Vulnerability, resilience and resistance in diverse societies

The editorial presents the fifteenth ETMU Conference,  held at Åbo Akademi University in Turku on 15–16 November 2018, dedicated to the theme "Vulnerabil­ity, Resilience and Resistance in Diverse Societies’. The first two articles of the current issue are based on papers presented at the conference

Met expectations and the well-being of ethnic remigrants: A longitudinal study

Peer reviewe

Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland

Objectives To assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages. Design Prospective population-based register study. Setting Finland. Participants 11% random sample of the population aged 70-87 years resident in Finland at the end of year 2000 (n=54 964). Main outcome measure Incidence rates, Kaplan-Meier survival probabilities and Cox regression HRs of dementia mortality in 2001-2016 by midlife education, occupational social class and household income measured at ages 53-57 years. Results During the 528 387 person-years at risk, 11 395 individuals died from dementia (215.7 per 10 000 person-years). Lower midlife education, occupational social class and household income were associated with higher dementia mortality, and the differences persisted to the oldest old ages. Compared with mortality from all other causes, however, the socioeconomic differences emerged later. Dementia accounted for 28% of the difference between low and high education groups in overall mortality at age 70+ years, and for 21% of the difference between lowest and highest household income quintiles. All indicators of socioeconomic position were independently associated with dementia mortality, low household income being the strongest independent predictor (HR=1.24, 95% CI 1.16 to 1.32), followed by basic education (HR=1.14, 1.06 to 1.23). Manual occupational social class was related to a 6% higher hazard (HR=1.06, 1.01 to 1.11) compared with non-manual social class. Adjustment for midlife economic activity, baseline marital status and chronic health conditions attenuated the excess hazard of low midlife household income, although significant effects remained. Conclusion Several indicators of socioeconomic position predict dementia mortality independently and socioeconomic inequalities persist into the oldest old ages. The results demonstrate that dementia is among the most important contributors to socioeconomic inequalities in overall mortality at older ages.Peer reviewe

Time-varying effects of socio-demographic and economic factors on the use of institutional long-term care before dementia-related death : A Finnish register-based study

Objectives: The effects of socio-demographic and economic factors on institutional long-term care (LTC) among people with dementia remain unclear. Inconsistent findings may relate to time varying effects of these factors as dementia progresses. To clarify the question, we estimated institutional LTC trajectories by age, marital status and household income in the eight years preceding dementia-related and non-dementia-related deaths. Methods: We assessed a population-representative sample of Finnish men and women for institutional LTC over an eight-year period before death. Deaths related to dementia and all other causes at the age of 70+ in 2001-2007 were identified from the Death Register. Dates in institutional LTC were obtained from national care registers. We calculated the average and time-varying marginal effects of age, marital status and household income on the estimated probability of institutional LTC use, employing repeated-measures logistic regression models with generalised estimating equations (GEE). Results: The effects of age, marital status and household income on institutional LTC varied across the time before death, and the patterns differed between dementia-related and non-dementia-related deaths. Among people who died of dementia, being of older age, non-married and having a lower income predicted a higher probability of institutional LTC only until three to four years before death, after which the differences diminished or disappeared. Among women in particular, the probability of institutional LTC was nearly equal across age, marital status and income groups in the last year before dementia-related death. Among those who died from non-dementia-related causes, in contrast, the differences widened until death. Conclusions: We show that individuals with dementia require intensive professional care at the end of life, regardless of their socio-demographic or economic resources. The results imply that the potential for extending community living for people with dementia is likely to be difficult through modification of their socio-demographic and economic environments.Peer reviewe

Does the risk of hospitalisation for ischaemic heart disease rise already before widowhood?

Peer reviewe

The Composition and Functional Capacities of Saliva Microbiota Differ Between Children With Low and High Sweet Treat Consumption

Excess sugar consumption—common in youth—is associated with poor health. Evidence on the relationship between sugar consumption and the oral microbiome, however, remains scarce and inconclusive. We explored whether the diversity, composition, and functional capacities of saliva microbiota differ based on the consumption of select sugary foods and drinks (“sweet treats”). Using 16S rRNA gene sequencing, we characterized saliva microbiota from 11 to 13-year-old children who participated in the Finnish Health in Teens (Fin-HIT) cohort study. The sample comprised children in the lowest (n = 227) and highest (n = 226) tertiles of sweet treat consumption. We compared differences in the alpha diversity (Shannon, inverse Simpson, and Chao1 indices), beta diversity (principal coordinates analysis based on Bray–Curtis dissimilarity), and abundance (differentially abundant operational taxonomic units (OTUs) at the genus level) between these low and high consumption groups. We performed PICRUSt2 to predict the metabolic pathways of microbial communities. No differences emerged in the alpha diversity between low and high sweet treat consumption, whereas the beta diversity differed between groups (p = 0.001). The abundance of several genera such as Streptococcus, Prevotella, Veillonella, and Selenomonas was higher in the high consumption group compared with the low consumption group following false discovery rate correction (p < 0.05). Children with high sweet treat consumption exhibited higher proportions of nitrate reduction IV and gondoate biosynthesis pathways compared with the low consumption group (p < 0.05). To conclude, sweet treat consumption shapes saliva microbiota. Children who consume a high level of sweet treats exhibited different compositions and metabolic pathways compared with children who consume low levels of sweet treats. Our findings reveal novel insights into the relationship between sugary diets and oral microbiota.Peer reviewe

Evidence for genetic regulation of the human parieto-occipital 10-Hz rhythmic activity

Several functional and morphological brain measures are partly under genetic control. The identification of direct links between neuroimaging signals and corresponding genetic factors can reveal cellular-level mechanisms behind the measured macroscopic signals and contribute to the use of imaging signals as probes of genetic function. To uncover possible genetic determinants of the most prominent brain signal oscillation, the parieto-occipital 10-Hz alpha rhythm, we measured spontaneous brain activity with magnetoencephalography in 210 healthy siblings while the subjects were resting, with eyes closed and open. The reactivity of the alpha rhythm was quantified from the difference spectra between the two conditions. We focused on three measures: peak frequency, peak amplitude and the width of the main spectral peak. In accordance with earlier electroencephalography studies, spectral peak amplitude was highly heritable (h(2)>0.75). Variance component-based analysis of 28000 single-nucleotide polymorphism markers revealed linkage for both the width and the amplitude of the spectral peak. The strongest linkage was detected for the width of the spectral peak over the left parieto-occipital cortex on chromosome 10 (LOD=2.814, nominal PPeer reviewe

Elintarvike- ja vesivälitteiset epidemiat Suomessa vuosina 2017–2019

Vuosina 2017–2019 Ruokaviraston ylläpitämään elintarvike- ja vesivälitteisten epidemioiden rekisteriin luokiteltiin tehtyjen epidemiaselvitysten perusteella yhteensä 169 elintarvike- tai talousvesivälitteistä epidemiaa, joista 96 % oli elintarvikevälitteisiä. Talousvesivälitteisiä epidemioita raportoitiin samana ajanjaksona 7. Elintarvikkeiden välityksellä ilmoitettiin sairastuneen yhteensä 2 900 henkilöä ja talousveden välityksellä 567 henkilöä. Kuten aikaisemminkin 2000-luvulla, norovirus oli vuosina 2017–2019 yleisin raportoitu elintarvikevälitteisten epidemioiden aiheuttaja. Norovirus aiheutti 57 (35 %) elintarvikevälitteistä epidemiaa. Suurimmat elintarvikevälitteiset epidemiat aiheutti norovirus hoitolaitosruokailun välityksellä vuonna 2018 (292 ja 110 sairastunutta). Yleisimmät raportoidut välittäjäelintarvikkeet olivat kala ja kalavalmisteet sisältäen äyriäiset ja simpukat. Ne aiheuttivat 14 (9 %) epidemiaa. Toiseksi yleisin välittäjä oli liha ja lihavalmisteet sekä kasvikset ja niistä valmistetut tuotteet (kumpikin 12 epidemiaa; 7 %). Yli 70 %:ssa epidemioista välittäjäelintarvike jäi tuntemattomaksi tai välittäjäksi epäiltiin useita ruokia. Saastuneen raaka-aineen käytöllä oli selvä yhteys 33 (20 %) epidemian syntyyn. Raportoiduista epidemioista 22 %:n taustalla oli lämpötilaan ja säilytysaikaan liittyviä puutteita ja virheitä. Infektoituneen keittiötyöntekijän osallistuminen ruoanvalmistukseen ja puutteellinen käsihygienia oli syynä 19 %:iin elintarvikevälitteisistä epidemioista ja näissä melkein kaikissa tapauksissa aiheuttajana oli norovirus. Elintarvikevälitteisten epidemioiden tapahtumapaikaksi raportoitiin useimmiten ravintola, kahvila tai hotelli (90 kpl; 56 %) ja toiseksi yleisimmin koti (12 kpl; 7 %). Norovirukset aiheuttivat suurimman osan (3 kpl) tunnistetuista talousvesiepidemioista. Yhdessä epidemiassa epäiltiin sapovirusta aiheuttajaksi. Suurin talousvesivälitteinen epidemia havaittiin Nousiaisissa vuonna 2018. Sairastuneita raportoitiin 463. Taudinaiheuttajiksi epäiltiin mm. sapoviruksia. Vuosien 2017–2019 aikana taudinaiheuttaja jäi tuntemattomaksi 67 (41 %) elintarvikevälitteisessä ja kolmessa talousvesiepidemiassa. Uimavesivälitteisten epidemioiden raportointi alkoi vuonna 2012. Suomessa raportoitiin vuosina 2017–2019 neljä uimavesivälitteistä epidemiaa, joissa sairastui noin 200 henkilöä. Kolme epidemioista aiheutui noroviruksen ja yksi kampylobakteerin saastuttamasta uimavedestä tai uimarantaympäristöstä. Ulostevahingon saastuttamalla allasvedellä oli mahdollinen yhteys kylpyläympäristön epidemiaan. Jätevedellä saastunut luonnonvesi aiheutti yhden epidemian. Kahdessa uimarantaympäristöön liittyneessä epidemiassa uimaveden saastumisen syytä ei saatu selville