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(sic)/QALY was 63.0% (243(sic)) 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.Peer reviewe

Pelvic organ prolapse surgery and quality of life-a nationwide cohort study : Nationwide cohort study

BACKGROUND: Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE: To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN: This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS: In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of ImprovementI. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58-2.70) and vaginal bulge (1.90, 1.30-2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02-2.81). CONCLUSION: Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.Peer reviewe

Sexual Activity and Dyspareunia After Pelvic Organ Prolapse Surgery : A 5-Year Nationwide Follow-up Study

Background: Even though surgery generally improves sexual function and alleviates dyspareunia related to pelvic organ prolapse (POP), knowledge of the long-term effects is scarce. Objective: To describe changes in sexual activity and dyspareunia rates after POP surgery and to identify potential risk factors for the occurrence of dyspareunia. Design, setting, and participants: This was a prospective longitudinal cohort study of women aged over 18 yr undergoing POP surgery in Finland during 2015. Out of 3515 participants, sexual activity and dyspareunia data were available at baseline, 6 mo, 2 yr, and 5 yr for 79%, 68%, 63%, and 57%, respectively. Intervention: Native tissue, transvaginal mesh, and abdominal mesh repair. Outcome measurements and statistical analysis: Rates of sexual activity and dyspareunia were assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) at baseline and at 6 mo, 2 yr, and 5 yr after surgery. As a secondary outcome, risk factors for overall, persisting, and de novo dyspareunia were assessed using logistic regression models. Results and limitations: The proportion of sexually active women increased from 40.7% to 43% after surgery. Preoperative dyspareunia resolved in >50% of cases during the first 6 mo, irrespective of the surgical approach. De novo dyspareunia rates were low at all time points (1.9–3.1%). Several potential risk factors associated with preoperative and postoperative dyspareunia were identified: younger age, lower preoperative body mass index, lower prolapse stage at baseline, either pelvic pain or dyspareunia at baseline, prior surgery (stress urinary incontinence surgery, posterior colporrhaphy, POP surgery, hysterectomy), and posterior repair. Conclusions: Dyspareunia is significantly reduced after POP repair irrespective of the surgical approach. However, multiple factors seem to be associated with persisting and de novo symptoms, which should be considered in preoperative counseling. Patient summary: Our 5-year follow-up study demonstrates that surgery to repair pelvic organ prolapse (POP) in women improves sexual activity and reduces painful intercourse. Multiple factors, such as preoperative pain, previous POP surgery, and prolapse stage, may be associated with painful intercourse after surgery.publishedVersionPeer reviewe

Impact of type 2 diabetes treated with non-insulin medication and number of diabetes-coexisting diseases on EQ-5D-5L index scores in the Finnish population

Background: Type 2 diabetes (T2D) causes significant health and economic burden. In addition to comorbidities there are also coexisting diseases linked to obesity, lifestyle and T2D. The aim of this study was to examine the effect of T2D and T2D-coexisting diseases on health-related quality of life (HRQoL) in the Finnish population and whether it is T2D or the coexisting diseases that have the largest impact on HRQoL.Methods: The study was based on a national cross-sectional population survey (n=5305). Respondents' HRQoL was measured using the EQ-5D-5L instrument. Our study included diabetic respondents treated with non-insulin medications (NI-T2D) with or without insulin and non-diabetic respondents, whereas diabetic respondents not taking any anti-diabetic medications or treated with insulin alone were excluded. A crosswalk algorithm was used to convert EQ-5D-5L index scores into EQ-5D-3L index scores as a sensitivity analysis. A two-part model was used to examine the association between T2D and coexisting diseases and HRQoL.Results: The unadjusted mean (SD) EQ-5D-5L index scores for non-diabetics (n=4856) was 0.90 (0.13) and 0.85 (0.16) for respondents with NI-T2D (n=449). With adjustment for demographic factors, the difference in EQ-5D-5L index scores was 0.036 (95% CI 0.023-0.050). After adjusting for the number of coexisting diseases, the EQ-5D-5L index scores among respondents with NI-T2D and three or more coexisting diseases were lower when compared to all non-diabetics but not when compared to non-diabetics with similar number of coexisting diseases. The number of T2D-coexisting diseases had a larger effect on EQ-5D-5L index scores in younger age groups (20 and 40years old).Conclusions: Lower EQ-5D-5L index score is associated with NI-T2D when compared to non-diabetic respondents. When compared to non-diabetics, the disutility associated with NI-T2D increases as more coexisting diseases appear. The disutility effect of coexisting diseases was equally large in non-diabetics and respondents with NI-T2D. Thus, public health interventions targeting the prevention of both T2D and its coexisting diseases have potential to have significant benefits also in terms of HRQoL.</p

Healthy people in healthy premises : the Finnish Indoor Air and Health Programme 2018-2028

Clean and fresh indoor air supports health and well-being. However, indoor air can contain pollutants that can cause a variety of symptoms and reduce well-being. Individual exposure agents can also increase the risk of certain diseases. Finns have taken major steps to improve the quality of indoor air for several decades. The primary focus of these activities has been the prevention and reduction of exposure to poor indoor air quality through guidance and regulation directing remediation of damaged buildings. Nevertheless, reported symptoms related to poor indoor air quality are common in Finland. In addition to exposure to indoor air pollutants, this may be partly due to the lively public discussion on the health risks caused by poor indoor air quality, conflicting views between experts, and mistrust towards public authorities, building owners and builders. Because of the scale of the indoor air problems in Finland, people's needs for reliable information and support, and the major costs involved, there is a call for new evidence-based methods, perspectives and solutions. Therefore, the Finnish Institute for Health and Welfare initiated the Finnish Indoor Air and Health Programme 2018-2028 together with a number of collaborators and stakeholders. The primary, long-term objective of the programme is to reduce hazards to health and well-being linked to indoor environments in Finland. To fulfill this objective, the programme will focus on the promotion of human health and well-being, the prevention of hazards, improved communication and engage the whole health-care sector to manage better patients ' symptoms and complaints. The 10-year Finnish Indoor Air and Health Programme consists of four areas that aim (1) to increase understanding of the effects of indoor environments on health and well-being; (2) to develop the management of problems linked to indoor environments; (3) to improve the treatment and working and functional capacity of people with symptoms and illnesses; and (4) to strengthen the competence in matters related to indoor environments. The progress of the programme and reaching the predefined, quantitative goals will be monitored throughout the programme.Peer reviewe

Healthy people in healthy premises: the Finnish Indoor Air and Health Programme 2018–2028

Abstract Clean and fresh indoor air supports health and well-being. However, indoor air can contain pollutants that can cause a variety of symptoms and reduce well-being. Individual exposure agents can also increase the risk of certain diseases. Finns have taken major steps to improve the quality of indoor air for several decades. The primary focus of these activities has been the prevention and reduction of exposure to poor indoor air quality through guidance and regulation directing remediation of damaged buildings. Nevertheless, reported symptoms related to poor indoor air quality are common in Finland. In addition to exposure to indoor air pollutants, this may be partly due to the lively public discussion on the health risks caused by poor indoor air quality, conflicting views between experts, and mistrust towards public authorities, building owners and builders. Because of the scale of the indoor air problems in Finland, people’s needs for reliable information and support, and the major costs involved, there is a call for new evidence-based methods, perspectives and solutions. Therefore, the Finnish Institute for Health and Welfare initiated the Finnish Indoor Air and Health Programme 2018–2028 together with a number of collaborators and stakeholders. The primary, long-term objective of the programme is to reduce hazards to health and well-being linked to indoor environments in Finland. To fulfill this objective, the programme will focus on the promotion of human health and well-being, the prevention of hazards, improved communication and engage the whole health-care sector to manage better patients´ symptoms and complaints. The 10-year Finnish Indoor Air and Health Programme consists of four areas that aim (1) to increase understanding of the effects of indoor environments on health and well-being; (2) to develop the management of problems linked to indoor environments; (3) to improve the treatment and working and functional capacity of people with symptoms and illnesses; and (4) to strengthen the competence in matters related to indoor environments. The progress of the programme and reaching the predefined, quantitative goals will be monitored throughout the programme

Sisäilma ja terveys: kehitys, nykytilanne, seuranta ja vertailu eri maiden sekä julkisen ja yksityisen sektorin välillä

Tässä selvityksessä kartoitettiin Suomen sisäilman laadun nykytilaa ja sisäilmaongelmien määrää yksityisellä ja julkisella sektorilla sekä verrattiin tuloksia Ruotsin sisäilmatilanteeseen. Kuntien omistamissa ja käyttämissä rakennuksissa merkittäviä sisäilmaongelmia esiintyy 5–18 % rakennusten kokonaisneliömäärästä. Suomen ja Ruotsin kunnissa esiintyi lähes yhtä paljon merkittäviä sisäilmaongelmia, mutta yleisimmät syyt sisäilmaongelmien taustalla poikkesivat maiden välillä. Kiinteistökannan ikärakenne ja riittämättömät investoinnit nähtiin merkittävimpänä taustasyinä sisäilmaongelmille molemmissa maissa. Sisäilma-asioiden huomioiminen strategisella tasolla merkitsi usein toimivia sisäilmaongelmien käsittelyprosesseja ja parempaa sisäilmatilanteen hallintaa. Kyselytutkimuksien mukaan merkittävä osa suomalaisista on kokenut saaneensa oireita sisäilmasta joskus elämänsä aikana. Valtaosa ihmisistä raportoi oireiden olevan vaikeusasteeltaan lieviä tai kohtalaisia. Sisäilmaan liitetty oireilu on huomattavasti yleisempää työpaikoilla kuin kotona. Työpaikoilla kunta-alan työntekijät ja heistä hoito- ja opetustyötä tekevät työntekijät kokevat yleisemmin sisäilmaan liitettyjä oireita ja olosuhdehaittoja. Kuntien, valtion, yliopistokiinteistöjen ja sairaanhoitopiirin toimintatavat kiinteistöjen kunnon ja sisäilmaongelmien selvittämisessä ohjaavat eri tahoja yhteistyöhön ja prosessimaiseen etenemiseen. Rakennuksen omistussuhde vaikutti toimintamalleissa lähinnä vastuisiin ja rooleihin. Tarvitaan uusia keinoja vahvistaa eri toimijoiden yhteistyötä ja rooleja sisäilmaongelmien ratkaisemisessa. Kunnilla on edelleen tarve keskitetylle ohjeistukselle terveydellisen riskin arviointiin sekä lisäksi kaivataan käytäntöjä ja tukea, miten hallita julkisen paineen vaikutusta kunnallisessa päätöksen teossa. Riskiviestinnän osaamisen ja viestinnän toimintatapojen kehittämisen tarve on ilmeinen.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Taipuu vaan ei taitu - koronapandemiasta Suomen kriisinkestävyyden vahvistamiseen

SUOMALAINEN TIEDEAKATEMIA kokosi monitieteisen asiantuntijaryhmän esittämään näkemyksensä Suomen kriisinkestävyydestä koronapandemiakriisin oppien nojalla, tavoitteena vahva ja palautumiskykyinen Suomi. Kannanotto katsoo tulevaan pitemmällä aikavälillä kuin välitön toipuminen ajankohtaisesta kriisistä

Sisäilma ja terveys : kehitys, nykytilanne, seuranta ja vertailu eri maiden sekä julkisen ja yksityisen sektorin välillä

Tässä selvityksessä kartoitettiin Suomen sisäilman laadun nykytilaa ja sisäilmaongelmien määrää yksityisellä ja julkisella sektorilla sekä verrattiin tuloksia Ruotsin sisäilmatilanteeseen. Kuntien omistamissa ja käyttämissä rakennuksissa merkittäviä sisäilmaongelmia esiintyy 5–18 % rakennusten kokonaisneliömäärästä. Suomen ja Ruotsin kunnissa esiintyi lähes yhtä paljon merkittäviä sisäilmaongelmia, mutta yleisimmät syyt sisäilmaongelmien taustalla poikkesivat maiden välillä. Kiinteistökannan ikärakenne ja riittämättömät investoinnit nähtiin merkittävimpänä taustasyinä sisäilmaongelmille molemmissa maissa. Sisäilma-asioiden huomioiminen strategisella tasolla merkitsi usein toimivia sisäilmaongelmien käsittelyprosesseja ja parempaa sisäilmatilanteen hallintaa. Kyselytutkimuksien mukaan merkittävä osa suomalaisista on kokenut saaneensa oireita sisäilmasta joskus elämänsä aikana. Valtaosa ihmisistä raportoi oireiden olevan vaikeusasteeltaan lieviä tai kohtalaisia. Sisäilmaan liitetty oireilu on huomattavasti yleisempää työpaikoilla kuin kotona. Työpaikoilla kunta-alan työntekijät ja heistä hoito- ja opetustyötä tekevät työntekijät kokevat yleisemmin sisäilmaan liitettyjä oireita ja olosuhdehaittoja. Kuntien, valtion, yliopistokiinteistöjen ja sairaanhoitopiirin toimintatavat kiinteistöjen kunnon ja sisäilmaongelmien selvittämisessä ohjaavat eri tahoja yhteistyöhön ja prosessimaiseen etenemiseen. Rakennuksen omistussuhde vaikutti toimintamalleissa lähinnä vastuisiin ja rooleihin. Tarvitaan uusia keinoja vahvistaa eri toimijoiden yhteistyötä ja rooleja sisäilmaongelmien ratkaisemisessa. Kunnilla on edelleen tarve keskitetylle ohjeistukselle terveydellisen riskin arviointiin sekä lisäksi kaivataan käytäntöjä ja tukea, miten hallita julkisen paineen vaikutusta kunnallisessa päätöksen teossa. Riskiviestinnän osaamisen ja viestinnän toimintatapojen kehittämisen tarve on ilmeinen.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä