Perinatal health among migrant women : A longitudinal register study in Finland 2000-17

Migrants often have better health than the native-born population ('healthy immigrant effect'), although the effect tends to attenuate over time since migration. However, following the weathering hypothesis, migrants may have worse health due to a combination of discrimination and poorer financial conditions faced by many of them. Yet, little is known about interactions between migrant origin and individual socioeconomic status or the time spent in the host country in relation to reproductive health. We use Finnish register data of 491,532 women and 948,616 births spanning years 2000-17 to longitudinally study the association between the country of birth and perinatal outcomes (preterm birth, unplanned C-section, episiotomy and spontaneous vaginal birth); the interaction of country of birth with household income; and the effect of time since migration using random intercept logistic regression models. We show that a `healthy immigrant effect' largely does not exist for perinatal outcomes apart from migrants from a few high-income countries. Instead, in particular women from poorer countries tended to fare worse than native women. Often, the effect of the country of birth did not differ by household income, or the patterns were not clear. The impact of time since immigration was complex and dependent on country of birth and the outcome studied, but showed an increase in risk of preterm birth among migrants from low- and lower-middle-income countries compared to those born in Finland. Discrimination, language barriers in seeking care or refugee experiences are among some of the possible mechanisms explaining the worse perinatal health of migrants from poorer countries. The inequalities observed in a global scale in countries' economic outcomes may reproduce themselves as reproductive health inequalities among migrants living in wealthy countries.Peer reviewe

Kerrostalo Kempeleen Vihiluotoon

Tiivistelmä. Kandidaatintyöni koostuu kolmannen vuoden aikana toteutetusta yhteisprojektista, johon kuului yhdyskuntasuunnittelun, nykyaikaisen arkkitehtuurin ja kerrostalosuunnittelun kurssit. Näistä olen työssäni eniten keskittynyt kerrostalosuunnittelun rakennusopin osioon, mutta myös nykyaikaisen arkkitehtuurin sisällään pitämä asuntosuunnittelu, muodostaa merkittävän osan työstäni. Projekti alkoi asemakaavasuunnittelun kurssilla, jossa oli tehtävänä Kempeleen Vihiluodon Airport hotellin tontin ja sen ympäristön kehittäminen. Hankkeessa selvitettiin Kempeleen kunnan pyynnöstä erilaisten täydennysrakentamisvaihtoehtojen soveltumista alueelle. Suunnittelualueen koko oli noin 34 hehtaaria, josta 10 hehtaaria oli luonnonsuojelualuetta. Alueella rakentamisen pääpaino oli pientalovaltaisessa rakentamisessa, joka oli keskittynyt kapeasti Vihiluotoon suuntautuvan harjanteen päälle ja reunoille. Toimitilarakennusten korttelialueet sijoittuivat kaava-alueen eteläpuolelle Lentokentäntien varteen, muodostaen merkittävän työpaikka keskittymän. Vihiluodon pohjoisosa oli toistaiseksi kokonaan rakentamatonta alavaa kosteikkoa. Tavoitteenani oli parantaa Kempeleen kaupungin vetovoimaa ja viihtyisyyttä sekä luoda nykyhetkeä paremmin palvelevaa toimintaympäristöä, joka on joustava ja muuntautumiskykyinen vielä tulevaisuudessakin. Alueiden suunnittelussa ja toimintojen sijoittelussa kiinnitin huomiota alueen länsi ja itä päätyjen selkeästi erilaisiin luonteisiin, minkä voi huomata jo alueen teiden nimissäkin, jotka muuttuvat metropolimaisesta Lentokentäntiestä, akateemiseen Professorintiehen ja lopulta Torpankujaksi. Näin ollen päädyin suunnitelmassani toteuttamaan rakentamisen kahdessa mittakaavassa, mukaillen alueen olemassa olevaa rakennushierarkiaa. Yritystoiminta keskittyy Lentokentäntien varteen korkeampana rakentamisena ja pienempimittakaavainen omakotitalo rakentaminen puolestaan Kempeleenlahden satama-alueen ympäristöön. Suunnittelualue on myös kansainvälisesti merkittävä lintuvesi alue ja iso osa suunnittelualueesta oli luonnonsuojelualuetta, mikä kertoo alueen kauniista ja yksilöllisestä luonnosta, jonka tuominen paremmin ihmisten saavutettavaksi oli itselleni tärkeää. Pyrinkin luomaan alueelle uusia kevyen liikenteen reittejä ja puistomaisia virkistysalueita sekä asuntojen että työpaikkakeskittymän läheisyyteen. Asunto- ja kerrostalosuunnittelun kurssit olivat jatkoa Kempeleen Vihiluotoon laadittuun asemakaavaan. Tehtävänä oli jatkaa suunnittelua yhden asuinkerrostalon osalta aina pihasuunnitelmista rakennusosapiirustuksiin asti, huomioiden kerrostalojen rakennusmääräykset, paloturvallisuuden ja esteettömyyden. Valitsin suunnitelmani lähtökohdaksi yksittäisen, omalla tontillaan sijaitsevan pistekerrostalon heti Vihiluodontien ja Professorintien risteyksessä. Pyrin suunnittelemaan lämminhenkisen ja modernin kerrostalon, joka sopii paikkaansa puiston reunalla sekä on vuoropuhelussa vastapäätä sijaitsevan toimistorakennusten keskittymän kanssa. Rakennusmateriaaliksi valitsin puun ja vielä tarkemmin Siperian lehtikuusen, joka täyttää P2-paloluokan määräykset. Pidin ideasta käyttää puuta sille hyvin epätyypillisessä kontekstissa. Perinteisesti puutaloissa on totuttu näkemään harjakatto ja muodonannollisesti ulkonevia terassi ja parveke ratkaisuja, mutta oma kerrostaloni on tämän vastakohta; tasakattoinen kuutio. Koin, että näiden kahden yhdistäminen loi modernin ja tavanomaisesta poikkeavan kokonaisuuden. Noppamaisen ulkomuodon säilyttämiseksi päädyin tekemään sisäänvedetyt parvekkeet. Mielenkiintoa lisätäkseni päätin tehdä parvekkeista vuorokerroksittain risteileviä, sen sijaan, että ne olisivat menneet samassa linjassa ylhäältä alas, mikä vaati enemmän suunnittelua muun muassa asuntopohjien ja kantavien rakenteiden osalta. Parvekkeiden ulkoreunaan tein vielä kolmionmalliset kukkaistutuslaatikot, joista on mahdollista nähdä vehreän kasvillisuuden jatkuvan aina rakennuksen viherkatolle asti. Ensimmäiseen kerrokseen suunnittelin kahvilan, joka lisää vuorovaikutusta toimistorakennusten kanssa ja aktivoi samalla alueen käyttö, sitoen Professorintien puolia paremmin toisiinsa. Lisäksi ensimmäisessä kerroksessa on rakennuksen läpi jatkuvan aulatila, joka liittää Professorintien ja rakennuksen takana olevan puiston toisiinsa, muodostaen näköyhteyden näiden kahden välille. Yhteisprojektin viimeinen vaihe oli kerrostalosuunnittelun kurssi, jossa lähdin työstämään asuntosuunnittelussa kehittämääni työtä eteenpäin. Muutoksia tapahtui niin rakennuksen ulkonäössä, kuin myös asuntotyypeissä. Asumisessa panostin viihtyvyyteen sekä toimiviin arjen ratkaisuihin ja pyrin suunnittelemaan monipuolisesti erilaisia ja kokoisia asuntoja. Myös rakenne- ja talotekniset vaatimukset, esimerkiksi väestönsuojan ja roilojen osalta tarkentuivat ja pyrin löytämään niille toimivat sijoitukset. Kokonaisuudessaan pyrin huomioimaan puun luontaiset ominaisuudet, kuitenkin pitäen kiinni suunnitelmani modernista visiosta

Early Adolescent Health Problems, School Performance, and Upper Secondary Educational Pathways : A Counterfactual-Based Mediation Analysis

Peer reviewe

Socioeconomic differences in psychiatric treatment before and after self-harm : an observational study of 4,280 adolescents and young adults

Background: Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. Methods: The study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. Results: An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and low- est probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care. Conclusions: The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.Peer reviewe

Changes in regional variation in mortality over five decades – The contribution of age and socioeconomic population composition

Existing evidence suggests that within-country area variation in mortality has increased in several high-income countries. Little is known about the role of changes in the population composition of areas in these trends. In this study, we look at mortality variation across Finnish municipalities over five decades. We examine trends by sex, age categories and two broad cause of death groups and assess the role of individual-level compositional factors. Analyses rely on individual-level register data on the total Finnish population aged 30 years and over. We estimated two-level Weibull survival-models with individuals nested in areas for 10 periods between 1972 and 2018 to assess municipal-level variation in mortality. Median hazard ratio (MHR) was used as our summary measure and analyses were adjusted for age and socioeconomic characteristics. The results show a clear overall growth in area variation in mortality with MHR increasing from 1.14 (95% CI 1.12–1.15) to 1.28 (CI 1.26–1.30) among men and 1.17 (CI 1.15–1.18) to 1.30 (CI 1.27–1.32) among women. This growth, however, was fully attenuated by adjustment for age. Area differentials were largest and increased most among men at ages 30–49, and particularly for external causes. This increase was largely due to increasing differentiation in the socioeconomic composition of municipalities. In conclusion, our study shows increases in mortality differentials across municipalities that are mostly attributable to increasing differentiation between municipalities in terms of individual compositional factors.Peer reviewe

Experience of maternal and paternal adversities in childhood as determinants of self-harm in adolescence and young adulthood

Introduction Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities. Methods The study uses administrative register data on a 20% random sample of Finnish households with children aged 0–14 years in 2000. We follow children born in 1986–1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models. Results The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities. Conclusions Our findings suggest that both parents’ adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.Peer reviewe

Evaluating the Role of Parental Education and Adolescent Health Problems in Educational Attainment

This article reconsiders the role of social origin in health selection by examining whether parental education moderates the association between early health and educational attainment and whether health problems mediate the intergenerational transmission of education. We used longitudinal register data on Finns born in 1986–1991 (n = 352,899). We measured the completion of secondary and tertiary education until age 27 and used data on hospital care and medication reimbursements to assess chronic somatic conditions, frequent infections, and mental disorders at ages 10–16. We employed linear probability models to estimate the associations between different types of health problems and educational outcomes and to examine moderation by parental education, both overall in the population and comparing siblings with and without health problems. Finally, we performed a mediation analysis with g-computation to simulate whether a hypothetical eradication of health problems would weaken the association between parental and offspring education. All types of health problems reduced the likelihood of secondary education, but mental disorders were associated with the largest reductions. Among those with secondary education, there was further evidence of selection to tertiary education. High parental education buffered against the negative impact of mental disorders on completing secondary education but exacerbated it in the case of tertiary education. The simulated eradication of health problems slightly reduced disparities by parental education in secondary education (up to 10%) but increased disparities in tertiary education (up to 2%). Adolescent health problems and parental education are strong but chiefly independent predictors of educational attainment.Peer reviewe

The Population Impact of Childhood Health Conditions on Dropout from Upper-Secondary Education

Objectives To quantify how large a part of educational dropout is due to adverse childhood health conditions and to estimate the risk of dropout across various physical and mental health conditions. Study design A registry-based cohort study was conducted on a 20% random sample of Finns born in 1988-1995 (n = 101 284) followed for school dropout at ages 17 and 21. Four broad groups of health conditions (any, somatic, mental, and injury) and 25 specific health conditions were assessed from inpatient and outpatient care records at ages 10-16 years. We estimated the immediate and more persistent risks of dropout due to health conditions and calculated population-attributable fractions to quantify the population impact of childhood health on educational dropout, while accounting for a wide array of sociodemographic confounders and comorbidity. Results Children with any health condition requiring inpatient or outpatient care at ages 10-16 years were more likely to be dropouts at ages 17 years (risk ratio 1.71, 95% CI 1.61-1.81) and 21 years (1.46, 1.37-1.54) following adjustment for individual and family sociodemographic factors. A total of 30% of school dropout was attributable to health conditions at age 17 years and 21% at age 21 years. Mental disorders alone had an attributable fraction of 11% at age 21 years, compared with 5% for both somatic conditions and injuries. Adjusting for the presence of mental disorders reduced the effects of somatic conditions. Conclusions More than one fifth of educational dropout is attributable to childhood health conditions. Early-onset mental disorders emerge as key targets in reducing dropout.Peer reviewe

Work-family context and the longevity disadvantage of US women

Female life expectancy is currently shorter in the United States than in most high-income countries. This study examines work-family context as a potential explanation. While work-family context changed similarly across high-income countries during the past half century, the United States has not implemented institutional supports, such as universally available childcare and family leave, to help Americans contend with these changes. We compare the United States to Finland—a country with similar trends in work-family life but generous institutional supports—and test two hypotheses to explain US women's longevity disadvantage: (1) US women may be less likely than Finnish women to combine employment with childrearing; and (2) US women's longevity may benefit less than Finnish women's longevity from combining employment with childrearing. We used data from women aged 30–60 years during 1988–2006 in the US National Health Interview Survey Linked Mortality File and harmonized it with data from Finnish national registers. We found stronger support for hypothesis 1, especially among low-educated women. Contrary to hypothesis 2, combining employment and childrearing was not less beneficial for US women's longevity. In a simulation exercise, more than 75 percent of US women's longevity disadvantage was eliminated by raising their employment levels to Finnish levels and reducing mortality rates of non-married/non-employed US women to Finnish rates

Ergonomie cognitive de la post-édition de traduction automatique : enjeux pour la qualité des traductions

La nature même du processus associant traduction automatique et post-édition humaine influence profondément les caractéristiques des textes ainsi produits, en raison de l’ergonomie cognitive propre à cette interaction homme-machine. Ainsi, l’automatisation d’une partie du processus traductionnel perturbe, via l’interposition de la sortie de traduction automatique, l’application des stratégies de traduction habituelles par le post-éditeur. Les consignes de post-édition minimalistes, privilégiant la rapidité aux dépens des considérations stylistiques, tout comme l’accoutumance à la sortie de traduction automatique, renforcent encore cette interférence de la langue source. Dans cet article, nous explorons comment, en conséquence, les textes issus de ce nouveau mode de production diffèrent de ceux produits par la traduction humaine, ainsi que les enjeux spécifiques qui en découlent pour les usagers.The very nature of the process associating machine translation and human post-editing, because of the cognitive ergonomics of this specific human-machine interaction, profoundly influences the characteristics of the resulting texts. Through the interposition of machine translation output, automatization of part of the process disrupts the application of usual translation strategies by post-editors. Minimalistic post-editing guidelines insisting on rapidity over stylistic considerations, as well as post-editors adapting to machine translation output, further reinforce this interference from the source language. In this paper, we explore how, as a consequence, post-edited texts differ from human translations, and the specific issues arising for the users of these translated texts