Adverse Childhood Experiences and Risk of Binge Drinking and Drunkenness in Middle-Aged Finnish Men

Objective. The purpose of this study was to investigate associations between adverse childhood experiences and binge drinking and drunkenness in adulthood using both historical and recalled data from childhood. Methods. Data on childhood adverse experiences were collected from school health records and questionnaires completed in adulthood. Adulthood data were obtained from the baseline examinations of the male participants (n = 2682) in the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) in 1984–1989 from eastern Finland. School health records from the 1930s to 1950s were available for a subsample of KIHD men (n = 952). Results. According to the school health records, men who had adverse childhood experiences had a 1.51-fold (95% CI 1.05 to 2.18) age- and examination-year adjusted odds of binge drinking in adulthood. After adjustment for socioeconomic position in adulthood or behavioural factors in adulthood, the association remained unchanged. Adjustment for socioeconomic position in childhood attenuated these effects. Also the recalled data showed associations with adverse childhood experiences and binge drinking with different beverages. Conclusions. Our findings suggest that childhood adversities are associated with increased risk of binge drinking in adulthood

The Need for a Paradigm Shift in the Existing Strategies for Effective COVID-19 Control

Non peer reviewe

Simulation of the Progression of the COVID-19 Outbreak in Northwest Syria Using a Basic and Adjusted SIR Model

Syria has experienced armed conflict since 2011, and the provision of health care has been severely compromised due to the hostilities. At the time of writing, Northwest Syria (NWS) was outside governmental control and faced the challenges of the COVID-19 outbreak. Since the emergence of this disease, several studies have looked at the dynamics of COVID-19 transmission, predicted its progression, and determined the impact of different preventive measures. While most of these studies’ settings were in stable contexts, this study investigated the progression of the COVID-19 pandemic in Northwest Syria, a conflict-affected region, for nine months (from July 2020 to March 2021) using the Suspected-Infected-Removed (SIR) model. We adjusted the SIR model to study the impact of wearing facial masks on the outbreak dynamics and progression. Based on available data and using the basic and adjusted SIR models, we estimated the value of the basic reproduction number (R0), which provides an initial prediction of disease progression. Using the basic SIR model, the estimated R0 for the first wave of SARS-CoV-2 in Northwest Syria was 2.38. The resulting figures were overestimated in comparison with the reported numbers and data on the COVID-19 pandemic. However, the results were significantly reasonable when we adjusted the model for a preventive measure (in this case, wearing face masks). Face masks, the most available preventive measure to be applied in emergency and conflict settings, remarkably affect the outbreak dynamics and may play a key role in controlling and limiting the spread of COVID-19. The novelty of the study is provided by simulating the progress of the COVID-19 outbreak in conflict settings, as it is the first study to predict the dynamics of COVID-19 disease in NWS by adjusting for face-mask-wearing as a preventive measure to explore its impact on outbreak dynamics

Simulation of the Progression of the COVID-19 Outbreak in Northwest Syria Using a Basic and Adjusted SIR Model

Syria has experienced armed conflict since 2011, and the provision of health care has been severely compromised due to the hostilities. At the time of writing, Northwest Syria (NWS) was outside governmental control and faced the challenges of the COVID-19 outbreak. Since the emergence of this disease, several studies have looked at the dynamics of COVID-19 transmission, predicted its progression, and determined the impact of different preventive measures. While most of these studies’ settings were in stable contexts, this study investigated the progression of the COVID-19 pandemic in Northwest Syria, a conflict-affected region, for nine months (from July 2020 to March 2021) using the Suspected-Infected-Removed (SIR) model. We adjusted the SIR model to study the impact of wearing facial masks on the outbreak dynamics and progression. Based on available data and using the basic and adjusted SIR models, we estimated the value of the basic reproduction number (R0), which provides an initial prediction of disease progression. Using the basic SIR model, the estimated R0 for the first wave of SARS-CoV-2 in Northwest Syria was 2.38. The resulting figures were overestimated in comparison with the reported numbers and data on the COVID-19 pandemic. However, the results were significantly reasonable when we adjusted the model for a preventive measure (in this case, wearing face masks). Face masks, the most available preventive measure to be applied in emergency and conflict settings, remarkably affect the outbreak dynamics and may play a key role in controlling and limiting the spread of COVID-19. The novelty of the study is provided by simulating the progress of the COVID-19 outbreak in conflict settings, as it is the first study to predict the dynamics of COVID-19 disease in NWS by adjusting for face-mask-wearing as a preventive measure to explore its impact on outbreak dynamics

The difference in chronic inflammation between individuals with officially documented and self-reported adverse childhood experiences is maintained until older middle-age

Non peer reviewe

Health-Related Quality of Life After Breast Reconstruction : Comparing Outcomes Between Reconstruction Techniques Using the BREAST-Q

Background Reconstruction of the breast following mastectomy can improve patients' health-related quality of life (HRQL). We aimed to assess HRQL in women after mastectomy and breast reconstruction and to identify differences in HRQL related to the reconstruction method used. Methods A cross-sectional study was performed on patients who had undergone breast reconstruction in Helsinki University Hospital between 08/2017 and 7/2019. The postoperative HRQL was assessed using the BREAST-Q (2.0) Reconstruction Module. The results were compared between patients with different reconstruction methods using the Kruskal-Wallis test. Results A total of 146 patients were identified. Microvascular flaps (n = 77) were the most common method for primary breast reconstruction, followed by latissimus dorsi (LD) flaps (n = 45), fat grafting (n = 18) and implant reconstruction (n = 6). The satisfaction with breasts was high in all groups (median 61, IQR 49-71). The physical well-being of the chest was high regardless of the reconstructive method (median 100, IQR 80-100). However, women with fat grafting reported more adverse effects of radiation (median 17, IQR 14-17 vs. 18, IQR 17-18 for other groups, p = 0.02). Donor site morbidity was low, and patients reported high satisfaction with the back (median 66/100, IQR57-90) and abdomen (median 9/12, IQR 8-10), and physical well-being of the back (median 61/100, IQR 53-70) and abdomen (median 65/100, IQR 60-86). Conclusions The patient-reported HRQL after breast reconstruction is high. Most women report being satisfied with the reconstruction, irrespective of the reconstruction method used. The reconstruction method can thus be chosen individually in cooperation between the patient and the surgeon.Peer reviewe

Caught in crossfire : health care workers’ experiences of violence in Syria

Health care is attacked in many contemporary conflicts despite the Geneva Conventions. The war in Syria has become notorious for targeted violence against health care. This qualitative study describes health care workers’ experi-ences of violence using semi-structured interviews (n = 25) with professionals who have been working in Syria. The participants were selected using a snow-ball sampling method and interviewed in Turkey and Europe between 2016– 2017. Analysis was conducted using content analysis. Results revealed that the most destructive and horrific forms of violence health care workers have experienced were committed mostly by the Government of Syria and the Islamic State. Non-state armed groups and Kurdish Forces have also committed acts of violence against health care, though their scope and scale were con-sidered to have a lower mortality. The nature of violence has evolved during the conflict: starting from verbal threats and eventually leading to hospital bomb-ings. Health care workers were not only providers of health care to injured demonstrators, they also participated in non- violent anti-government actions. The international community has not taken action to protect health care in Syria. For health workers finding safe environments in which to deliver health care has been impossible.Peer reviewe

Lipoprotein(a) is not associated with venous thromboembolism risk

<p><i>Objectives.</i> Evidence from case-control studies as well as meta-analyses of these study designs suggest elevated lipoprotein(a) [Lp(a)] to be associated with an increased risk of venous thromboembolism (VTE). Prospective evidence on the association is limited, uncertain, and could be attributed to regression dilution bias. We aimed to assess the prospective association of Lp(a) with risk of VTE and correct for regression dilution. <i>Design.</i> We related plasma Lp(a) concentrations to the incidence of VTE in 2,180 men of the Kuopio Ischemic Heart Disease cohort study. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed and repeat measurements of Lp(a) at 4 and 11 years from baseline, were used to correct for within-person variability. <i>Results.</i> After a median follow-up of 24.9 years, 110 validated VTE cases were recorded. The regression dilution ratio of log_e Lp(a) adjusted for age was 0.85 (95% CI: 0.82–0.89). In analyses adjusted for several established risk factors and potential confounders, the HR (95% CI) for VTE per 1 SD (equivalent to 3.56-fold) higher baseline log_e Lp(a) was 1.06 (0.87–1.30). In pooled analysis of five population-based cohort studies (including the current study) comprising 66,583 participants and 1314 VTE cases, the fully-adjusted corresponding HR for VTE was 1.00 (95% CI: 0.94–1.07), with no evidence of heterogeneity between studies. <i>Conclusions.</i> Primary analysis as well as pooled evidence from previous studies suggest circulating Lp(a) is not prospectively associated with future VTE risk, indicating that evidence of associations demonstrated in case-control designs may be driven by biases such as selection bias.</p

Loneliness and social isolation increase cancer incidence in a cohort of Finnish middle-aged men. A longitudinal study

Globally, cancer is the second leading cause of death. Loneliness has been suggested as a risk factor for cancer mortality. However, connections between loneliness, social isolation, and cancer are poorly understood. In our longitudinal study (mean follow-up: 20.44 years) of 2570 middle-aged men, loneliness, social isolation, and health-related factors were measured at baseline. Cox proportional hazards analysis was used to examine the association between cancer incidence, loneliness, and social isolation. The effect of relationship status on cancer mortality among cancer patients was tested with the Kaplan-Meier method. Loneliness was associated with total cancer incidence after adjustments for tested lifestyle and health-related covariates. Social Isolation was associated with total cancer incidence, except when adjusted for lifestyle, diet, or Human Population Laboratory (HPL) Depression Scale scores. Loneliness was associated with lung cancer incidence, except when adjusted for HPL Depression Scale scores. There was no significant association between social isolation and lung cancer. Neither loneliness nor social isolation were connected with prostate or colorectal cancer. Being single at baseline was associated with worse survival outcomes for cancer patients. Our findings suggest that regardless of the social network size, loneliness among middle-aged men is associated with an increased likelihood of cancer.Peer reviewe