Let's Talk about Children Evaluation (LTCE) study in northern Finland: a multiple group ecological study of children's health promotion activities with a municipal and time-trend design.

INTRODUCTION: Making change towards child and family-based and coordinated services is critical to improve quality, outcomes and value. The Let's Talk about Children (LTC) approach, which consists of brief psychoeducational discussions with parents of kindergarten-aged and school-aged children, has been launched as a municipality-specific programme in the Council of Oulu Region. The aim of this paper is to present a protocol of an ecological study evaluating the group-specific effects of an intervention about LTC activities in a geographically defined population. The programme is designed to promote children's socioemotional well-being. METHODS AND ANALYSIS: A quasi-experimental ecological study protocol is implemented to evaluate whether systematic LTC practices improve children's well-being. A multi-informant setting covers 30 municipalities in northern Finland and involves all the municipal teachers, social and healthcare workers. In each municipality, a Local Management Team is responsible for implementing the LTC programme and collecting the annual data of LTC discussions and network meetings. The outcome data are retrieved from child welfare statistics and hospital registers. The population data, child welfare statistics and referrals to hospitals was retrieved at baseline (2014), and will be retrieved annually. Furthermore, the annual data of LTC discussions and network meetings will be collected of the years 2015-2018. ETHICS AND DISSEMINATION: The study design has been approved by the management of the Oulu University Hospital in accordance with the guidelines given by The Regional Ethics Committee of the Northern Ostrobothnia Hospital District in Oulu, Finland. All data are treated and implemented according to national data security laws. Study findings will be disseminated to provincial and municipal partners, collaborative community groups and the research and development community. The Let's Talk about Children Evaluation study databases will guide future regional development action and policies.

Occupational exposure to solvents and gasoline and risk of cancers in the urinary tract among Finnish workers.

BACKGROUND: Bladder cancer (BC) is generally considered as an occupational disease, and some chemical exposures may also be associated with renal cell cancer (RCC). The aim of this study was to estimate the risk of cancers of the urinary tract in relation to occupational exposure to solvents and gasoline. METHODS: A cross-sectional cohort of all economically active Finns from the 1970 population census was followed up for BC (10,277 cases) and RCC (9,954 cases). Census occupations were assigned estimates of exposure to hydrocarbon (HC) solvents and gasoline with a job exposure matrix. Relative risk (RR) estimates were defined using Poisson regression models, adjusted for smoking and obesity. RESULTS: Exposure to solvents was positively associated with the incidence of BC in women but not in men. The RR estimates were above 1.2 in nearly all exposure categories of all exposures studied but a statistically significant excess was only seen for middle levels of chlorinated HC solvents (1.7; 95% CI = 1.2-2.5) and a low level of aromatic HC solvents (1.6; 95% CI = 1.3-2.1). The RR estimates for RCC were close to unity in all categories of exposure. CONCLUSIONS: Our findings suggest that occupational exposure to certain solvents may have an impact on BC risk. The risk of RCC does not appear to be altered by exposure to HC solvents or gasoline.

Regional differences in the prevalence of decreased work ability among young employees in Finland.

OBJECTIVES: The demographic developments of municipality types differ distinctly. In population-based surveys, the Work Ability Index (WAI) is a useful tool in identifying decreased work ability and high-risk groups. The aim of this study was to examine the prevalence of decreased WAI according to municipal settlements. STUDY DESIGN: Cross-sectional analyses on a birth cohort study base. METHODS: Data on work ability, occupation and marital status were collected by postal questionnaire and in a clinical examination. Areas of residence were obtained from the Population Registration Centre and were delimited using the Finnish rural tripartitioning and urban settlements. Altogether, 3725 employees living in northern Finland or in the Helsinki region during 1997-1998, and working in a wide range of occupations, were selected for the analyses. Analyses of the association between low WAI scores (at or below 36 points), major occupational group and place of residence were carried out separately for men and women by means of logistic regression. RESULTS: At an early stage of the working career, decreased work ability is more likely in rural-type municipalities, especially among women. The regional differences were in close linkage to occupation. CONCLUSIONS: In population-based surveys, the WAI questionnaire measures early signs of decreased work ability and it can be utilized in policy-making.

Work ability index of young employees and their sickness absence during the following year.

OBJECTIVES: The work ability index is widely used in occupational health care. The aim of this study was to determine the extent to which a low index among young employees is predictive of sickness absence during the following year. METHODS: Altogether 3725 employees aged 31 years were followed from 1997 to 1999 as part of the northern Finland birth cohort 1966 study. The participants' self-administered questionnaires at baseline and a 1-year follow-up period with comprehensive sickness absence records was obtained from the Social Insurance Institution of Finland. The records contained only medically certified long-term sickness absences (>9 days). A multivariable logistic regression was used to examine how the work ability index and covariates were associated with sickness absence during the following year. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for the index and its covariates. RESULTS: In a comparison with an excellent index score (>44 points), a low score (<37 points) was associated with sickness absence for both the men (OR 3.6, 95% CI 1.6-7.9) and the women (OR 6.2, 95% CI 2.9 to 13.5) after adjustment for occupation, control over work, social support at work, marital status, number of children at home, physical activity, body mass index, and alcohol consumption. Of the 518 participants with a low index, 90 had long-term sickness absence, giving a positive predictive value of 17.4% (95% CI 14.1-20.6). The negative predictive value was 93.1% (95% CI 92.3-94.0). CONCLUSIONS: For young employees, the work ability index is a practical tool for predicting long-term sickness absence, but it does not predict "no sickness absence".

Classification of Work Ability Index among young employees.

BACKGROUND: The reference values of the Work Ability Index (WAI) are best known for people aged over 45 years. However, the WAI score is highly dependent on age and population-based reference values for young employees are needed. AIM: To present WAI scores calculated for a population-based sample of employees in their early 30s. METHODS: A self-administered questionnaire including the items of the WAI was used. The study included 3725 employees (2021 men and 1704 women) aged 31 from part of the Northern Finland Birth Cohort 1966 Study (NFBC-66) and who were working in a wide range of occupations in northern Finland or in the Helsinki region during 1997-1998. RESULTS: The WAI scores among young employees varied from 15 to 49 with a mean of 40.7 points (SD 4.2). The 15th percentile, median and 85th percentile of the WAI scores were 37, 41 and 45 points, respectively. The WAI scores were relatively high for both men and women. CONCLUSIONS: When classification of WAI scores into four work ability categories is used, the scores of employees in their early 30s should be evaluated separately from those of older age groups. For young employees work ability categories poor (7-36 points), moderate (37-40 points), good (41-44 points) and excellent (45-49 points) are suggested.

Incidence of asthma in twelve thousand Finnish adults born in 1966.

OBJECTIVES: Asthma prevalence is increasing in many countries. Some recent articles, however, claim that this tendency is drawing to an end. Hence, the incidence of persistent asthma was drawn from a birth cohort study in Finland. MATERIALS AND METHODS: A cohort of 6107 men and 5839 women was followed from 1981 to 2004. The participants were members of the Northern Finland Birth Cohort 1966 Study (NFBC-66). The single-year birth cohort was followed from the age of 15 to 38 years by means of a complete register held by the national Social Insurance Institute (SII) in Finland. Within the register data, an incident case of asthma was defined by the received right for reimbursement for asthma medication from the SII. RESULTS: Over a 23-year follow-up period, persistent asthma occurred in 466 study participants of whom 54% were women. The incidence of persistent asthma increased from the rate of 10 cases per 10 000 person-years at the age of 15-20 years to 21 cases per 10 000 person-years at the age of 36-38 years. In females, a peak of incidence rate was found between the age of 31 and 35 years, up to 27 cases per 10 000 person-years. CONCLUSIONS: The follow-up of a population-based birth cohort among young working aged Finns shows the increasing incidence rate of persistent asthma. In recent years, however, a decline in new cases of asthma occurred in females aged between 36 and 38 years.