Kuntien rakennuskannan kehitys- ja säästöpotentiaali

Tutkimushankkeessa selvitettiin kuntien rakennuskannan nykytilannetta ja ennusteita maakunta- ja sote-uudistuksen jälkeiselle ajalle, arvioitiin rakennuskantaan sisältyvää kehitys- ja säästöpotentiaalia sekä tunnistettiin keskeisimmät keinot potentiaalin hyödyntämiseksi. Kunnat ovat kooltaan, rakenteiltaan ja taloudeltaan erilaisia, mutta kaikille keskeisin haaste toimitilakysymyksissä on, kuinka kukin kunta pystyy jatkossa sopeuttamaan rakennuskantansa palvelutarvettaan vastaavaksi niin, että siinä otetaan huomioon muuttuvat tarpeet myös pitkälle tulevaisuuteen. Kuntien rakennuskannassa on selkeästi merkittävää kehitys- ja säästöpotentiaalia, joka koostuu mm. tyhjistä, vajaakäyttöisistä ja käyttötarkoitukseensa sopimattomista rakennuksista sekä energiatehokkuudesta. Potentiaalin hyödyntäminen ei kuitenkaan ole nopealla aikataululla mahdollista, vaan vaatii pitkäaikaisia, valtakunnallisia ja kuntakohtaisia toimenpiteitä. Erityisesti toimenpiteet tulee kohdistaa väestöään menettäneisiin kuntiin ja kaupunkeihin. Tutkimushankkeessa määritettiin kymmenen tärkeintä strategista ja operatiivista toimenpidettä, joiden avulla kuntia tuetaan oman kuntakohtaisen kehitys-ja säästöpotentiaalin tunnistamisessa, analysoinnissa, suunnittelussa ja toteuttamisessa ja joiden avulla kunnat pystyvät parantamaan taloutensa vakautta, vähentämään massiivista korjausvelkaa ja pääsemään vähitellen eroon myös rakennusterveysongelmist

From Pubs to Scrubs: Alcohol Misuse and Health Care Use

To analyze the relationships between alcohol misuse and two types of acute health care use—hospital admissions and emergency room (ER) episodes. Data Sources/Study Setting . The first (2001/2002) and second (2004/2005) waves of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC). Study Design . Longitudinal study using a group of adults (18–60 years in Wave 1, N =23,079). Gender-stratified regression analysis adjusted for a range of covariates associated with health care use. First-difference methods corrected for potential omitted variable bias. Data Collection . The target population of the NESARC was the civilian noninstitutionalized population aged 18 and older residing in the United States and the District of Columbia. The survey response rate was 81 percent in Wave 1 ( N =43,093) and 65 percent in Wave 2 ( N =34,653). Principal Findings . Frequent drinking to intoxication was positively associated with hospital admissions for both men and women and increased the likelihood of using ER services for women. Alcohol dependence and/or abuse was related to higher use of ER services for both genders and increased hospitalizations for men. Conclusions . These findings provide updated and nationally representative estimates of the relationships between alcohol misuse and health care use, and they underscore the potential implications of alcohol misuse on health care expenditures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73063/1/j.1475-6773.2009.00987.x.pd

Weight reduction is not a major reason for improvement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediterranean diets

OBJECTIVES: Several investigators have reported that clinical improvements of patients with rheumatoid arthritis (RA), from participating in therapeutic diet intervention studies, have been accompanied by loss of body weight. This has raised the question whether weight reduction per se can improve RA. In order to test this hypothesis, three previously conducted diet intervention studies, comprising 95 patients with RA, were pooled. Together with Age, Gender, and Disease Duration, change during the test period in body weight, characterised dichotomously as reduction or no reduction (dichoΔBody Weight), as well as Diet (dichotomously as ordinary diet or test diet), were the independent variables. Dependent variables were the difference (Δ) from baseline to conclusion of the study in five different disease outcome measures. ΔESR and ΔPain Score were both characterised numerically and dichotomously (improvement or no improvement). ΔAcute Phase Response, ΔPhysical Function, and ΔTender Joint Count were characterised dichotomously only. Multiple logistic regression was used to analyse associations between the independent and the disease outcome variables. RESULTS: Statistically significant correlations were found between Diet and three disease outcome variables i.e. ΔAcute-Phase Response, ΔPain Score, and ΔPhysical Function. Δ Body Weight was univariately only correlated to ΔAcute-Phase Response but not significant when diet was taken into account. CONCLUSION: Body weight reduction did not significantly contribute to the improvement in rheumatoid arthritis when eating lacto-vegetarian, vegan or Mediterranean diets

The effects of alcohol consumption, psychological distress and smoking status on emergency department presentations in New South Wales, Australia

BACKGROUND: Despite clear links between risky alcohol consumption, mental health problems and smoking with increased morbidity and mortality, there is inconclusive evidence about how these risk factors combine and if they are associated with increased attendance at emergency departments. This paper examines the population-level associations and interactions between alcohol consumption, psychological distress and smoking status with having presented to an emergency department in the last 12 months. METHODS: This study uses data from a representative sample of 34,974 participants aged 16 years and over from the New South Wales Population Health Survey, administered between 2002 and 2004. Statistical analysis included univariate statistics, cross-tabulations, and the estimation of prevalence rate ratios using Cox's proportional hazard regression model. RESULTS: Results show that high-risk alcohol consumption, high psychological distress and current smoking were all significantly and independently associated with a greater likelihood of presenting to an emergency department in the last year. Presenting to an emergency department was found to be three times more likely for women aged 30 to 59 years with all three risk factors and ten times more likely for women aged 60 years or more who reported high risk alcohol consumption and high psychological distress than women of these age groups without these risk factors. For persons aged 16 to 29 years, having high-risk alcohol consumption and being a current smoker doubles the risk of presenting to an emergency department. CONCLUSION: The combination of being a high-risk consumer of alcohol, having high psychological distress, and being a current smoker are associated with increased presentations to emergency departments, independent of age and sex. Further research is needed to enhance recognition of and intervention for these symptoms in an emergency department setting in order to improve patient health and reduce future re-presentations to emergency departments

Distinguishing four components underlying physical activity: a new approach to using physical activity questionnaire data in old age

<p>Abstract</p> <p>Background</p> <p>It is evident that physical activity has many benefits, but it often remains unclear which types of activity are optimal for health and functioning in old age. The aim of this methodological study was to propose a method for distinguishing four components underlying self reported physical activity of older adults: intensity, muscle strength, turning actions and mechanical strain.</p> <p>Methods</p> <p>Physical activity was assessed by the validated LAPAQ questionnaire among 1699 older adults of the Longitudinal Aging Study Amsterdam. Based on expert consultation and literature review, the four component scores for several individual daily and sports activities were developed. Factor analysis was performed to confirm whether the developed components indeed measured different constructs of physical activity.</p> <p>Results</p> <p>Based on the factor analyses, three components were distinguished: 1. intensity and muscle strength loaded on the same factor, 2. mechanical strain and 3. turning actions. Analyses in gender, age and activity level subgroups consistently distinguished three factors.</p> <p>Conclusion</p> <p>Future research using these components may contribute to our understanding of how specific daily and sports activities may have a different influence on health and physical functioning in old age.</p

Behavioural Risk Factors in Mid-Life Associated with Successful Ageing, Disability, Dementia and Frailty in Later Life: A Rapid Systematic Review.

BACKGROUND: Smoking, alcohol consumption, poor diet and low levels of physical activity significantly contribute to the burden of illness in developed countries. Whilst the links between specific and multiple risk behaviours and individual chronic conditions are well documented, the impact of these behaviours in mid-life across a range of later life outcomes has yet to be comprehensively assessed. This review aimed to provide an overview of behavioural risk factors in mid-life that are associated with successful ageing and the primary prevention or delay of disability, dementia, frailty and non-communicable chronic conditions. METHODS: A literature search was conducted to identify cohort studies published in English since 2000 up to Dec 2014. Multivariate analyses and a minimum follow-up of five years were required for inclusion. Two reviewers screened titles, abstracts and papers independently. Studies were assessed for quality. Evidence was synthesised by mid-life behavioural risk for a range of late life outcomes. FINDINGS: This search located 10,338 individual references, of which 164 are included in this review. Follow-up data ranged from five years to 36 years. Outcomes include dementia, frailty, disability and cardiovascular disease. There is consistent evidence of beneficial associations between mid-life physical activity, healthy ageing and disease outcomes. Across all populations studied there is consistent evidence that mid-life smoking has a detrimental effect on health. Evidence specific to alcohol consumption was mixed. Limited, but supportive, evidence was available relating specifically to mid-life diet, leisure and social activities or health inequalities. CONCLUSIONS: There is consistent evidence of associations between mid-life behaviours and a range of late life outcomes. The promotion of physical activity, healthy diet and smoking cessation in all mid-life populations should be encouraged for successful ageing and the prevention of disability and chronic disease.This work was funded by the National Institute for Health and Care Excellence (NICE), invitation to tender reference DDER 42013, and supported by the National Institute for Health Research School for Public Health Research. The scope of the work was defined by NICE and the protocol was agreed with NICE prior to the start of work. The funders had no role in data analysis, preparation of the manuscript or decision to publish.This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pone.014440

Associations of Smoking, Alcohol Consumption and Physical Activity with Health and Health Care Utilization - A Prospective Follow-up of Middle-aged and Elderly Men and Women

Fyysinen aktiivisuus ja tupakoimattomuus suojaavat pitkäaikaissairauksilta ja vähentävät terveyspalvelujen käyttöä Tupakointi, runsas alkoholin käyttö ja fyysinen inaktiivisuus ovat monien pitkäaikaissairauksien ja ennenaikaisen kuolleisuuden tunnettuja vaaratekijöitä erityisesti miehillä. Väestöpohjaista tietoa kyseisten elintapojen yhteydestä miesten ja naisten terveyspalvelujen käyttöön ja kustannuksiin on sen sijaan kansainvälisestikin tarkasteltuna vähän. THM, KTK Nina Haapanen-Niemen Tampereen yliopistossa tarkastettavassa ja UKK-instituutissa toteutetussa väitöskirjatutkimuksessa selvitettiin eri elintapojen, erityisesti vapaa-ajan fyysisen aktiivisuuden yhteyttä terveyteen ja terveyspalvelujen käyttöön 16 vuoden seurannan aikana kainuulaista aikuisväestöä edustavassa otoksessa. Seurantaan osallistuneet reilut 5000 miestä ja naista olivat tutkimuksen alkaessa 19-63-vuotiaita. Arkiaktiivisuus suojaa ennenaikaiselta kuolemalta Tutkimus osoitti, että viikoittain kunto- ja arkiliikunnasta kertyvä runsas fyysinen aktiivisuus suojasi keski-ikäisiä ja vanhempia miehiä ja naisia ennenaikaiselta kokonais- ja sydän- ja verisuonitautikuoleman vaaralta. Fyysisesti inaktiivisten miesten kokonaiskuoleman vaara oli noin kaksinkertainen ja sydän- ja verisuonitautikuoleman vaara jopa yli kolminkertainen fyysisesti aktiivisimpiin miehiin verrattuna. Yksittäisistä liikuntamuodoista merkitystä oli erityisesti metsätöillä sekä piha- ja puutarhatöillä. Fyysinen aktiivisuus suojaa pitkäaikaissairauksilta Fyysisellä aktiivisuudella oli miehillä erityisesti sepelvaltimotautiin ja verenpainetautiin sairastumista suojaavaa vaikutusta. Naisilla korostui puolestaan aktiivisuuden suojaava vaikutus diabetesta vastaan. Tutkimus viittaa siihen, että fyysisen aktiivisuuden suojavaikutus voi erota miesten ja naisten välillä, mutta myös erot sukupuolten päivittäisen aktiivisuuden muodostumisessa saattavat johtaa erilaisiin terveysvaikutuksiin. Fyysinen aktiivisuus ja tupakoimattomuus vähentävät sairaala- ja avoterveydenhuollon palvelujen käyttöä 16 vuoden seurannan aikana tupakoivilla miehillä ja naisilla oli 50-70 % enemmän sairaalapäiviä kuin tupakoimattomilla tutkittavilla. Tupakoivat miehet ja naiset kuormittivat myös avoterveydenhuollon lääkäripalveluja tupakoimattomia enemmän. Tupakoivien miesten ja naisten lisääntynyt terveyspalvelujen käyttö heijastui myös terveyspalvelujen käytöstä aiheutuneiden kustannusten kasvuna. Fyysinen aktiivisuus vähensi niin ikään sairaalapalvelujen käyttöä fyysisesti inaktiivisiin tutkittaviin verrattuna. Fyysisesti inaktiivisilla miehillä oli 16 vuoden seuranta-aikana 36 % ja naisilla 23 % enemmän sairaalavuorokausia kuin aktiivisimmilla tutkittavilla. Terveitä elintapoja suosivaa terveyspolitiikkaa Tutkimuslöydökset elintapojen vaikutuksista terveyteen sekä terveyspalvelujen käyttöön ja kustannuksiin tukevat terveyspoliittisia päämääriä terveellisten elintapojen edistämiseksi väestössä. Fyysisen aktiivisuuden osalta huomiota tulee kiinnittää erityisesti myös turvallisuuteen, jotta liikuntatapaturmia ja niistä aiheutuvaa terveyspalvelujen käyttöä voitaisiin vähentää.The primary purpose of this study was to assess and compare, in the context of public health policy, the role of smoking, alcohol consumption and leisure time physical activity (LTPA) for health and health care utilization during a 16-year follow-up period among middle-aged and elderly men and women. Most of the morbidity data were based on responses to a self-administered questionnaire, and the purpose of study I was therefore to ensure the valid use of questionnaire-based morbidity data. As a consequence, in study I, the agreement between selected self-reported diseases in a questionnaire survey and data from medical records was assessed using a random sample of men and women (n = 596) initially aged 35-63 years. The agreement between the two sources was substantial (kappa 0.73-0.80) for cardiovascular diseases (CVD) as a group, hypertension, angina pectoris, and diabetes. In accordance with current evidence, the lowest agreement (kappa Study I indicated that self-reported information on coronary heart disease (CHD), hypertension and diabetes is likely to be valid. Thereafter study II was designed to determine the effect of these selected diseases and LTPA in a cohort of 1340 men and 1500 women initially aged 35-63 years during a 10-year follow-up. Among the men, an active life-style decreased the risk of CHD and hypertension, while among the women a protective effect against non-insulin-dependent-diabetes (NIDDM) was found. The results indicate that the protective effect of LTPA can differ for men and women, and the relative importance of the total amount and the intensity can vary depending on the outcome measure. Differences in the type of LTPA in which men and women are engaged may also lead to different health-related effects. Study III was targeted to investigate the effect of LTPA on the risk of premature all-cause and CVD mortality in a cohort of men and women initially aged 35-63 years in a 10-year, 10-month follow-up period. A high level of LTPA, as assessed by a physical activity index computed as an estimate of weekly energy expenditure for leisure-time activity and commuting to and from work, and participation in several specific activities of daily living and domestic chores, including forestry work, gardening and growing vegetables, had a protective effect against premature mortality from both all causes and CVD. Therefore, in this study sample, representing a rural region of Finland, the results highlight the role of the total amount of activity through an active way of life, as also recommended in recent physical activity guidelines. Study IV was targeted to examine the effect of smoking, alcohol consumption, and LTPA on the use of hospital services among a cohort of 19- to 63-year-old men (n = 2534) and women (n = 2668) followed for 16 years. In accordance with the morbidity and mortality data of the overall project and also the results of others, male and female non-smokers and physically active subjects used hospital and outpatient physician services less than current smokers and physically inactive subjects. During the 16-year follow-up the initially 19- to 63-year-old male smokers had 70% more hospital days due to any reason than the never smokers did, and the female smokers had 49% more such days after adjustment for age, socioeconomic status, and total alcohol consumption (study IV). The increased use of hospital days and outpatient physician visits among male and female smokers was reflected also as increased costs for health care compared with never smokers. Similarly, in comparison with the most active men, those with a low level of total energy expenditure during LTPA had 36% more hospital days after adjustment for age, socioeconomic status, smoking and total alcohol consumption. Sedentary women had 23% more hospital days than women who were physically active. Surprisingly, however, the increased use of hospital care among physically inactive men was not reflected as an increase in costs for hospital care. In contrast to the numerous studies showing J- or U-shaped alcohol-related health effects, alcohol consumption did not determine the use of hospital services in this study. This relationship may have been attenuated, at least partly, by the small number of high-volume drinkers, especially among the women. Overall, smoking, excess alcohol consumption and low-level LTPA were important risk factors for morbidity and mortality. Smoking and low-level LTPA increased the utilization of health care services, especially the use of hospital services. Surprisingly, however, the impact of smoking on health care costs was substantial, while that of low-level LTPA was not. The results support the objectives of public health policy that advocate a reduction of the prevalence of poor living habits as a means of improving the functioning and quality of life of the population, preventing its suffering from premature morbidity, and prolonging its survival