Predictors of non-completion of upper secondary education in Finland based on register data.

AIMS: School non-completion is a public health and educational concern in most countries. This study sought to identify the strongest predictors of the non-completion of upper secondary education based on register data. METHODS: A cross-validated elastic net regression analysis was used to predict school non-completion in a population of 2696 students in the city of Jyväskylä, Finland. The register data included data from the primary social and healthcare register and the educational register. RESULTS: The non-completion rate was 13.1% (13.4% for males, 12.8% for females). The non-completion of upper secondary education was best predicted by the following seven features (ordered from strongest to weakest): unauthorized absences (odds ratio (OR) = 2.27), out-of-home placement (OR = 2.23), average grade when leaving lower secondary education (OR = 0.73), an anxiety/depression diagnosis (OR = 1.43), visits to child guidance and family counselling centres (OR = 1.17), family poverty (OR = 1.11) and the grade point average in the 5th Grade (OR = 0.95). CONCLUSIONS: Register data can be utilized to find the strongest predictors of school non-completion. Predictors support multidisciplinary actions preventing non-completion by providing both early signals to target actions more specifically and indicators for monitoring the impact of preventative actions.

Citizens' digital footprints to support health promotion at the local level-PUHTI study, Finland.

BACKGROUND: We aimed to explore to the possibilities of utilizing automatically accumulating data on health-owned for example by local companies and non-governmental organizations-to complement traditional health data sources in health promotion work at the local level. METHODS: Data for the PUHTI study consisted of postal code level information on sport license holders, drug purchase and sales advertisements in a TOR online underground marketplace, and grocery sales in Tampere. Additionally, open population register data were utilized. An interactive reporting tool was prepared to show the well-being profile for each postal code area. Feedback from the tool's end-users was collected in interviews. RESULTS: The study showed that buying unhealthy food and alcohol, selling or buying drugs, and participating in organized sport activities differed by postal code areas according to its socioeconomic profile in the city of Tampere. The health and well-being planners and managers of Tampere found that the new type of data brought added value for the health promotion work at the local level. They perceived the interactive reporting tool as a good tool for planning, managing, allocating resources and preparing forecasts. CONCLUSIONS: Traditional health data collection methods-administrative registers and health surveys-are the cornerstone of local health promotion work. Digital footprints, including data accumulated about people's everyday lives outside the health service system, can provide additional information on health behaviour for various population groups. Combining new sources with traditional health data opens a new perspective for health promotion work at local and regional levels.

Asymmetric distribution of glucose transporter mRNA provides a growth advantage in yeast.

Asymmetric localization of mRNA is important for cell fate decisions in eukaryotes and provides the means for localized protein synthesis in a variety of cell types. Here, we show that hexose transporter mRNAs are retained in the mother cell of S. cerevisiae until metaphase-anaphase transition (MAT) and then are released into the bud. The retained mRNA was translationally less active but bound to ribosomes before MAT Importantly, when cells were shifted from starvation to glucose-rich conditions, HXT2 mRNA, but none of the other HXT mRNAs, was enriched in the bud after MAT This enrichment was dependent on the Ras/cAMP/PKA pathway, the APC ortholog Kar9, and nuclear segregation into the bud. Competition experiments between strains that only expressed one hexose transporter at a time revealed that HXT2 only cells grow faster than their counterparts when released from starvation. Therefore, asymmetric distribution of HXT2 mRNA provides a growth advantage for daughters, who are better prepared for nutritional changes in the environment. Our data provide evidence that asymmetric mRNA localization is an important factor in determining cellular fitness.

A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland.

BACKGROUND: Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors' roles in implementing the local obesity program. METHODS: Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009-2016 and five representatives of other core parties. RESULTS: Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children's lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process. CONCLUSION: Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.

Dampness and student-reported social climate: two multilevel mediation models.

BACKGROUND: Little previous research has analysed the relationship between schools' indoor air problems and schools' social climate. In this study, we analysed a) whether observed mould and dampness in a school building relates to students' perceptions of school climate (i.e. teacher-student relationships and class spirit) and b) whether reported subjective indoor air quality (IAQ) at the school level mediates this relationship. METHODS: The data analysed was created by merging two nationwide data sets: survey data from students, including information on subjective IAQ (N = 25,101 students), and data from schools, including information on mould and dampness in school buildings (N = 222). The data was analysed using multilevel mediational models. RESULTS: After the background variables were adjusted, schools' observed mould and dampness was not significantly related to neither student-perceived teacher-student relationships nor class spirit. However, our mediational models showed that there were significant indirect effects from schools' observed mould and dampness to outcome variables via school-level subjective IAQ: a) in schools with mould and dampness, students reported significantly poorer subjective IAQ (standardised ß = 0.34, p < 0.001) than in schools without; b) the worse the subjective IAQ at school level, the worse the student-reported teacher-student relationships (ß = 0.31, p = 0.001) and class spirit (ß = 0.25, p = 0.006). CONCLUSIONS: Problems in a school's indoor environment may impair the school's social climate to the degree that such problems decrease the school's perceived IAQ.

Students' school-level symptoms mediate the relationship between a school's observed moisture problems and students' subjective perceptions of indoor air quality.

Moisture damage can influence the subjective assessment of indoor air quality (subjective IAQ) in various ways. We studied whether the frequency of symptoms reported across students at school level mediates the relationship between observed mold and dampness in a school building and students' subjective IAQ. To answer this research question, we tested a multilevel path model. The analyzed data were created by merging two nationwide data sets: (a) survey data from students, including information on subjective IAQ (N = 24,786 students); (b) data from schools, including information on mold and dampness in a school building (N = 222). After the background variables were adjusted, schools' observed mold and dampness were directly and significantly related to poor subjective IAQ (standardized beta (ß)= 0.22, P = .002). In addition, in schools with mold and dampness, students reported significantly more symptoms (ß = 0.22, P = .023) than in schools without; the higher the prevalence of symptoms at school level, the worse the students' subjective IAQ (ß = 0.60, P < .001). This indirect path was significant (P = .023). In total, schools' observed mold and dampness and student-reported symptoms explained 52% of the between-school variance in subjective IAQ.

Parents' Participation in School Health Examinations for Their Adolescent Children in Finland.

Engaging parents in school health examinations can promote adolescents' well-being. We examined parents' participation in universal school health examinations in Finland reported by adolescents in school surveys (14 to 16-year-olds, N = 58,232). Further we studied variation between service providers and schools, and student and school-level factors in participation. National data were analyzed using multilevel logistic regression models. Less than half of the adolescents reported parents' participation. The variation between service providers and schools was large. Non-participation was associated with mother's low education, students' immigrant background, daily health complaints, heavy drinking, and discussion difficulties with parents. Boys and those who did not live with both mother and father had a higher risk for parents' non-participation. Adolescents with a long-term illness or being bullied reported participation more often. Inviting parents and the school health nurse resource were not associated with participation. Our results raise the question of barriers to participation in health examinations.

Access to a school health nurse and adolescent health needs in the universal school health service in Finland.

Universal school health services are expected to offer similar, needs-based services to all students across schools, service providers and students' socio-economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students' characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self-reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16-year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%-41%) and schools (0%-75%). Students with lower socio-economic background, poorer well-being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services.

Health in All Policies: From rhetoric to implementation and evaluation - the Finnish experience.

The principles of the Health in All Policies (HiAP) approach are not new. Their international roots can be traced back to 1978 and the Alma-Ata Declaration and the 1986 Ottawa Charter. In Finland, the roots of HiAP go back to 1972 when the Economic Council of Finland, chaired by the Prime Minister, launched the 'Report of the working group exploring the goals of health'. The paper discusses the history, rationale, and implementation of the principles underlying the umbrella concept of HiAP. A rationale for implementing a new concept - HiAP in 2006 during the Finnish European Union presidency - is given. The focus here will be on implementation of HiAP. International material supporting the implementation is introduced and practical examples from Finland presented. The Benchmarking System for Health Promotion Capacity Building is introduced, since it has been used as a primary source of information for monitoring and evaluating HiAP in Finland at the local level. The experience from Finland clearly indicates that HiAP as an approach and as a way of working requires long-term commitment and vision. For working across sectors it is crucial to have data on health and health determinants and analyses of the links between health outcomes, health determinants, and policies across sectors and levels of governance. Intersectoral structures, processes, and tools for the identification of problems and solutions, decisions, and implementation across sectors are prerequisites of HiAP. Legislative backing has proven to be useful, especially in providing continuation and sustainability.

Development of measurable indicators to enhance public health evidence-informed policy-making.

BACKGROUND: Ensuring health policies are informed by evidence still remains a challenge despite efforts devoted to this aim. Several tools and approaches aimed at fostering evidence-informed policy-making (EIPM) have been developed, yet there is a lack of availability of indicators specifically devoted to assess and support EIPM. The present study aims to overcome this by building a set of measurable indicators for EIPM intended to infer if and to what extent health-related policies are, or are expected to be, evidence-informed for the purposes of policy planning as well as formative and summative evaluations. METHODS: The indicators for EIPM were developed and validated at international level by means of a two-round internet-based Delphi study conducted within the European project 'REsearch into POlicy to enhance Physical Activity' (REPOPA). A total of 82 researchers and policy-makers from the six European countries (Denmark, Finland, Italy, the Netherlands, Romania, the United Kingdom) involved in the project and international organisations were asked to evaluate the relevance and feasibility of an initial set of 23 indicators developed by REPOPA researchers on the basis of literature and knowledge gathered from the previous phases of the project, and to propose new indicators. RESULTS: The first Delphi round led to the validation of 14 initial indicators and to the development of 8 additional indicators based on panellists' suggestions; the second round led to the validation of a further 11 indicators, including 6 proposed by panellists, and to the rejection of 6 indicators. A total of 25 indicators were validated, covering EIPM issues related to human resources, documentation, participation and monitoring, and stressing different levels of knowledge exchange and involvement of researchers and other stakeholders in policy development and evaluation. CONCLUSION: The study overcame the lack of availability of indicators to assess if and to what extent policies are realised in an evidence-informed manner thanks to the active contribution of researchers and policy-makers. These indicators are intended to become a shared resource usable by policy-makers, researchers and other stakeholders, with a crucial impact on fostering the development of policies informed by evidence.

Sales of tobacco and nicotine replacement therapy products, especially nicotine pouches, increased in Finland during the COVID-19 pandemic.

Aim: Some previous studies suggest that the consumption of tobacco and nicotine products overall declined during the COVID-19 pandemic, but the results are mixed. We investigated tobacco and nicotine product sales in Finland, including the sales of nicotine replacement therapy (NRT). Our particular focus was on nicotine pouches used as NRT. We aimed to evaluate the effect of the COVID-19 pandemic on the sales of tobacco and NRT products in 2020 by comparing the sales to the previous year. Methods: The data were derived from a large sales group (S group) in Finland, representing 46% of the market share in grocery trade in 2020. The gross weekly sales of tobacco (cigarettes, loose tobacco) and NRT (patches, inhalers, tablets, gum and "other", consisting mainly of nicotine pouches) were retrieved from February to December 2020 from 1062 points of sale throughout the country and compared to the same period in 2019. Results: During this period, there was a significant increase in cigarette sales. Moreover, the sales of NRT were significantly higher throughout 2020 compared with 2019. Specifically, the sales of nicotine pouches sold as NRT increased, especially after the travel restrictions in Finland were initiated and the national boundaries closed in the spring of 2020. Conclusions: During the COVID-19 pandemic in Finland, the sales of cigarettes and NRT products increased, especially those of nicotine pouches sold as NRT. Our findings call for further research to reveal the factors leading to this increase and to determine whether the situation is long-standing.

C(sp3)-F bond activation of CF3-substituted anilines with catalytically generated silicon cations: spectroscopic evidence for a hydride-bridged Ru-S dimer in the catalytic cycle.

Heterolytic splitting of the Si-H bond mediated by a Ru-S bond forms a sulfur-stabilized silicon cation that is sufficiently electrophilic to abstract fluoride from CF(3) groups attached to selected anilines. The ability of the Ru-H complex, generated in the cooperative activation step, to intramolecularly transfer its hydride to the intermediate carbenium ion (stabilized in the form of a cationic thioether complex) is markedly dependent on the electronic nature of its phosphine ligand. An electron-deficient phosphine thwarts the reduction step but, based on the Ru-S catalyst, half of an equivalent of an added alkoxide not only facilitates but also accelerates the catalysis. The intriguing effect is rationalized by the formation of a hydride-bridged Ru-S dimer that was detected by (1)H NMR spectroscopy. A refined catalytic cycle is proposed.

Catalytic generation of borenium ions by cooperative B-H bond activation: the elusive direct electrophilic borylation of nitrogen heterocycles with pinacolborane.

The B-H bond of typical boranes is heterolytically split by the polar Ru-S bond of a tethered ruthenium(II) thiolate complex, affording a ruthenium(II) hydride and borenium ions with a dative interaction with the sulfur atom. These stable adducts were spectroscopically characterized, and in one case, the B-H bond activation step was crystallographically verified, a snapshot of the σ-bond metathesis. The borenium ions derived from 9-borabicyclo[3.3.1]nonane dimer [(9-BBN)2], pinacolborane (pinBH), and catecholborane (catBH) allowed for electrophilic aromatic substitution of indoles. The unprecedented electrophilic borylation with the pinB cation was further elaborated for various nitrogen heterocycles.

Health in all policies-the Finnish initiative: background, principles, and current issues.

Many historical developments, such as the Alma Ata Declaration or the Ottawa Charter, have drawn attention to the need for intersectoral work and for considering the health aspects of different policy proposals. In the 1970s, Finland started broad actions to change national diets to reduce the high mortality associated with cardiovascular diseases (CVDs). This and other work in Finland have involved many sectors and policies, resulted in significant public health improvements, and paved the way for the Health in All Policies (HiAP) initiative started during the Finnish European Union (EU) presidency in 2006. The initiative and the principles have encouraged further developments in Finland and have been linked with related developments within the EU and the World Health Organization (WHO).

Is health recognized in the EU's policy process? An analysis of the European Commission's impact assessments.

BACKGROUND: The European Commission has an Impact Assessment (IA) procedure that aims to inform decision-makers of the all important impacts that decisions may have. This article studies how health is considered in the IA procedure and how it is reflected in the reports: what aspects, whose and simply in what context health is mentioned in the IA reports. METHODS: Half of the Commissions IAs from 2006 were studied. The analysis was text based and informed by content analysis. In total, 48 reports by 17 DGs were analysed. RESULTS: Five DGs (29%) and 10 reports (21%) made no reference to human health, public health or health systems. Five DGs were clearly considering health impacts more often than others; DG EMPL, SANCO, AGRI, ELARG and ENV. Health systems/services were most often and human health next most common referred to (39% and 29% of all, respectively). Health impacts were usually referred to in the sections on the definition of problems and the analysis of impacts. Seldom were they reported on in the sections on policy options, comparing options, or in the monitoring and evaluation sections. CONCLUSION: The results partly support concerns about the potential neglect of health impacts. The results also suggest that health is not considered an important factor when discussing alternative policy choices, and neither does it seem to be an important objective. There is a clear need for further exploration on ways in which health could be more appropriately considered when impacts of other policies are considered by the various DGs.

Quality of the contraceptive service structure: a pilot study in Finnish health centre organisations.

OBJECTIVES: To evaluate the quality of the contraceptive service structure in health centre organisations (HCOs) in western Finland and to establish whether the characteristics of the HCOs are associated with the quality measured. METHODS: Survey data were collected from all HCOs in a university hospital area in western Finland (N = 63). Quality was evaluated using a score of ten indicators. Associations between the score and the characteristics of the HCOs were studied using rank correlation analysis and a multivariate ordered logit model. RESULTS: Among 51 HCOs yielding complete data for the evaluation, the quality score ranged from 3 to 10, the mean being 5.8. From 25 variables studied, 'a chief nursing officer or leading nurse engaged in the HCO' (p = 0.001) and 'an appointed person responsible for management of health promotion' (p = 0.006) were found to be associated with a good score in the rank correlation analysis, and they also remained significant in multivariate analysis (Odds Ratio [OR] = 11.5, 95% confidence interval [CI] 2.3-56.5 and OR = 5.9, 95% CI 1.6-21.5, respectively). CONCLUSIONS: In the majority of the HCOs involved, the quality of service structure was rated average, but there was much variation between the HCOs. The results of the multivariate analysis emphasise the importance of good management of services.

The comparative and objective measurement of health promotion capacity-building: from conceptual framework to operationalization.

The aim of this study was to analyse and test a theoretical generic health promotion capacity-building framework with empirical data on primary health care. The framework consists of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation and other core functions. The data were collected in 2014 from all the health centres in Finland, of which 156 (99%) submitted their data. The data were scored by the quality of activities on a scale from 0 to 100, where 100 stands for desirable quality. Individual indicators were nested into subdimensions, which in turn were nested into the dimensions of the theoretical framework. Variables were clustered using the dimensions and subdimensions as initial partitions. The internal consistency of dimensions and subdimensions was tested with standardized Cronbach's alpha both before and after the clustering analysis. The results showed that although the internal consistency of the dimensions was high in the initial classification, it is possible to get even more consistent dimensions. The internal consistency of the initial classification varied from 0.62 in participation to 0.93 in common practices. In the clustering analysis, 45 out of 203 indicators were assigned to a dimension different from the initial partition. The biggest gain in internal consistency was achieved in the subdimension of systematic mass communications by relocating two indicators. This study suggests that it is possible to assess the health promotion capacity-building of organizations in a coherent way with comparable and objective indicators. These analyses also show that the number of indicators can be reduced. It would be interesting to see how the framework works in other governmental structures or political contexts.

Psychosocial Problems, Indoor Air-Related Symptoms, and Perceived Indoor Air Quality among Students in Schools without Indoor Air Problems: A Longitudinal Study.

The effect of students' psychosocial problems on their reporting of indoor air quality (subjective IAQ) and indoor air-related (IA-related) symptoms has not been studied in schools in a longitudinal setting. Therefore, we analyzed whether changes in students' psychosocial problems (socioemotional difficulties and perceived teacher⁻student relations) between the beginning of seventh grade (age 12⁻13 years) and the end of ninth grade (15⁻16 years) predicted subjective IAQ and IA-related symptoms at the end of ninth grade. In order to explore the independent effect of psychosocial factors, we focused only on students in schools without observed indoor air problems. The analysis was of longitudinal data (N = 986 students) using latent change modelling. Increased socioemotional difficulties were related to more IA-related symptoms (standardized beta = 0.20) and deteriorated subjective IAQ (standardized beta = 0.20). Increased problems in teacher⁻student relations were related to deteriorated subjective IAQ (standardized beta = 0.21). Although students' psychosocial problems explained only 9⁻13% of the total variances, our findings support the notion that psychosocial factors also need to be taken into account in the evaluation of IAQ and the prevalence of IA-related symptoms in schools.

Indoor air problems and the perceived social climate in schools: A multilevel structural equation analysis.

Indoor air problems in schools appear to influence learning outcomes and absence rates. However, previous research has not investigated whether indoor air problems influence the social climate of schools. Therefore, we studied whether indoor air problems observed in schools associate with students' perceptions of the teacher-student relationship and class spirit. The nationwide sample of Finnish schools (N=194 schools/27153 students) was analyzed using multilevel structural equation modeling. Data on the schools' social climate collected from students were merged with independently collected data on observed indoor air problems from school principals. We found that the teacher-student relationship was reported to be worse in schools with observed indoor air problems compared to those without observed indoor air problems. Furthermore, the reported class spirit was worse in schools with observed indoor air problems, but only among students with a high grade point average. Our findings indicate that indoor air problems may affect the student-perceived social climate.