Effect of centralization on geographic accessibility of maternity hospitals in Finland.

BACKGROUND: In the past two decades, the number of maternity hospitals in Finland has been reduced from 42 to 22. Notwithstanding the benefits of centralization for larger units in terms of increased safety, the closures will inevitably impair geographical accessibility of services. METHODS: This study aimed to employ a set of location-allocation methods to assess the potential impact on accessibility, should the number of maternity hospitals be reduced from 22 to 16. Accurate population grid data combined with road network and hospital facilities data is analyzed with three different location-allocation methods: straight, sequential and capacitated p-median. RESULTS: Depending on the method used to assess the impact of further reduction in the number of maternity hospitals, 0.6 to 2.7% of mothers would have more than a two-hour travel time to the nearest maternity hospital, while the corresponding figure is 0.5 in the current situation. The analyses highlight the areas where the number of births is low, but a maternity hospital is still important in terms of accessibility, and the areas where even one unit would be enough to take care of a considerable volume of births. CONCLUSIONS: Even if the reduction in the number of hospitals might not drastically harm accessibility at the level of the entire population, considerable changes in accessibility can occur for clients living close to a maternity hospital facing closure. As different location-allocation analyses can result in different configurations of hospitals, decision-makers should be aware of their differences to ensure adequate accessibility for clients, especially in remote, sparsely populated areas.

Body mass index and overweight in relation to residence distance and population density: experience from the Northern Finland birth cohort 1966.

BACKGROUND: The effect of urban sprawl on body weight in Finland is not well known. To provide more information, we examined whether body mass index (BMI) and the prevalence of overweight are associated with an individual's distance to the local community centre and population density in his/her resident area. METHODS: The sample consisted of 5363 men and women, members of the Northern Finland Birth Cohort 1966 (NFBC), who filled in a postal questionnaire and attended a medical checkup in 1997, at the age of 31 years. Body mass index (BMI; kg/m(2)) and the prevalence of overweight (BMI ≥ 25.0 kg/m(2)) were regressed on each subject's road distance to the resident commune's centre and on population density in the 1 km(2) geographical grid in which he/she resided, using a generalized additive model. Adjustments were made for sex, marital status, occupational class, education, leisure-time and occupational physical activity, alcohol consumption and smoking. RESULTS: The mean BMI among the subjects was 24.7 kg/m(2), but it increased by increasing road distance (by 1.3 kg/m(2) from 5-10 to 20-184 km) and by decreasing population density (by 1.7 kg/m(2) from 1000-19,192 to 1-5 inhabitants/km(2)). The respective increases in overweight (overall prevalence 41%) were 13 per cent units for distance and 14 per cent units for population density. Adjusted regressions based on continuous explanatory variables showed an inverse L-shaped pattern with a mean BMI of 24.6 kg/m(2) at distances shorter than 5 km and a rise of 2.6 kg/m(2) at longer distances, and an increase of 2.5 kg/m(2) from highest to lowest population density. The associations with road distance were stronger for women than men, while the sex difference in association with population density remained indeterminate. CONCLUSIONS: We conclude that young adults in Northern Finland who live far away from local centres or in the most sparsely populated areas are fatter than those who live close to local centres or in densely populated areas. The likely explanations include variations in everyday physical activity in different residential environments, although causality of the associations remains to be confirmed.

Residential history and changes in perceived health-The Northern Finland Birth Cohort 1966 study.

Neighbourhood socioeconomic status and physical access to amenities and greenness are factors that have been associated with mental, physical and perceived health. However, associations between long-time exposure to these circumstances and changes in perceived health in the middle-age population have remained a relatively underexamined area. This study aimed to examine the association between residential environmental history and changes in perceived health in the Northern Finland Birth Cohort 1966 (N = 5973) population encompassing the two latest data collections at 31 and 46 years of age. Longitudinal time-varying geographical data on the residential environment's economic dependency ratio, population density, distance to local services and presence of green areas were derived from various spatial registers and linked to cohort members' exact residential history. According to a multivariable logistic regression analysis, having a residential history in municipalities with higher-than-average (poor) economic dependency ratios was associated with higher odds of poor perceived health changing to good. Among men, living farther than 2 km away from local services was associated with a higher risk of change from good perceived health to poor, and living farther than 300 m away from green areas was associated with a lower risk of change from good perceived health to poor. The residential environments's urban/rural context may be one factor contributing to the findings. The results point to the importance of considering local residential area characteristics and residence duration in certain areas as potential determinants of health. Finally, having long-term residential history in areas with poor access to services and amenities has the potential to undermine health during one's lifetime.

Satellite Imaging-Based Residential Greenness and Accelerometry Measured Physical Activity at Midlife-Population-Based Northern Finland Birth Cohort 1966 Study.

BACKGROUND: Recently, the importance of light physical activity (LPA) for health has been emphasized, and residential greenness has been positively linked to the level of LPA and a variety of positive health outcomes. However, people spend less time in green environments because of urbanization and modern sedentary leisure activities. AIMS: In this population-based study, we investigated the association between objectively measured residential greenness and accelerometry measured physical activity (PA), with a special interest in LPA and gender differences. METHODS: The study was based on the Northern Finland Birth Cohort 1966 (5433 members). Participants filled in a postal questionnaire and underwent clinical examinations and wore a continuous measurement of PA with wrist-worn Polar Active Activity Monitor accelerometers for two weeks. The volume of PA (metabolic equivalent of task or MET) was used to describe the participant's total daily activity (light: 2-3.49 MET; moderate: 3.5-4.99 MET; vigorous: 5-7.99 MET; very vigorous: ≥8 MET). A geographic information system (GIS) was used to assess the features of each individual's residential environment. The normalized difference vegetation index (NDVI) was used for the objective quantification of residential greenness. Multiple linear regression and a generalized additive model (GAM) were used to analyze the association between residential greenness and the amount of PA at different intensity levels. RESULTS: Residential greenness (NDVI) was independently associated with LPA (unadjusted ß = 174; CI = 140, 209) and moderate physical activity (MPA) (unadjusted ß = 75; CI = 48, 101). In the adjusted model, residential greenness was positively and significantly associated with LPA (adjusted ß = 70; CI = 26, 114). In men, residential greenness was positively and significantly associated with LPA (unadjusted ß = 224; CI = 173, 275), MPA (unadjusted ß = 75; CI = 48, 101), and moderate to vigorous physical activity (MVPA) (unadjusted ß = 89; CI = 25, 152). In women, residential greenness was positively related to LPA (unadjusted ß = 142; CI = 96, 188) and inversely associated with MPA (unadjusted ß = -22; CI = -36, -8), vigorous/very vigorous physical activity (VPA/VVPA) (unadjusted ß = -49; CI = -84, -14), and MVPA (unadjusted ß = -71; CI = -113, -29). In the final adjusted models, residential greenness was significantly associated only with the amount of LPA in men (adjusted ß = 140; CI = 75, 204). CONCLUSIONS: Residential greenness was positively associated with LPA in both genders, but the association remained significant after adjustments only in men. Residential greenness may provide a supportive environment for promoting LPA.

Physical Activity, Residential Environment, and Nature Relatedness in Young Men-A Population-Based MOPO Study.

Background: In general, nature relatedness is positively associated with physical activity, health, and subjective well-being. However, increased residence in urban areas, and the decrease in natural spaces, may affect the younger generation most adversely. The associated environmental changes can increase youths' risk of spending most of their time indoors, and weaken their nature relatedness, making them less likely to enjoy nature's health benefits. This is a serious public health issue, since inadequate physical activity, combined with minimum time spent in green space, can affect health across the whole lifespan. Thus, to develop effective interventions for physical activation and promote health and well-being among young men, further knowledge of the determinants of their nature relatedness is necessary. Aims: To explore factors related to nature relatedness, including physical activity, physical activity with parents, and residential environment. Methods: The study population consisted of all 914 young men (mean-17.8 years; SD-0.5) who participated in mandatory call-ups for military service and completed the study questionnaire in 2013. The questionnaire inquired about their nature relatedness, demographic characteristics, socioeconomic status, physical activity, health, and subjective well-being. A geographic information system (GIS) was used to assess the features of their residential environments. Multivariable linear regression was used to analyze the data. Results: Physical activity (p = 0.021) and physical activity with parents at primary school age (p = 0.007), and currently (p = 0.001) as well as good self-rated health (p = 0.001), and father's higher socioeconomic status (p = 0.041), were positively connected to nature relatedness. Conclusions: Physical activity in general, physical activity with parents, and nature relatedness were positively related. This knowledge can be utilized in promoting physical activity and health among young men.

Accessibility of tertiary hospitals in Finland: A comparison of administrative and normative catchment areas.

The determination of an appropriate catchment area for a hospital providing highly specialized (i.e. tertiary) health care is typically a trade-off between ensuring adequate client volumes and maintaining reasonable accessibility for all potential clients. This may pose considerable challenges, especially in sparsely inhabited regions. In Finland, tertiary health care is concentrated in five university hospitals, which provide services in their dedicated catchment areas. This study utilizes Geographic Information Systems (GIS), together with grid-based population data and travel-time estimates, to assess the spatial accessibility of these hospitals. The current geographical configuration of the hospitals is compared to a normative assignment, with and without capacity constraints. The aim is to define optimal catchment areas for tertiary hospitals so that their spatial accessibility is as equal as possible. The results indicate that relatively modest improvements can be achieved in accessibility by using normative assignment to determine catchment areas.

Urbanity as a determinant of exposure to grass pollen in Helsinki Metropolitan area, Finland.

Little is known about the levels of exposure to grass pollen in urban environments. We assessed the spatio-temporal variation of grass pollen concentrations and the role of urbanity as a determinant of grass pollen exposure in the Helsinki Metropolitan area. We monitored grass pollen concentrations in 2013 at 16 sites during the peak pollen season by using rotorod-type samplers at the breathing height. The sites were in the cities of Helsinki and Espoo, Finland, and formed city-specific lines that represented urban-rural gradient. The monitoring sites were both visually and based on land use data ranked as high to low (graded 1 to 8) pollen area. The lowest grass pollen concentrations were observed in the most urban sites compared to the least urban sites (mean 3.6 vs. 6.8 grains/m3 in Helsinki; P<0.0001, and 5.2 vs. 87.5 grains/m3 in Espoo; P<0.0001). Significant differences were observed between concentrations measured in morning periods compared to afternoon periods (4.9 vs. 5.4 in Helsinki, P = 0.0186, and 21.8 vs. 67.1 in Espoo, P = 0.0004). The mean pollen concentration increased with decreasing urbanity both in Helsinki (0.59 grains/m3 per urbanity rank, 95% CI 0.25-0.93) and Espoo (8.42, 6.23-10.61). Pollen concentrations were highest in the afternoons and they were related to the ambient temperature. Urbanity was a strong and significant determinant of pollen exposure in two Finnish cities. Pollen exposure can periodically reach such high levels even in the most urban environments that can cause allergic reactions among individuals with allergies.

Invasive Group A Streptococcal Infections in Children: A Nationwide Survey in Finland.

BACKGROUND: The incidence of invasive group A streptococcus (iGAS) infections varies in time and geographically for unknown reasons. We performed a nationwide survey to assess the population-based incidence rates and outcomes of children with iGAS infections. METHODS: We collected data on patients from hospital discharge registries and the electronic databases of microbiological laboratories in Finland for the period 1996-2010. We then recorded the emm types or serotypes of the strains. The study physician visited all university clinics and collected the clinical data using the same data entry sheet. RESULTS: We identified 151 children with iGAS infection. Varicella preceded iGAS infection in 20% of cases and fasciitis infection in 83% of cases. The annual incidence rate of iGAS infection was 0.93 per 100,000 in 1996-2000, 1.80 in 2001-2005 and 2.50 in 2006-2010. The proportion of emm 1.0 or T1M1 strains peaked in 1996-2000 and again in 2006-2010, to 44% and 37% of all typed isolates. The main clinical diagnoses of the patients were severe soft-tissue infection (46%), sepsis (28%), empyema (10%), osteoarticular infection (9%) and primary peritonitis (5%). Severe pain was the most typical symptom for soft-tissue infections. More than half of the patients underwent surgery and received clindamycin. The readmission rate was 7%, and the case fatality rate was 2%. CONCLUSIONS: The incidence rate of pediatric iGAS infections tripled during our study. The increase was not, however, the result of a change in the strain types causing iGAS. Varicella immunization would likely have prevented a significant number of the cases.

Fine-Scale Exposure to Allergenic Pollen in the Urban Environment: Evaluation of Land Use Regression Approach.

BACKGROUND: Despite the recent developments in physically and chemically based analysis of atmospheric particles, no models exist for resolving the spatial variability of pollen concentration at urban scale. OBJECTIVES: We developed a land use regression (LUR) approach for predicting spatial fine-scale allergenic pollen concentrations in the Helsinki metropolitan area, Finland, and evaluated the performance of the models against available empirical data. METHODS: We used grass pollen data monitored at 16 sites in an urban area during the peak pollen season and geospatial environmental data. The main statistical method was generalized linear model (GLM). RESULTS: GLM-based LURs explained 79% of the spatial variation in the grass pollen data based on all samples, and 47% of the variation when samples from two sites with very high concentrations were excluded. In model evaluation, prediction errors ranged from 6% to 26% of the observed range of grass pollen concentrations. Our findings support the use of geospatial data-based statistical models to predict the spatial variation of allergenic grass pollen concentrations at intra-urban scales. A remote sensing-based vegetation index was the strongest predictor of pollen concentrations for exposure assessments at local scales. CONCLUSIONS: The LUR approach provides new opportunities to estimate the relations between environmental determinants and allergenic pollen concentration in human-modified environments at fine spatial scales. This approach could potentially be applied to estimate retrospectively pollen concentrations to be used for long-term exposure assessments. CITATION: Hjort J, Hugg TT, Antikainen H, Rusanen J, Sofiev M, Kukkonen J, Jaakkola MS, Jaakkola JJ. 2016. Fine-scale exposure to allergenic pollen in the urban environment: evaluation of land use regression approach. Environ Health Perspect 124:619-626; http://dx.doi.org/10.1289/ehp.1509761.

Health and well-being of movers in rural and urban areas--a grid-based analysis of northern Finland birth cohort 1966.

We examined the association of health and well-being with moving using a detailed geographical scale. 7845 men and women born in northern Finland in 1966 were surveyed by postal questionnaire in 1997 and linked to 1 km(2) geographical grids based on each subject's home address in 1997-2000. Population density was used to classify each grid as rural (1-100 inhabitants/km²) or urban (>100 inhabitants/km²) type. Moving was treated as a three-class response variate (not moved; moved to different type of grid; moved to similar type of grid). Moving was regressed on five explanatory factors (life satisfaction, self-reported health, lifetime morbidity, activity-limiting illness and use of health services), adjusting for factors potentially associated with health and moving (gender, marital status, having children, housing tenure, education, employment status and previous move). The results were expressed as odds ratios (OR) and their 95% confidence intervals (CI). Moves from rural to urban grids were associated with dissatisfaction with current life (adjusted OR 2.01; 95% CI 1.26-3.22) and having somatic (OR 1.66; 1.07-2.59) or psychiatric (OR 2.37; 1.21-4.63) morbidities, the corresponding ORs for moves from rural to other rural grids being 1.71 (0.98-2.98), 1.63 (0.95-2.78) and 2.09 (0.93-4.70), respectively. Among urban dwellers, only the frequent use of health services (≥ 21 times/year) was associated with moving, the adjusted ORs being 1.65 (1.05-2.57) for moves from urban to rural grids and 1.30 (1.03-1.64) for urban to other urban grids. We conclude that dissatisfaction with life and history of diseases and injuries, especially psychiatric morbidity, may increase the propensity to move from rural to urbanised environments, while availability of health services may contribute to moves within urban areas and also to moves from urban areas to the countryside, where high-level health services enable a good quality of life for those attracted by the pastoral environment.

Self-reported health in urban-rural continuum: a grid-based analysis of Northern Finland Birth Cohort 1966.

OBJECTIVES: To evaluate the association of self-reported health with residential area type defined by the population density in individual's local environment using a population-based cohort in Finland. METHODS: Young adults of the Northern Finland Birth Cohort 1966 (4,201 women and 3,835 men), surveyed by a postal questionnaire in 1997, were linked to population density of their resident grid (1 km(2)) depicting different types of residential areas. Self-reported health was regressed on residential area type using ordinal logistic analysis, adjusting for psychosocial well-being, social relationships, health behaviour, education and residence time. RESULTS: Cumulative odds ratios (COR) for poor health were lowest in high-rise centres, highest in scattered settlement areas and second highest in transitional zones. Adjustments (especially for education and time of residence) reduced the CORs to insignificance except the persistently high COR for women in scattered settlement areas. CONCLUSION: Poor self-reported health is associated with individual's residential area type, with the lowest occurrence in high-rise centres and higher elsewhere. The difference is likely explained, at least partly, by a complex of psychosocial factors, possibly different for women and men.