SAS Macros for Calculation of Population Attributable Fraction in a Cohort Study Design

The population attributable fraction (PAF) is a useful measure for quantifying the impact of exposure to certain risk factors on a particular outcome at the population level. Recently, new model-based methods for the estimation of PAF and its confidence interval for different types of outcomes in a cohort study design have been proposed. In this paper, we introduce SAS macros implementing these methods and illustrate their application with a data example on the impact of different risk factors on type 2 diabetes incidence.

What Works for Whom : Patients' Psychological Resources and Vulnerabilities as Common and Specific Predictors of Working Alliance in Different Psychotherapies

Publisher Copyright: Copyright © 2022 Heinonen, Knekt and Lindfors.Background: Across different types of psychotherapy, one of the most robust predictors of better therapeutic outcomes is a good working alliance between patient and therapist. Yet there is little comparative research on whether particular patients more likely achieve a better alliance in certain treatments which represent particular therapeutic approaches or durations. Methods: 326 patients suffering from depressive and/or anxiety disorder were randomized into two short-term (solution-focused or psychodynamic) and one long-term (psychodynamic) therapy models. Treatments lasted ~7 and 36 months, respectively. Before randomization, patients were assessed with the interview-based Suitability for Psychotherapy Scale and filled Childhood Family Atmosphere and Life Orientation Test questionnaires. Patients filled Working Alliance Inventory after 3rd therapy session and at end of treatment; the long-term therapy patients, additionally, at 7 months' time point. Linear regression models were used. Results: Greater psychological resources (e.g., capacity for self-reflection, affect regulation, flexible interaction) had little effect on alliance during the course of the short-term therapies. However, they did predict better working alliances at end of long-term as opposed to short-term therapy. Childhood adversities impacted alliances already at 7 months. Conclusions: Although patients with certain qualities achieve better alliances in long-term as opposed to short-term therapies, apparently the theoretical orientation of therapy makes little difference. For patients with childhood adversities, differences between long-term (psychodynamic) treatment vs. various brief therapy models may be particularly salient.Peer reviewe

Poor suitability for psychotherapy : a risk factor for treatment non-attendance?

Publisher Copyright: © 2021Background: Patient suitability has been suggested to predict treatment non-attendance but information on its effect is limited. Aim: To study the prediction of the Suitability for Psychotherapy Scale (SPS), on occurrence of treatment non-attendance. Methods: Altogether 326 outpatients, with depressive or anxiety disorder, were randomized to short-term psychodynamic psychotherapy (SPP), long-term psychodynamic psychotherapy (LPP), and solution-focused therapy (SFT). SPS was based on seven components from three suitability domains: nature of problems, ego strength, and self-observing capacity. Treatment non-attendance was defined as refusal of engaging therapy and of premature termination. The Cox model and logistic regression were used. Results: Treatment non-attendance was significantly more common in LPP patients with poor SPS (RR = 2.76, 95% CI = 1.45-5.26). This was mainly due to poor flexibility of interaction, poor self-concept, and poor reflective ability. Premature termination in SFT showed a similar trend but due to other SPS components: absence of a circumscribed problem, poor modulation of affects, and poor response to trial interpretation. On the contrary, individuals with good values of SPS were more prone to premature termination in SPP. Limitations: The prediction of suitability on refusal could only be studied in the LPP group due to few refusals in the short-term therapy groups. The sample consisted of patients who participated in a trial. Thus the findings may not be directly generalized to unselected patients in the public mental health setting. Conclusions: Poor suitability, apparently, predicts non-attendance in LPP and SFT, but not in SPP. More studies on large cohorts are needed.Peer reviewe

Horisontaalisten yrityskauppojen vaikutukset ja kilpailupolitiikka

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Tässä työssä käsitellään horisontaalisten yrityskauppojen vaikutuksia ja sitä, miten kilpailuviranomaisten tulisi suhtautua niihin. Yrityskauppojen vaikutukset voivat olla joko yhteiskunnan hyvinvointia lisäävät tai vähentävät. Hyvinvointia vähentäviä vaikutuksia yrityskaupoista syntyy silloin, kun niiden seurauksena hinnat nousevat. Tämä hinnankorotus voi johtua joko yksipuolisista vaikutuksista tai koordinointivaikutuksista. Yksipuoliset vaikutukset ovat yrityskaupan osapuolten yksipuolinen hinnankorotus, joka on siis riippumaton sen kilpailijoiden toimista. Koordinointivaikutukset puolestaan esiintyvät silloin, kun yrityskaupat muuttavat markkinoiden toiminnan luonteen kilpailullisesta enemmän kollusiiviseksi. Tällöin toimialan kaikki yritykset nostavat yhteisesti hintoja, ja ovat siis riippuvaisia kilpailijoidensa toimista. Yrityskauppojen hyvinvointia lisäävinä vaikutuksina pidetään esimerkiksi yrityskauppojen yhteydessä syntyviä tehokkuuksia. Tällaisia ovat muun muassa tuotannon rationalisointi, skaalaedut ja tekninen kehitys. Tehokkuuksien merkitys on tärkeä, koska niiden ajatellaan pienentävän yrityskaupoista muuten koituvaa hinnankorotusta. Yrityskauppojen vaikutuksia pyritään tuomaan esille erilaisten oligopolimallien avulla. Pääosin keskitytään Cournot-kilpailuun perustuvaan malliin, joka keskittyy yrityskauppojen tehokkuus- ja ulkoisvaikutuksiin. Malli pyrkii osoittamaan, että yrityskaupat ilman merkittäviä tehokkuusvaikutuksia nostavat hintoja. Kuitenkin malli todistaa myös sen, että yrityskaupat ilman tehokkuuksia voivat olla yhteiskunnalle hyödyllisiä, mikäli ne tuottavat positiivista ulkoisvaikutusta. Ulkoisvaikutuksilla mallissa tarkoitetaan sitä yrityskaupoista koituvaa tuotannon tehostumista, kun tuotanto siirtyy korkeiden kustannusten yrityksiltä alhaisempien kustannusten yrityksille. Lisäksi käsitellään nyky-yrityskauppavalvonnan periaatteita. Erityisesti keskitytään EU:n ja USA:n yrityskauppavalvontoihin, joiden yhtäläisyyksiä ja eroavaisuuksia käydään läpi. Yrityskauppavalvonnassa markkinavoimalla on keskeinen merkitys. Tyypillisesti ajatellaan, että mitä suurempi markkinavoima ehdotetulla yrityskaupalla tulisi olemaan, sitä todennäköisemmin se johtaa hintojen nousuun. Esitettyjen oligopolimallien pohjalta pyritään sitten arvioimaan, kuinka yhdenmukainen kilpailulainsäädäntö on talousteorian kanssa. Lopuksi tarkastellaan uuden talouden tuomaa uutta dynamiikka sen asettamia kilpailupolitiikan haasteita. Uuden talouden ominaispiirteitä ovat innovaatioiden nopeus ja suuruus, verkostovaikutukset sekä standardit ja niiden asettamisprosessi. Näiden ilmiöiden pohjalta pohditaan, soveltuuko tämän päivän kilpailupolitiikka niiden vaikutusten arviointiin sekä, voidaanko staattisten mallien lopputuloksia yleistää myös uutta taloutta koskeviksi

Resistant Hypertension and Obstructive Sleep Apnea: The Sparring Partners

Enhanced target organ damage and cardiovascular morbidity represent common issues observed in both resistant hypertension and obstructive sleep apnea. Common pathophysiological features and risk factors justify their coexistence, especially in individuals with increased upper-body adiposity. Impaired sodium handling, sympathetic activation, accelerated arterial stiffening, and impaired cardiorenal hemodynamics contribute to drug-resistant hypertension development in obstructive sleep apnea. Effective CPAP therapy qualifies as an effective “add-on” to the underlying antihypertensive pharmacological therapy, and emerging evidence underlines the favorable effect of mineralocorticoid antagonists on both resistant hypertension and obstructive sleep apnea treatment

Associations of early childhood adversities with mental disorders, psychological functioning, and suitability for psychotherapy in adulthood

Childhood adversities frequently precede adulthood depression and anxiety. Yet, how they impact needed treatment duration, type or focus in these common disorders, is unclear. For developing more individualized and precise interventions, we investigated whether specific early adversities associate with patients' distinct psychiatric problems, psychological vulnerabilities, and suitability for psychotherapy. A total of 221 depressed and anxious adult outpatients (excluding psychotic, severe personality, bipolar, and substance abuse disorders) referred from community, student, occupational, and private healthcare services filled the Childhood Family Atmosphere Questionnaire (CFAQ). They also filled self-reports on interpersonal behavior and problems, perceived competence, dispositional optimism, sense of coherence, defenses, and psychiatric history. Clinicians assessed the patients' symptomatology, personality, object relations, cognitive performance, and psychotherapy suitability. Regression analyses were conducted. Childhood adversities predicted both worse current psychological functioning (e.g., interpersonal problems), and better clinician-rated capacities for benefiting from psychotherapy (e.g. self-reflection, capacity for interaction). Parental problems had the most numerous negative associations to psychological functioning. Best capacities for psychotherapy were predicted by recollected family unhappiness. Associations with psychiatric criteria were, however, largely non-significant. In conclusion, for psychosocial treatment planning, patients' early adversities may indicate both vulnerability and resources. As childhood adversities are frequent among treatment-seekers, further studies examining how early adversities predict psychotherapy outcome are needed.Peer reviewe

Self-Report Dieters: Who Are They?

Dieting attempts have become popular worldwide. Dieting, however, seems to have both positive and negative health-related consequences. So far, only a few studies have focused on the determinants of dieting in detail. This study explores the association between self-report dieting attempts and intentional weight loss (IWL) during the previous year and several demographic, lifestyle, health, and psychological factors in a cross-sectional study design using data from the representative Finnish Health 2000 Survey. The sample comprised 2147 men and 2378 women, aged 30–69. Information for potential determinants was assembled via health examinations, interviews, and questionnaires. Approximately 24% of the men and 39% of the women reported dieting attempts and 10% of the men and 15% of the women reported IWL. Dieting attempts were associated with younger age, education, BMI, formerly smoking, more favourable values in lifestyle variables, and unfavorable values in serum HDL and triglycerides, a worse sense of coherence, concerns about one’s appearance, and concerns about one’s health. Among men, diabetics and those sleeping ≤6 h a night more frequently reported dieting attempts and those with osteoarthritis reported IWL. Moreover, the gradient between BMI and dieting attempts was significantly stronger in men than in women. Men seem to attempt dieting when they have actual health-related reasons, while such reasons are not so strongly associated with dieting in women. These findings can be used for determining subpopulations with obesity and real weight-loss needs and, alternatively, subpopulations with normal weight unnecessarily attempting dieting

Associations of tissue transglutaminase antibody seropositivity with coronary heart disease: Findings from a prospective cohort study.

Clinical experience and observational studies suggest that individuals with coeliac disease are at increased risk of coronary heart disease (CHD), but the precise mechanism for this is unclear. Laboratory studies suggest that it may relate to tissue transglutaminase antibodies (tTGAs). Our aim was to examine whether seropositivity for tTGA and endomysial antibodies (EMAs) are associated with incident CHD in humans. We used data from Mini-Finland Health Survey, a prospective cohort study of Finnish men and women aged 35-80 at study baseline 1978-80. TTGA and EMA seropositivities were ascertained from baseline blood samples and incident CHD events were identified from national hospitalisation and death registers. Cox regression was used to examine the associations between antibody seropositivity and incident CHD. Of 6887 men and women, 562 were seropositive for tTGAs and 72 for EMAs. During a median follow-up of 26 years, 2367 individuals experienced a CHD event. We found no clear evidence for an association between tTGA positivity (hazard ratio, HR: 1.04, 95% confidence interval, CI: 0.83, 1.30) or EMA positivity (HR: 1.16, 95% CI: 0.77, 1.74) and incident CHD, once pre-existing CVD and known CHD risk factors had been adjusted for. We found no clear evidence for an association of tTGA or EMA seropositivity with incident CHD outcomes, suggesting that tTG autoimmunity is unlikely to be the biological link between coeliac disease and CHD

Self-Report Dieters: Who Are They?

Dieting attempts have become popular worldwide. Dieting, however, seems to have both positive and negative health-related consequences. So far, only a few studies have focused on the determinants of dieting in detail. This study explores the association between self-report dieting attempts and intentional weight loss (IWL) during the previous year and several demographic, lifestyle, health, and psychological factors in a cross-sectional study design using data from the representative Finnish Health 2000 Survey. The sample comprised 2147 men and 2378 women, aged 30–69. Information for potential determinants was assembled via health examinations, interviews, and questionnaires. Approximately 24% of the men and 39% of the women reported dieting attempts and 10% of the men and 15% of the women reported IWL. Dieting attempts were associated with younger age, education, BMI, formerly smoking, more favourable values in lifestyle variables, and unfavorable values in serum HDL and triglycerides, a worse sense of coherence, concerns about one’s appearance, and concerns about one’s health. Among men, diabetics and those sleeping ≤6 h a night more frequently reported dieting attempts and those with osteoarthritis reported IWL. Moreover, the gradient between BMI and dieting attempts was significantly stronger in men than in women. Men seem to attempt dieting when they have actual health-related reasons, while such reasons are not so strongly associated with dieting in women. These findings can be used for determining subpopulations with obesity and real weight-loss needs and, alternatively, subpopulations with normal weight unnecessarily attempting dieting

Risk factors for first hospitalization due to meniscal lesions - a population-based cohort study with 30 years of follow-up

Background: Meniscal lesions are among the most common injuries of the knee, yet limited epidemiologic data is available on their risk factors. We investigated the association of lifestyle factors and physical strenuousness of work on knee injuries with a focus on meniscal lesions. Methods: We examined a nationally representative sample of persons aged 30 to 59 years, who participated in a comprehensive health examination (the Mini-Finland Health Survey). Subjects without any injury or osteoarthritis in the knee joint at baseline (n = 4713) were subsequently followed via the National Hospital Discharge Register up to 30 years. Results: During the follow-up, 338 knee injuries were identified of which 224 were meniscal lesions. Obesity and regular leisure time physical exercise were associated with an increased risk of first hospitalization due to meniscal lesions (hazard ratio (HR) 1.62 and 95% confidence interval (CI) 1.06-2.48 and 1.53, 95% CI 1.05-2.23, respectively). The types of sports predicting the highest risk of meniscal lesions were ballgames, gymnastics and jogging. Physical strenuousness of work did not predict meniscal lesion. The hazard of other knee injury was increased among those reporting irregular or regular physical exercise at baseline (HR 1.64, 95% CI 1.03-2.64 and 1.88 CI 1.05-2.36, respectively). Smoking or alcohol intake were not associated with knee injuries. Conclusions: Better safety measures in high-risk sports and weight control would likely improve the prevention of meniscal lesions in populations.Peer reviewe