Intergenerational social mobility, smoking and smokeless tobacco (snus) use among adolescents during 2008-2017

Background: Socioeconomic differences in smoking and other tobacco use are prevalent in adolescents. Less is known about the association between intergenerational social mobility and tobacco use. Methods: Five waves of national cross-sectional School Health Promotion Study during 2008-2017 in Finland were used, including non-academically and academically oriented adolescents (15-21 years, N = 384,379). The adolescents' educational orientation was compared with the educational track of the parents as a proxy for intergenerational social mobility, which was used as the independent variable in regression models to examine the differences in daily smoking and daily snus use. Results: Smoking declined in all mobility groups over time, but remained more prevalent among non-academically oriented adolescents among boys and girls. Daily snus use among boys increased over time in all mobility groups. Multiple adjusted models showed that upward mobility and downward mobility are differently associated with tobacco use, the latter increasing the probability of tobacco use compared with the stable high group (boys: smoking: OR = 5.24, 95% CI 5.02-5.46; snus use: OR = 1.57, 95% CI 1.50-1.66). In smoking, absolute socioeconomic differences between the mobility groups decreased over time while relative differences increased. In snus use, both absolute and relative differences increased. Conclusions: Adolescent smoking and snus use associate strongly with the adolescent's educational track, irrespective of the social mobility class. Non-academically oriented adolescents have an increased risk of tobacco use. The academic and non-academic orientation should already be taken into account in tobacco use prevention in basic education.Peer reviewe

Synnynnäisten sydänvikojen perkutaaninen hoito

Vertaisarvioitu. Teema : lastenkardiologia. English summaryPeer reviewe

Synnynnäisten sydänvikojen perkutaaninen hoito

Vertaisarvioitu. Teema : lastenkardiologia. English summaryPeer reviewe

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey

Aims: There is a lack of longitudinal, population-based studies on the association between education and smoking cessation. A more thorough examination of this association is needed to address inequalities in smoking. Methods: The longitudinal Health 2000 Survey and Health 2011 Survey, representing the Finnish population aged > 30 years, were analysed. Of the 1352 baseline daily smokers, 945 (70%) provided a smoking status at the follow-up. The analytic sample size was 884 (excluding the follow-up occasional smokers). Self-reported questionnaire data and measurements (e.g. plasma cotinine) from the baseline were utilised. The outcome variable was smoking cessation at the follow-up, and the main explanatory variable was education. Logistic regression was the main method for statistical analyses. All of the analyses accounted for the sampling design. Results: At the follow-up, 28% of the baseline daily smokers had quit smoking. An adjusted regression model showed that highly educated respondents had a higher likelihood of quitting smoking compared with those with basic education. Controlling for demographic and health-related variables had a modest effect on this association. Higher scores for plasma cotinine, symptoms of depression and heavy alcohol use were associated with a lower likelihood of quitting smoking. The association between education and smoking cessation was weaker for women than it was for men. Conclusions: High education is associated with smoking cessation among the general adult population, especially among men. A higher plasma cotinine level is strongly associated with continued smoking among both sexes. Background variables only modestly affected the association between education and smoking cessation.Peer reviewe

Exercise Prescription Enhances Maximal Oxygen Uptake and Anaerobic Threshold in Young Single Ventricle Patients with Fontan Circulation

Correction: Volume43, Issue4 Page: 922-922 DOI: 10.1007/s00246-022-02871-7 Published: APR 2022A modified Fontan procedure is performed to palliate single ventricle malformations. This hemodynamic arrangement sets systemic venous pressure unphysiologically high which predisposes the patient to severe long-term complications. As a means of self-care, exercise may ease transpulmonary flow. We investigated the effects of 6-month exercise prescription on pediatric Fontan patients. Eighteen stable Fontan patients (14 +/- 2.6 years, 160.4 +/- 11.3 cm, and 51.4 +/- 14.4 kg) were recruited. Baseline fitness was assessed by physical activity questionnaire, body composition, cardiorespiratory performance, and muscle fitness tests. Exercise prescription was individually tailored for a 6-month training period at home. At entrance to the study, Fontan patients had lower than normal maximal oxygen uptake (VO2max) of 28. +/- 5.9 ml/kg/min (61 +/- 11% of normal). VO2max significantly correlated with weekly amount of habitual exercise and muscle mass of the lower limbs (p < 0.001 for both). After 6 months of training, the patients had improved their anaerobic threshold of 18 +/- 3.5 vs 20 +/- 4.8 ml/kg/min, p = 0.007, and workload tolerance of 119 +/- 39 vs 132.4 +/- 44 W, p = 0.001. At EUROFIT tests, the patient muscle fitness was below age-matched reference, but correlations existed between VO2max and lower limb muscle tests. Our patients with Fontan hemodynamics were able to positively respond to an exercise program by enhancing submaximal performance which should be beneficial for getting through daily activities. Future studies should correlate whether hemodynamic findings at Fontan completion influence physical activity and exercise reserves, and whether these predict predisposition to chronic complications.Peer reviewe

Complete Atrioventricular Septal Defect : Evolution of Results in a Single Center During 50 Years

Background. Operative mortality after complete atrioventricular septal defect (cAVSD) repair has improved vastly. Less improvement has been demonstrated regarding late mortality and reoperation rates, however. There is evident lack of comprehensive population-based studies analyzing the history and progress of the ever-changing operative results. Methods. This is a 5-million population-based retrospective study of consecutive 388 cAVSD patients operated in Finland between 1962 and 2014. Data were collected using Children's Cardiac Surgical Registry of Children's Hospital at the Helsinki University Hospital, Finland. Mortality data and reoperation rates were analyzed on a decade-by-decade basis. Results. During the early era, overall mortality was 17.4%, operative mortality constituting 10.9%. The operative results have improved significantly over the decades, and eventually, the last decade showed no mortality. A total of 23 late deaths occurred; of these, 20 were directly heart-related. Half of the late mortality occurred during the first postoperative year. The only significant risk factor for overall mortality was an earlier decade of operation (p <0.001). Reoperation rates have not decreased but slightly increased over decades (p = 0.621), and reoperations have been performed mainly during the first year after the primary operation. Actuarial freedom from left side atrioventricular valve reoperation at 15 years was 90.9%. Conclusions. There has been an outstanding improvement in surgical results through the years even though the general operative approach has remained the same. Rates of reoperation have not been declining, but the reoperations are dated to early childhood years. The improvement in results has been ongoing. (C) 2019 by The Society of Thoracic SurgeonsPeer reviewe

Systemic-to-pulmonary collateral flow associations with antegrade pulmonary flow in single ventricle patients: insights from cardiac magnetic resonance imaging

PurposeIn the palliated single ventricle anomalies, a considerable amount of the aortic flow may be absorbed by the systemic-pulmonary collateral flow (SPCF), which can be noninvasively assessed by cardiac magnetic resonance (CMR). The aims of this study were to (1) identify factors associated with SCPF in pediatric single ventricle patients, and (2) establish a cutoff values indicating an association between SCPF and a reduction in antegrade pulmonary flow.MethodsA retrospective single-tertiary-center cohort study included 158 consecutive CMR studies of patients with a single ventricle. In the uni- and multivariable analysis, SPCF was presented as a percentage of the total pulmonary venous flow (SPCF%PV). The minimal clinically important difference in QP/QS ratios was estimated as ≥0.50, and an optimal cutoff value was defined using the receiver operating characteristic (ROC) curve.ResultsSPCF%PV was significantly smaller in the post-total cavopulmonary connection (TCPC) group than in the pre-TCPC patients (p &lt; 0.001). The patient's higher age and a higher antegrade pulmonary flow were associated with a lower SPCF%PV. A negative weak association was observed between the SPCF%PV and systemic saturation (r = −0.39, p &lt; 0.001). SPCF%PV did not associate with ventricular volumes nor ejection fraction. The SPCF%PV was significantly smaller in patients that were palliated primarily with a pulmonary artery banding compared to those palliated with a BT-shunt (p = 0.002) or RV-PA- shunt (p = 0.044). In the ROC analysis, for pre-TCPC patient's, a cutoff of SPCF%PV 42% yielded a sensitivity of 100% and specificity of 80% for significantly reduced antegrade pulmonary flow (AUC 0.97). In the post-TCPC group, the optimal SPCF%PV cutoff was 34% (sensitivity 100%, specificity 98%, AUC 0.99).ConclusionSPCF results in a considerable left-to-right shunt, which subsequently diminishes spontaneously after TCPC. Our findings indicated that for pre-TCPC patients, an SPCF%PV threshold of 42% (sensitivity 100%, specificity 80%), and for the post-TCPC group, a threshold of 34% (sensitivity 100%, specificity 98%) were effective in identifying reduced antegrade pulmonary flow

Thirty-eight-year trends of educational differences in smoking in Finland

ObjectivesSmoking is declining, but it is unevenly distributed among population groups. Our aim was to examine the socio-economic differences in smoking during 1978-2016 in Finland, a country with a history of strict tobacco control policy.MethodsAnnual population-based random sample data of 25-64-year-olds from 1978 to 2016 (N=104,315) were used. Response rate varied between 84 and 40%. In addition to logistic regression analysis, absolute and relative educational differences in smoking were examined.ResultsSmoking was more prevalent among the less educated but declined in all educational groups during the study period. Both absolute and relative differences in smoking between the less and highly educated were larger at the end of the study period than at the beginning. Cigarette price seemed to have a larger effect on the smoking among the less educated.ConclusionsSocio-economic differences in smoking among the Finnish adult population have increased since the 1970s until 2016. Further actions are needed, especially focusing on lower socio-economic positions, to tackle inequalities in health. They should include support for smoking cessation and larger cigarette tax increases.Peer reviewe

Management of the hypoplastic left heart syndrome : from fetus to adult

Non peer reviewe