku Institute of Advanced Studies (TIAS).

Nightmares: Prevalence among the Finnish General Adult Population and War Veterans during 1972-2007

To investigate the prevalence of nightmares among the Finnish general adult population during 1972-2007 and the association between nightmare prevalence and symptoms of insomnia, depression, and anxiety in World War II veterans. Eight independent cross-sectional population surveys of the National FINRISK Study conducted in Finland in 1972, 1977, 1982, 1987, 1992, 1997, 2002, and 2007. Epidemiologic. A total of 69,813 people (33,811 men and 36,002 women) age 25-74 years. N/A. The investigation of nightmare prevalence and insomnia, depression, and anxiety symptoms was based on questionnaires completed by the participants. Among the whole sample, 3.5% of the men and 4.8% of the women reported frequent nightmares (P < 0.0001 for sex difference), but the prevalence was affected by the age of participants and the year of the survey. Nightmare prevalence increased with age, particularly among the men. The number of people reporting occasional nightmares increased roughly by 20% for both sexes from 1972 to 2007 (P < 0.0001). Participants with war experiences reported more frequent nightmares and symptoms of insomnia, depression, and anxiety than participants without such experiences (P < 0.0001). Prevalence of nightmares was affected by the sex and age of the participants, and occasional nightmares have become more common in Finland. Exposure to war elevates nightmare prevalence as well as insomnia, depression, and anxiety symptoms even decades after the war; large numbers of war veterans can affect nightmare prevalence on population level. Sandman N; Valli K; Kronholm E; Ollila HM; Revonsuo A; Laatikainen T; Paunio T. Nightmares: prevalence among the Finnish general adult population and war veterans during 1972-2007. SLEEP 2013;36(7):1041-1050.

An analysis of problem gambling among the Finnish working-age population: a population survey

BackgroundGambling problems currently affect approximately 100 000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied.MethodAn annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling.ResultsA total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling.ConclusionGambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.

Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study

We aimed to determine the incidence, risk factors and outcome of acute kidney injury (AKI) in Finnish ICUs. This prospective, observational, multi-centre study comprised adult emergency admissions and elective patients whose stay exceeded 24 h during a 5-month period in 17 Finnish ICUs. We defined AKI first by the Acute Kidney Injury Network (AKIN) criteria supplemented with a baseline creatinine and second with the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We screened the patients' AKI status and risk factors for up to 5 days. We included 2,901 patients. The incidence (95 % confidence interval) of AKI was 39.3 % (37.5-41.1 %). The incidence was 17.2 % (15.8-18.6 %) for stage 1, 8.0 % (7.0-9.0 %) for stage 2 and 14.1 % (12.8-15.4 %) for stage 3 AKI. Of the 2,901 patients 296 [10.2 % (9.1-11.3 %)] received renal replacement therapy. We received an identical classification with the new KDIGO criteria. The population-based incidence (95 % CI) of ICU-treated AKI was 746 (717-774) per million population per year (reference population: 3,671,143, i.e. 85 % of the Finnish adult population). In logistic regression, pre-ICU hypovolaemia, diuretics, colloids and chronic kidney disease were independent risk factors for AKI. Hospital mortality (95 % CI) for AKI patients was 25.6 % (23.0-28.2 %) and the 90-day mortality for AKI patients was 33.7 % (30.9-36.5 %). All AKIN stages were independently associated with 90-day mortality. The incidence of AKI in the critically ill in Finland was comparable to previous large multi-centre ICU studies. Hospital mortality (26 %) in AKI patients appeared comparable to or lower than in other studies.

Socio-economic differences in self-reported insomnia and stress in Finland from 1979 to 2002: a population-based repeated cross-sectional survey

BackgroundOver the decades, global public health efforts have sought to reduce socio-economic health differences, including differences in mental health. Only a few studies have examined changes in socio-economic differences in psychological symptoms over time. The aim of this study was to assess trends in socio-economic differences in self-reported insomnia and stress over a 24-year time period in Finland.MethodsThe data source is a repeated cross-sectional survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from the years 1979 to 2002, divided into five study periods. Indicators for socio-economic status included employment status from the survey, and educational level and household income from the Statistics Finland register data. We studied the age group of 25–64 years (N = 70115; average annual response rate 75%). Outcome measures were single questions of self-reported insomnia and stress.ResultsThe overall prevalence of insomnia was 18-19% and that of stress 16-19%. Compared to the first study period, 1979–1982, the prevalence of stress increased until study period 1993–1997. The prevalence of insomnia increased during the last study period, 1998–2002. Respondents who were unemployed or had retired early reported more insomnia and stress over time among both men and women. Lower education was associated with more insomnia especially among men; and conversely, with less stress among both sexes. Compared to the highest household income level, those in the intermediate levels of income had less stress whereas those in the lowest income levels had more stress among both sexes. Income level differences in insomnia were less consistent. In general, socio-economic differences in self-reported insomnia and stress fluctuated some, but did not change substantially over the study period 1979–2002.ConclusionsSelf-reported insomnia and stress were more common during later study periods. The socio-economic differences in insomnia and stress have remained fairly stable over a 24-year time period. However, some of the associations in socio-economic differences were curvilinear and converse. Future studies are needed to explore the complex socio-economic gradients, especially in stress.

Sociodemographic and socioeconomic differences in sleep duration and insomnia-related symptoms in Finnish adults

BackgroundPoor sleep tends to be patterned by sociodemographic and socioeconomic factors. The aim of this study was to examine the associations of sociodemographic and socioeconomic factors with sleep duration and insomnia-related symptoms across life course.MethodsWe used cross-sectional Health 2000 Survey (2000–2001) among a total of 5,578 adult Finns, aged 30–79 years, representative of adult Finnish population. Data about sociodemographic and socioeconomic circumstances, insomnia-related symptoms over the previous month as well as average sleep duration were collected by questionnaires. Multinomial logistic regression models were adjusted first for gender and age, second for sociodemographic factors, third additionally for socioeconomic factors, and fourth for all covariates and self-perceived health simultaneously.ResultsOn average 70% of Finnish adults slept 7–8 hours a day. Frequent insomnia-related symptoms were more prevalent among women (14%) than men (10%). Not being married, not having children, having low education, low income, being unemployed, and being a disability retiree were associated with frequent insomnia-related symptoms. Similar factors were associated with short and long sleep duration. However, childhood socioeconomic position was mostly unrelated to sleep in adulthood except parental education had some associations with short sleep duration.ConclusionsDisadvantaged socioeconomic position in adulthood, in particular income and employment status, is associated with poorer sleep. When promoting optimal sleep duration and better sleep quality, families with low incomes, unemployed people, and disability retirees should be targeted.

Drug expenditure of high-cost patients and their characteristics in Finland

Little information exists on how constantly growing pharmaceutical expenditures are distributed in large representative samples of national populations in Western countries. This study analyzes the distribution of pharmaceutical expenditures in ambulatory care and explores the basic characteristics of the high-cost drug users. Reimbursed prescription drug purchases in 2009 were derived from the National Prescription Register for a 50% sample of the adult Finnish population. The high-cost users who were among the top 5% in terms of drug expenditures were identified based on annual drug costs. The distribution of pharmaceutical costs is strongly skewed in Finland; only 5% of the population accounts for about half of the costs. These high-cost drug users were older than the low-cost drug users, with more than one-fourth of them being over 75 years old. The high-cost drug users used, on average, more drugs than the low-cost drug users, but approximately 15% of them used only 1-5 drugs. Almost 50% of the high-cost drug users used more than 10 drugs per year. They had chronic diseases more often than the low-cost drug users, especially uremia requiring dialysis, post-transplant conditions, severe anemia associated with chronic renal failure and multiple sclerosis were common among the high-cost users. The skewness of the cost distribution indicates a need for more patient-specific cost-containment methods, and the high number of drugs in the high-cost group calls for exploring the possibilities of disease management and patient monitoring techniques in cost containment.

Gender framing effects in victim surveys

Crime victimization surveys are important sources of trend information and provide data for basic criminological research. In recent years, victim surveys have proliferated and their strengths are well known. The aim of this study is to increase the methodological literature on victim surveys by analysing framing effects, defined as the way the survey instrument communicates its topic and aim, especially in terms of the gendered nature of violence. Three experimental frames were applied to independent, random samples of the adult Finnish population: male-to-male violence frame, female-to-male violence frame, and male-to-female violence frame. The impacts of these frames were analysed in relation to two outcome variables: self-assessed propensity to report hypothetical borderline incidents in a victim survey and reporting of prior personal violent victimization. Thus, we utilized measures of both intended survey reporting behaviour and real survey reporting behaviour. The findings indicate that the male-to-female violence frame increases the willingness of the respondents to report borderline cases to survey researchers, regardless of other factors. It also increases the prevalence of reported prior victimizations. The female-to-male frame has a similar but weaker framing effect. The findings are discussed from the point of view of the ‘conversation’ paradigm of survey methods research.

Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate

The objective of the study was to assess the prognostic value of variability in home-measured blood pressure (BP) and heart rate (HR) in a general population. We studied a representative sample of the Finnish adult population with 1866 study subjects aged 45-74 years. BP and HR self-measurements were performed on 7 consecutive days. The variabilities of BP and HR were defined as the SDs of morning minus evening, day-by-day, and first minus second measurements. The primary end point was incidence of a cardiovascular event. The secondary end point was total mortality. During a follow-up of 7.8 years, 179 subjects had experienced a cardiovascular event, and 130 subjects had died. In Cox proportional hazard models adjusted for age, sex, BP/HR, and other cardiovascular risk factors, morning-evening home BP variability (systolic/diastolic relative hazard: 1.04/1.10 [95% CI: 1.01-1.07/1.05-1.15] per 1-mm Hg increase in BP variability) and morning day-by-day home BP variability (relative hazard: 1.04/1.10 [95% CI: 1.00-1.07/1.04-1.16] per 1-mm Hg increase in BP variability) were predictive of cardiovascular events. Morning-evening home HR variability (relative hazard: 1.07 [95% CI: 1.02-1.12] per 1-bpm increase in HR variability) and morning day-by-day home HR variability (relative hazard: 1.11 [95% CI: 1.05-1.17] per 1-bpm increase in HR variability) were also independent predictors of cardiovascular events. Greater variabilities of morning home BP and HR are independent predictors of cardiovascular events. Because the variabilities of home BP and HR are easily acquired in conjunction with home BP and HR level, they should be used as the additive information in the assessment of cardiovascular risk.

Variability in home-measured blood pressure and heart rate

Both self-reported sleep disorders and higher variability in home blood pressure (BP) and home heart rate (HR) have been associated with increased cardiovascular mortality. The objective of our study was to assess the associations of the variability in home-measured BP and HR with self-reported insomnia and sleep duration. We studied a representative sample of Finnish adult population with 1908 study participants aged 41-74 years. BP/HR measurements were performed on 7 consecutive days. The variability in home-measured BP/HR was defined as the standard deviation of morning - evening, day-by-day and first - second measurements. Self-reported insomnia and sleep duration questionnaires were used to classify participants with sleep disorders. Results from Finn-home study show that morning - evening, day-by-day (morning and evening) and first - second home BP variability variables were significantly higher in participants with persistent insomnia than in those without insomnia. Morning - evening, day-by-day, morning day-by-day and first - second measurements of home HR variability variables were significantly higher in participants with persistent insomnia than in those without insomnia. Systolic morning - evening, day-by-day and morning day-by-day variables of home BP variability were significantly higher in long sleepers and systolic morning day-by-day, diastolic day-by-day and diastolic first - second measurement of home BP variability variables were higher in short sleepers than in the reference group. Insomnia combined with short sleep duration further increases home BP/HR variability. As self-reported sleep disorders are associated with greater variability in home BP/HR and both have cardiovascular prognostic value, we encourage physicians to evaluate these easily obtainable measurements in clinical practice to help identify patients at risk.