The impact of chronic conditions on productivity-adjusted life years (PALYs) in both the workplace and household settings in the general adult population in Finland.

OBJECTIVES: This study aimed to quantify the burden of eight non-communicable conditions on productivity-adjusted life year (PALY) at work and within the household among the Finnish general adult population. METHODS: Survey data on 18-79-year-old Finnish respondents collected in 2022 was used to calculate age- and sex-specific productivity indices at work and within the household using zero- and one-inflated beta regression for individuals with and without a certain condition (asthma or chronic obstructive pulmonary disease, cardiovascular disease, depression or other mental health problem, diabetes, gastrointestinal disease, hypothyroidism or other thyroid disease, migraine or other chronic headache, and musculoskeletal disease). Age and sex distributions of the Finnish population obtained from Statistics Finland together with the prevalence of the condition and the estimated productivity indices were used to produce the population-level one-year losses in PALYs at work and within the household. RESULTS: Among eight conditions, depression and other mental health problems had the highest PALY losses (99 570 PALY loss burden at work, 256 086 PALY loss at home, and 250 980 PALY loss in general adult populations), with diabetes having the lowest (3 666 PALY loss burden at work, 46 344 PALY loss at home, and 43 443 PALY loss in general adult populations). All the examined conditions were as significant in affecting both the productivity at work and the within-household productivity. CONCLUSIONS: Depression and other mental health problems have a major effect on self-reported work ability and productivity when compared with other chronic conditions.

Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study.

OBJECTIVES: This study examined the effectiveness of an individualised Coordinated Return to Work (CRtW) model on the length of the return to work (RTW) period compared with a standard prescription of 2-3 months RTW during recovery after lumbar discectomy and hip and knee arthroplasty among Finnish working-age population. METHODS: Cohorts on patients aged 18-65 years old with lumbar discectomy or hip or knee arthroplasty were extracted from the electronic health records of eight Finnish hospital districts in 2015-2021 and compiled with retirement and sickness benefits. The overall effect of the CRtW model on the average RTW period was calculated as a weighted average of area-specific mean differences in RTW periods between 1 year before and 1 year after the implementation. Longer-term effects of the model were examined with an interrupted time series design estimated with a segmented regression model. RESULTS: During the first year of the CRtW model, the average RTW period shortened by 9.1 days (95% CI 4.1 to 14.1) for hip arthroplasty and 14.4 days (95% CI 7.5 to 21.3) for knee arthroplasty. The observed differences were sustained over longer follow-up times. For lumbar discectomy, the first-year decrease was not statistically significant, but the average RTW had shortened by 36.2 days (95% CI 33.8 to 38.5) after 4.5 years. CONCLUSIONS: The CRtW model shortened average RTW periods among working-age people during the recovery period. Further research with larger samples and longer follow-up times is needed to ensure the effectiveness of the model as a part of the Finnish healthcare system.

Association of the timing of evening eating with BMI Z-score and waist-to-height ratio among preschool-aged children in Finland.

Later timing of eating has been associated with higher adiposity among adults and children in several studies, but not all. Moreover, studies in younger children are scarce. Hence, this study investigated the associations of the timing of evening eating with BMI Z-score and waist-to-height ratio (WHtR), and whether these associations were moderated by chronotype among 627 preschoolers (3-6-year-olds) from the cross-sectional DAGIS survey in Finland. Food intake was measured with 3-d food records, and sleep was measured with hip-worn actigraphy. Three variables were formed to describe the timing of evening eating: (1) clock time of the last eating occasion (EO); (2) time between the last EO and sleep onset; and (3) percentage of total daily energy intake (%TDEI) consumed 2 h before sleep onset or later. Chronotype was assessed as a sleep debt-corrected midpoint of sleep on the weekend (actigraphy data). The data were analysed with adjusted linear mixed effects models. After adjusting for several confounders, the last EO occurring closer to sleep onset (estimate = -0·006, 95 % CI (-0·010, -0·001)) and higher %TDEI consumed before sleep onset (estimate = 0·0004, 95 % CI (0·00003, 0·0007)) were associated with higher WHtR. No associations with BMI Z-score were found after adjustments. Clock time of the last EO was not significantly associated with the outcomes, and no interactions with chronotype emerged. The results highlight the importance of studying the timing of eating relative to sleep timing instead of only as clock time.

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation.

BACKGROUND: Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. METHODS: The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. RESULTS: Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09,  -0.09). CONCLUSIONS: Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior. TRIAL REGISTRATION: ISRCTN57165350 (8 January, 2015).

Economic evaluation of using polygenic risk score to guide risk screening and interventions for the prevention of type 2 diabetes in individuals with high overall baseline risk.

Type 2 diabetes (T2D) with increasing prevalence is a significant global public health challenge. Obesity, unhealthy diet, and low physical activity are one of the major determinants of the rise in T2D prevalence. In addition, family history and genetic risk of diabetes also play a role in the process of developing T2D. Therefore, solutions for the early identification of individuals at high risk for T2D for early targeted detection of T2D, prevention, and intervention are highly preferred. Recently, novel genomic-based polygenic risk scores (PRSs) have been suggested to improve the accuracy of risk prediction supporting the targeting of preventive interventions to those at highest risk for T2D. Therefore, the aim of the present study was to assess the cost-utility of an additional PRS testing information (as a part of overall risk assessment) followed by a lifestyle intervention and an additional medical therapy when estimated 10-year overall risk for T2D exceeded 20% among Finnish individuals screened as at the high-risk category (i.e., 10%-20% 10-year overall risk of T2D) based on traditional risk factors only. For a cost-utility analysis, an individual-level state-transition model with probabilistic sensitivity analysis was constructed. A 1-year cycle length and a lifetime time horizon were applied in the base-case. A 3% discount rate was used for costs and QALYs. Cost-effectiveness acceptability curve (CEAC) and estimates for the expected value of perfect information (EVPI) were calculated to assist decision makers. The use of the targeted PRS strategy reclassified 12.4 percentage points of individuals to be very high-risk individuals who would have been originally classified as high risk using the usual strategy only. Over a lifetime horizon, the targeted PRS was a dominant strategy (i.e., less costly, more effective). One-way and scenario sensitivity analyses showed that results remained dominant in almost all simulations. However, there is uncertainty, since the probability (EVPI) of cost-effectiveness at a WTP of 0€/QALY was 63.0% (243€) indicating the probability that the PRS strategy is a dominant option. In conclusion, the results demonstrated that the PRS provides moderate additional value in Finnish population in risk screening leading to potential cost savings and better quality of life when compared with the current screening methods for T2D risk.

Willingness to Pay for Implementation of an Environmentally Friendly Pharmaceutical Policy in Finland-A Discrete Choice Experiment Study.

The use of pharmaceuticals is their main pathway to the environment, making the public a major stakeholder in environmentally friendly pharmaceutical policies, including an environmental classification system for medicines. We studied the Finnish adult population's (n = 2030) preferences and willingness to pay (WTP) for an environmentally friendly pharmaceutical policy by means of an online survey employing a discrete choice experiment (DCE). We also studied the relative importance of the policy attributes, namely, the environmental impact, geographical scope, available information about the environmental impact of a pharmaceutical, and the effect of the respondents' general environmental attitudes on the WTP. The total annual WTP of the Finnish adult population ranges from 37 million to 134 million euros, depending on the attribute levels. Moreover, the environmental attitude of a respondent had a significant impact on the WTP. Generally, the environmental impact of the policy was the most important attribute, the geographical scope of the policy the second, and information about the environmental impact of pharmaceuticals was the third most important attribute. However, the most environmentally friendly respondents preferred information as the second important attribute. This study provides insights into the environmental valuations of the public to be used in preparing new pharmaceutical policy measures.

Hospital treatment costs associated with incident complications in patients with type 2 diabetes-real-world study based on electronic patient information systems.

BACKGROUND: Type 2 diabetes (T2D) and its complications cause a significant public health and economic challenge. To enable the optimal resource allocation across different prevention and treatment policies for the management of T2D-related complications, detailed cost estimates related to the complications of T2D are needed. Therefore, the objective of the study was to provide reliable and sufficiently detailed real-world estimates of costs associated with different T2D complications in a Finnish university hospital setting. METHODS: A cohort of T2D patients living in the catchment area of a university hospital during 2012 and 2016 was identified from the comprehensive national FinDM diabetes database for longitudinal assessment of T2D associated complication treatment costs. Data on patient-level events were extracted from the FinDM data and complemented with all accountable services and related detailed costing data gathered from the university hospital's electronic patient information systems by using unique personal identity codes. Patients were screened for their first diagnoses of complications using the same national quality registry definitions as in the FinDM database. Multivariable gamma regression model with a log link function was applied to study the association between baseline factors and complication costs. In addition, an interactive online tool was developed to create predicted costs for complication costs with selected baseline factors. RESULTS: A total of 27 255 prevalent and incident patients with T2D were identified from the national FinDM register. Finally, a total of 16 148 complication episodes for 7 895 patients were included in the cost analyses. The mean estimated one-year hospital treatment costs of T2D-related complication varied from 6 184 to 24 507 euros per complication. Regression analyses showed that coexisting conditions are significantly associated with initial and recurrent complication costs. CONCLUSIONS: The study shows updated Finnish cost estimates and their main cost drivers for T2D-related complications treated in the university hospital setting. The results of our study highlight the significance of guideline implementation, effective preventive treatments for T2D, as well as the importance of treatment adherence to avoid these costly complications.

Body Mass Index, Physical Activity, and Body Image in Adolescents.

Body image dissatisfaction is a concern for adolescents' mental and physical well-being, and the role of body mass index (BMI) and physical activity (PA) in it is still unclear. This study investigates the associations of BMI and PA with body image, separately for boys and girls, in a large sample of Finnish adolescents. We also examine the associations of BMI with body image in varying PA levels. A total of 10,496 adolescents (girls 52.6%) were included in the analyses. Body image was assessed using a pictorial tool, and categorized as wishing for a smaller body, being satisfied, and wishing for a bigger body. BMI (kg/m2) was categorized as thin, normal weight, and overweight/obese. Self-reported PA was divided into three similar-sized categories as low, moderate, and high PA levels. Adjusted ordinal regression analyses were conducted. Our results show that adolescents with thinness had higher odds of wishing for a bigger body compared to their normal-weight peers, while adolescents with overweight/obesity had smaller odds of wishing for a bigger body. Adolescents in low and middle PA levels had lower odds of wishing for a bigger body compared to adolescents in the high PA level. Yet, the PA level modified the associations between BMI and body image, especially in adolescents with thinness and more so in girls than in boys. These findings highlight the need to pay attention to healthy weight gain and PA in adolescents to support their body image satisfaction.

Development and Psychometric Testing of the Registered Nurses' Perceptions of Rewarding Scale.

BACKGROUND: Rewarding is a powerful way to recognize, manage, and retain staff. However, the perceptions of registered nurses (RNs) toward rewarding have not yet been extensively examined in nursing studies. It is important to identify optimal and potentially innovative ways to reward RNs by taking their perceptions into consideration. PURPOSE: The aim of this study was to develop and psychometrically test the Registered Nurses' Perceptions of Rewarding Scale (RNREWS). METHODS: A cross-sectional study design was used. The scale was developed in the three phases of item generation, content validity testing, and examination of psychometric properties. Tests of the scale included evaluation of content validity, exploratory factor analysis, parallel analysis, and internal consistency tests using Cronbach's alpha. Survey participants included 402 RNs working in Finnish healthcare in Autumn 2015. RESULTS: The RNREWS was found to have acceptable construct validity and good internal consistency. Exploratory factor analysis indicated that a 66-item scale with a 14-factor structure fits the data best. The final scale includes two subscales. The first is "reward type preferences" with 61 items covering 13 factors, and the second is "significance of rewarding" with five items covering one factor. The two sets of items accounted for 73.1% and 58.5% of the variance in responses and earned Cronbach's α values of .90 and .80, respectively. CONCLUSIONS: The RNREWS is a valid and reliable instrument for acquiring knowledge regarding the perspective of RNs on rewarding in the nursing context. The results enhance the understanding of the range of rewards that may be implemented in the nursing profession and may assist human resources managers and administrators to formulate effective reward systems for their RNs to improve the rewarding and retention of nursing professionals. However, cultural equivalence and linguistic differences must be considered if this scale is to be applied in other countries or environments.

Registered nurses' perceptions of rewarding and its significance.

AIM: To examine reward type preferences and their relationships with the significance of rewarding perceived by registered nurses in Finland. BACKGROUND: Previous studies have found relationships between nurses' rewarding and their motivation at work, job satisfaction and organisational commitment. METHODS: Data were collected in a cross-sectional, descriptive, questionnaire survey from 402 registered nurses using the Registered Nurses' Perceptions of Rewarding Scale in 2015, and analysed with descriptive and multivariate statistical methods. RESULTS: Registered nurses assigned slightly higher values to several non-financial than to financial rewards. The non-financial reward types appreciation and feedback from work community, worktime arrangements, work content, and opportunity to develop, influence and participate were highly related to the significance of rewarding. CONCLUSIONS: We identified various rewards that registered nurses value, and indications that providing an appropriate array of rewards, particularly non-financial rewards, is a highly beneficial element of nursing management. IMPLICATIONS FOR NURSING MANAGEMENT: It is important to understand the value of rewards for nursing management. Nurse managers should offer diverse rewards to their registered nurses to promote excellent performance and to help efforts to secure and maintain high-quality, safe patient care. The use of appropriate rewards is especially crucial to improving registered nurses' reward satisfaction and job satisfaction globally in the nursing profession.