Impacts of school-wide positive behaviour support: Results from National Longitudinal Register Data

Problem behaviour in schools may have detrimental effects both on students' well-being and academic achievement. A large literature has consistently found that school-wide positive behaviour support (SWPBS) successfully addresses social and behavioural problems. In this paper, we used population-wide longitudinal register data for all Norwegian primary schools and a difference-in-difference (DiD) design to evaluate effects of SWPBS on a number of primary and secondary outcomes, including indicators of externalising behaviour, school well-being, pull-out instruction, and academic achievement. Indications of reduced classroom noise were found. No other effects were detected. Analyses revealed important differences in outcomes between the intervention and control schools, independent of the implementation of SWPBS, and that a credible design like DiD is essential to handle such school differences.

Dimensions of Social Stratification and Their Relation to Mortality: A Comparison Across Gender and Life Course Periods in Finland

Differences in mortality between groups with different socioeconomic positions (SEP) are well-established, but the relative contribution of different SEP measures is unclear. This study compares the correlation between three SEP dimensions and mortality, and investigates differences between gender and age groups (35-59 vs. 60-84). We use an 11% random sample with an 80% oversample of deaths from the Finnish population with information on education, occupational class, individual income, and mortality (n = 496,658; 274,316 deaths between 1995 and 2007). We estimate bivariate and multivariate Cox proportional hazard models and population attributable fractions. The total effects of education are substantially mediated by occupation and income, and the effects of occupation is mediated by income. All dimensions have their own net effect on mortality, but income shows the steepest mortality gradient (HR 1.78, lowest vs. highest quintile). Income is more important for men and occupational class more important among elderly women. Mortality inequalities are generally smaller in older ages, but the relative importance of income increases. In health inequality studies, the use of only one SEP indicator functions well as a broad marker of SEP. However, only analyses of multiple dimensions allow insights into social mechanisms and how they differ between population subgroups.

Parity and Mortality: An Examination of Different Explanatory Mechanisms Using Data on Biological and Adoptive Parents

A growing literature has demonstrated a relationship between parity and mortality, but the explanation for that relationship remains unclear. This study aims to pick apart physiological and social explanations for the parity-mortality relationship by examining the mortality of parents who adopt children, but who have no biological children, in comparison with the mortality of parents with biological children. Using Swedish register data, we study post-reproductive mortality amongst women and men from cohorts born between 1915 and 1960, over ages 45-97. Our results show the relative risks of mortality for adoptive parents are always lower than those of parents with biological children. Mortality amongst adoptive parents is lower for those who adopt more than one child, while for parents with biological children we observe a U-shaped relationship, where parity-two parents have the lowest mortality. Our discussion considers the relative importance of physiological and social depletion effects, and selection processes.

A register-based study on associations between vaccination, antimicrobial use and productivity in conventional Danish finisher pig herds during 2011 to 2014

Reduction of antimicrobial use (AMU) in pigs is a priority to counteract development of antimicrobial resistance in animal and human pathogens. However, there is concern that Danish pig producers complying with official AMU restrictions might experience reduced herd health and productivity in the future, if alternative strategies are not available. Vaccination has been suggested as a strategy to prevent disease and minimise the need for antimicrobial treatments. The aim of this register-based study was to assess the associations between data on vaccination, productivity and AMU in Danish finisher herds over a 4-year period following initiation of the Yellow Card, which is a restrictive AMU control scheme. For each of the years 2011 to 2014, sow herds were grouped according to purchase patterns regarding Porcine Circovirus Type 2 (PCV2) (use/no use). For the sow herds (N = 179-433), additional information of purchases of vaccines against Mycoplasma hyopneumoniae (MYC), Actinobacillus pleuropneumoniae (APP), Porcine Reproductive and Respiratory Syndrome virus (PRRS) and Lawsonia intracellularis (LAW) was included. By use of movement data, finisher herds receiving pigs from the sow herds were tracked and included in the analyses. Finisher herds (N = 40-62) with register data on productivity (i.e. average daily weight gain, feed conversion rate, mortality and lean meat percentage) and data on prescriptions of antimicrobials measured in Animal Daily Doses/100 finishers/day as well as the proportion of parenteral AMU treatments out of all treatments (AMU-ratio) were included. Univariable combinations were tested for statistically significant associations (P < 0.05) and included in multivariable linear mixed-effects model for each of the six outcome variables representing productivity (N=4) or AMU (N=2). Herd number was included as a random effect to account for the herds appearing more than once. The variables representing PCV2, enrolment in the Danish Specific Pathogen Free (SPF) system, year, herd type and herd size were included as potential confounders. Vaccination against PRRS and higher AMU for finishers were associated with increased lean meat percentage, potentially due to disease outbreaks resulting in reduced growth of the pigs and lower carcass weight at slaughter in herds with PRRS. None of the other types of vaccines was associated with any of the productivity outcomes. Vaccination against PCV2, PRRS and APP were associated with higher levels of AMU, and vaccination against LAW with a higher AMU-ratio. This may be explained as some farmers preferring to take action soon after observing disease problems. No association was found between vaccination against MYC and AMU. Herds enrolled in SPF had significantly higher average daily weight gain than non-SPF herds.

Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated

AIM

Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden.

METHODS

We analysed individual-level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000 to 2014, and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years.

RESULTS

Child deaths from all causes were 7914, and 2006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100 000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%).

CONCLUSION

Childhood deaths showed a sustained decline from 2000 to 2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths.

Comparing Observed and Unobserved Components of Childhood: Evidence From Finnish Register Data on Midlife Mortality From Siblings and Their Parents

In this study, we argue that the long arm of childhood that determines adult mortality should be thought of as comprising an observed part and its unobserved counterpart, reflecting the observed socioeconomic position of individuals and their parents and unobserved factors shared within a family. Our estimates of the observed and unobserved parts of the long arm of childhood are based on family-level variance in a survival analytic regression model, using siblings nested within families as the units of analysis. The study uses a sample of Finnish siblings born between 1936 and 1950 obtained from Finnish census data. Individuals are followed from ages 35 to 72. To explain familial influence on mortality, we use demographic background factors, the socioeconomic position of the parents, and the individuals' own socioeconomic position at age 35 as predictors of all-cause and cause-specific mortality. The observed part-demographic and socioeconomic factors, including region; number of siblings; native language; parents' education and occupation; and individuals' income, occupation, tenancy status, and education-accounts for between 10 % and 25 % of the total familial influence on mortality. The larger part of the influence of the family on mortality is not explained by observed individual and parental socioeconomic position or demographic background and thus remains an unobserved component of the arm of childhood. This component highlights the need to investigate the influence of childhood circumstances on adult mortality in a comprehensive framework, including demographic, social, behavioral, and genetic information from the family of origin.

Information bias of social gradients in sickness absence: a comparison of self-report data in the Norwegian Mother and Child Cohort Study (MoBa) and data in national registries

Background

Measurement error in self-report questionnaires is a common source of bias in epidemiologic studies. The study aim was to assess information bias of the educational gradient in sickness absence among participants in the Norwegian Mother and Child Cohort Study (MoBa), comparing self-report data with national register data.

Methods

MoBa is a national prospective cohort study. The present study included 49,637 participants, born 1967–1976, who gave birth 2000–2009. The highest completed education level was recorded in categories and as educational years. Sickness absence was defined as one or more spell lasting more than 16 days between pregnancy weeks 13 and 30. We computed sickness absence risk in mid-pregnancy in strata of education level. Associations between completed educational years and sickness absence were estimated as risk differences in binomial regression and compared between self-report and register data. In additional analyses, we aimed to explain discrepancies between estimates from the two data sources.

Results

The overall registry-based sickness absence risk was 0.478 and decreased for increasingly higher education in a consistent fashion, yielding an additive risk difference in association with one additional education year of − 0.032 (95% confidence interval − 0.035 to − 0.030). The self-report risk was lower (0.307) with a corresponding risk difference of only − 0.013 (95% confidence interval − 0.015 to − 0.011). The main explanation of the lower risk difference in the self-report data was a tendency for mothers in low education categories to omit reporting sickness absence in the questionnaire.

Conclusions

A plausible explanation for the biased self-report association is complexity of the sickness absence question and a resulting educational gradient in non-response. As shown for sickness absence in mid-pregnancy in the present study, national registries could be a preferred alternative to self-report questionnaires.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6208-9) contains supplementary material, which is available to authorized users.

Educational inequalities in mortality are larger at low levels of income: A register-based study on premature mortality among 2.3 million Swedes, 2006-2009

Education develops skills that help individuals use available material resources more efficiently. When material resources are scarce, each decision becomes comparatively more important. Education may also protect from health-related income decline, since the highly educated tend to work in occupations with lower physical demands. Educational inequalities in health may, therefore, be more pronounced at lower levels of income. The aim of this study is to assess whether the shape of the income gradient in premature mortality depends on the level of education.

Total population data on education, income and mortality was obtained by linking several Swedish registers. Income was defined as five-year average disposable household income for ages 35–64 and mortality follow-up covered the period 2006–2009. The final population comprised 2.3 million individuals, 6.2 million person-years and 14,362 deaths. Income was modeled using splines in order to allow variation in the functional form of the association across educational categories. Poisson regression with robust standard errors was used.

The curvilinear shape of the association between income and mortality was more pronounced among those with a low education. Both absolute and relative educational inequalities in premature mortality tended to be larger at low levels of income. The greatest income differences in mortality were observed for those with a low education and the smallest for the highly educated.

Education and income interact as predictors of mortality. Education is a more important factor for health when access to material resources is limited.

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Income and education interact as predictors of mortality.

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Educational inequalities in mortality are larger at low levels of income.

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Education is negatively associated with mortality at all levels of income.

Parental hospital-treated somatic illnesses during offspring's childhood associated with later offspring use of psychotropic medication during childhood to young adult - The 1987 Finnish Birth Cohort study

This study aimed to systematically examine whether parental hospital-treated somatic illnesses, diagnosed during an offspring's childhood (1987-1995), are associated with later use of psychotropic medication (1996-2012) by the offspring. If so, which parental somatic illnesses, in particular, increase the likelihood for later use of psychotropic medication among the offspring. The 1987 Finnish Birth Cohort study yields longitudinal nationwide follow-up data that include a complete census of children born in a single year. A total 58,551 offspring are included in this study and, of these 57,752 had a known father. Offspring who had used psychotropic medication between the ages of 9 and 24 years, more often had parents who had experienced a greater number of somatic illnesses when their child was aged under 9, compared to offspring without any use of psychotropic medication. The specific parental somatic illnesses early in life, for example disorders of female tract (OR 1.12, 95%CI 1.01-1.23), pregnancy with abortive outcome (1.18, 1.09-1.28), paternal acute infections (1.20, 1.05-1.38), and paternal symptoms, signs, and ill-defined conditions (1.21, 1.03-1.42), were found to be associated with psychotropic medication treatment using parental-related determinants; death, education, receipt of social assistance and psychiatric inpatient care as covariates. This suggests that these specific parental somatic illnesses can affect psychological well-being of the offspring. Preventive actions and support for the child, should be provided in situations where a parent with a somatic illness has limited ability to care for and rear their child.

Toward dynamic urban environmental exposure assessments in mental health research

It is increasingly recognized that mental disorders are affected by both personal characteristics and environmental exposures. The built, natural, and social environments can either contribute to or buffer against metal disorders. Environmental exposure assessments related to mental health typically rely on neighborhoods within which people currently live. In this article, I call into question such neighborhood-based exposure assessments at one point in time, because human life unfolds over space and across time. To circumvent inappropriate exposure assessments and to better grasp the etiologies of mental disease, I argue that people are exposed to multiple health-supporting and harmful exposures not only during their daily lives, but also over the course of their lives. This article aims to lay a theoretical foundation elucidating the impact of dynamic environmental exposures on mental health outcomes. I examine, first, the possibilities and challenges for mental health research to integrate people's environmental exposures along their daily paths and, second, how exposures over people's residential history might affect mental health later in life. To push the borders of scientific inquiries, I stress that only such mobility-based approaches facilitate an exploration of exposure duration, exposure sequences, and exposure accumulation.

Exploring the concurrent validity of the nationwide assessment of permanent nursing home residence in Denmark - A cross-sectional data analysis using two administrative registries

BACKGROUND

Many register studies make use of information about permanent nursing home residents. Statistics Denmark (StatD) identifies nursing home residents by two different indirect methods, one based on reports from the municipalities regarding home care in taken place in a nursing home, and the other based on an algorithm created by StatD. The aim of the present study was to validate StatD's nursing home register using dedicated administrative municipality records on individual nursing home residents as gold standard.

METHODS

In total, ten Danish municipalities were selected. Within each Danish Region, we randomly selected one municipality reporting to Stat D (Method 1) and one not reporting where instead an algorithm created by StatD was used to discover nursing home residents (Method 2). Method 1 means that municipalities reported to Stat D whether home care has taken place in a nursing home or in a private home. Method 2 is based on an algorithm created by Stat D for the municipalities where Method 1 is not applicable. Our gold standard was the information from the local administrative system in all ten selected municipalities. Each municipality provided a list with all individuals > 65 years living in a nursing home on January 1st, 2013 as well as the central personal number. This was compared to the list of individuals >65 living in nursing home facilities in the same ten municipalities on January 1st, 2013 retrieved from StatD.

RESULTS

According to the data received directly from the municipalities, which was used as our gold Standard 3821 individuals were identified as nursing home residents. The StatD register identified 6,141 individuals as residents. Additionally, 556 of the individuals identified by the municipalities were not identified in the StatD register. Overall sensitivity for the ten municipalities in the StatD nursing home register was 0.85 (95% CI 0.84-0.87) and the PPV was 0.53 (95% CI 0.52-0.54). The municipalities for which nursing home status was based on the StatD algorithm (method 2) had a sensitivity of 0.84 (95% CI 0.82-0.86) and PPV of 0.48 (95% CI 0.46-0.50). Both slightly lower than the reporting municipalities (method 1) where the sensitivity was 0.87(95% CI 0.85-0.88) and the PPV was 0.57 (95% CI 0.56-0.59). Additionally, the sensitivity and PPV of the Stat D register varied heavily among the ten municipalities from 0.51 (95% CI 0.43-0.59) to 0.96 (95% CI 0.95-0.98) and PPV correspondingly, from 0.14 (95% CI: 0.11-0.17) to 0.73 (95% CI 0.69-0.77).

CONCLUSIONS

The overall PPV of StatD nursing home register was low and differences between municipalities existed. Even in countries with extensive nation-wide registers, validating studies should be conducted for outcomes based on these registers.

How is disease severity associated with quality of life in psoriasis patients? Evidence from a longitudinal population-based study in Sweden

BACKGROUND

Assessing the impact of disease severity on generic quality of life (QOL) is a critical step in outcomes research and in the development of decision-analytic models structured around health states defined by clinical measures. While data from routine clinical practice found in healthcare registers are increasingly used for research, more attention should be paid to understanding the relationship between clinical measures of disease severity and QOL. The purpose of this work was therefore to investigate this relationship in psoriasis using a population-based dataset.

METHODS

Severity was measured by the Psoriasis Area and Severity Index (PASI), which combines severity of erythema, induration, and desquamation into a single value ranging from 0 to 72. The generic EQ-5D-3L utility instrument, under the UK tariff, was used to measure QOL. The association between PASI and EQ-5D-3L was estimated using a population-based dataset of 2674 patients with moderate to severe psoriasis enrolled over ten years in the Swedish psoriasis register (PsoReg). Given the repeated measurement of patients in the register data, a longitudinal fixed-effects model was employed to control for unobserved patient-level heterogeneity.

RESULTS

Marginal changes in PASI are associated with a non-linear response in EQ-5D-3L: Moving from PASI 10 to 9 (1 to 0) is associated with an increase of 0.0135 (0.0174) in EQ-5D-3L. Furthermore, unobserved patient-level heterogeneity appears to be an important source of confounding when estimating the relationship between QOL and PASI.

CONCLUSIONS

Using register data to estimate the impact of disease severity on QOL while controlling for unobserved patient-level heterogeneity shows that PASI appears to have a larger impact on QOL than previously estimated. Routine collection of generic QOL data in registers should be encouraged to enable similar applications in other disease areas.

TRIAL REGISTRATION

Not applicable.

The longitudinal association between multiple job holding and long-term sickness absence among Danish employees: an explorative study using register-based data

Purpose

Multiple job holding (MJH) is common in many countries, but little is known about its (health) consequences. Our aim is to explore the longitudinal association between MJH and long-term sickness absence (LTSA) among Danish employees.

Methods

We included employees (N = 8968) who participated in the Danish Work Environment Cohort Study (DWECS), based on a representative sample of the Danish working population. Three dichotomous independent variables were created: MJH in general, combination MJH (i.e. second job as employee) and hybrid MJH (i.e. self-employed in second job). LTSA (≥5 weeks) was measured using the Danish Register for Evaluation of Marginalization during 78 weeks of follow-up. Potential confounders included demographics, health, and work characteristics. Logistic regression analyses were performed to study whether LTSA was associated with MJH in general, combination MJH, and hybrid MJH. Interaction effects for gender, age, total working hours per week (≤37 or >37 h a week), and shift work were tested.

Results

In total, 11.7% (N = 1048) of the respondents reported having multiple jobs and 7.6% (N = 678) experienced LTSA during follow-up. After adjustment for confounders, no significant association between LTSA and MJH in general (OR = 0.82), combination MJH (OR = 0.81), or hybrid MJH (OR = 0.83) was found. Among employees working more than 37 h per week, combination MJH was associated with a higher likelihood of LTSA (OR = 1.50).

Conclusions

We did not find evidence for an increased likelihood of LTSA among multiple job holders. Future research should study the likelihood of LTSA among subgroups of multiple job holders, e.g. those working long hours.

Employment After Parenthood: Women of Migrant Origin and Natives Compared

Motherhood negatively affects female employment in majority populations across Europe. Although employment levels are particularly low among women of migrant origin, little is known about the motherhood-employment link in migrant populations. This paper investigates whether family formation differentially affects the labour market position of migrant women and their descendants compared to natives. Using longitudinal microdata from the Belgian social security registers, 12,167 women are followed from 12 months before until 48 months after the birth of their first child for the period 1999-2010. Levels of activity (versus inactivity), employment (versus unemployment) and full-time employment (versus part-time employment) are compared between natives and first- and second-generation women of Southern European, Eastern European, Turkish and Moroccan origin. We find that activity and employment levels decrease to a larger extent following the transition to parenthood among women of migrant origin than among natives. With respect to activity levels, differences between second-generation women and natives are largely explained by socio-demographic and pre-birth job characteristics, while differences between first-generation women and natives are not, suggesting that other factors such as tied migration patterns determine labour market attachment among first-generation mothers. With respect to employment levels, unemployment is increasing more among women of migrant origin of both generations than among natives, also when controlling for background characteristics, which signals differential access to stable job positions as well as to family policies. In sum, the results draw attention to the challenge that parenthood creates for mothers of migrant origin in terms of retaining and gaining employment, but also to the role of labour market entry and early career positions.

Differences Between Household Income from Surveys and Registers and How These Affect the Poverty Headcount: Evidence from the Austrian SILC

We take advantage of the fact that for the Austrian SILC 2008-2011, two data sources are available in parallel for the same households: register-based and survey-based income data. Thus, we aim to explain which households tend to under- or over-report their household income by estimating multinomial logit and OLS models with covariates referring to the interview situation, employment status and socio-demographic household characteristics. Furthermore, we analyze source-specific differences in the distribution of household income and how these differences affect aggregate poverty indicators based on household income. The analysis reveals an increase in the cross-sectional poverty rates for 2008-2011 and the longitudinal poverty rate if register data rather than survey data are used. These changes in the poverty rate are mainly driven by differences in employment income rather than sampling weights and other income components. Regression results show a pattern of mean-reverting errors when comparing household income between the two data sources. Furthermore, differences between data sources for both under-reporting and over-reporting slightly decrease with the number of panel waves in which a household participated. Among the other variables analyzed that are related to the interview situation (mode, proxy, interview month), only the number of proxy interviews was (weakly) positively correlated with the difference between data sources, although this outcome was not robust over different model specifications.

Health and Its Relationship with Residential Relocations of Older People to Institutions versus to Independent Dwellings

Research into older people’s relocations to independent dwellings has largely remained separate from research into moves to institutions. Yet, both types of moves could be a response to health problems and to a certain extent they could be substitutes for each other. Using Litwak and Longino’s model of moves of older people, this study assesses the extent to which three commonly used health measures (limitations in activities of daily living [ADL], self-rated health, and the prevalence of [limiting] chronic conditions) predict older people’s moves to subsidized care institutions and elsewhere, in one multinomial logistic regression model. The data were derived from the POLS survey for the Netherlands (N = 8306) enriched with administrative data on subsequent moves. In line with Litwak and Longino’s model, the findings indicate that older people’s moves to institutions were more likely among those with more severe health problems, whereas moves elsewhere were more likely among those with moderate health problems. Among the three investigated health measures, limitations in ADL had the strongest predictive value, and was the only one for which the difference in effect between relocations to care institutions and relocations elsewhere was statistically significant.

Health effects of parental deaths among adults in Norway: Purchases of prescription medicine before and after bereavement

We analyse effects of parental deaths on the health of women and men aged 18–59 in 2004–2008, indicated by purchases of prescription medicines. Register data covering the entire Norwegian population were used, and fixed-effects models were estimated to control for unobserved time-invariant individual factors. A parent's death seemed to have immediate adverse consequences in both main age groups considered (18–39, 40–59), although effects were lower in the older group. Some results suggested that this health disadvantage widened with increasing time since the parent's death. However, effects were weak: the annual number of different medicines purchased was only increased by 1–7% as a result of losing a parent. Death of a parent was associated with an immediate increase in purchases of medication for mental diseases, and there were indications of a physical response as well. As time since the parental death increased, there was a decline in the purchase of medication for mental diseases, but an opposite trend with respect to medication for other diseases. On the whole, maternal and paternal deaths had the same impact, and effects on daughters and sons were of the same magnitude.

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A parent’s death seemed to have immediate weakly adverse health consequences.

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Some results suggested that this health disadvantage widened with time since death.

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The effects on physical and mental health seemed to be different.

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Purchases of prescription medicine were used as indicators of health.

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Unobserved time-invariant individual factors were controlled for.

Ethnic differences in colon cancer care in the Netherlands: a nationwide registry-based study

Background

Ethnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands.

Methods

Data of 101,882 patients diagnosed with CC in 1996–2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival.

Results

Adequate LN evaluation was significantly more likely for patients from ‘other Western’ countries than for the Dutch (OR 1.09; 95% CI 1.01–1.16). ‘Other Western’ patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05–1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13–0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03–2.61) was statistically explained by differences in adjuvant chemotherapy receipt.

Conclusion

These results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients’ health literacy when looking at ethnic differences in treatment for CC.

Does death really make us equal? Educational attainment and resource compensation after paternal death in Finland

Attempts to explain the persistent importance of family background for children's educational attainment typically highlight the ways in which parents pass down educational, economic and social resources to their children. However, parental resources may also play a crucial role for preventing family crises from spiraling into cumulative disadvantage. To study such compensation processes, we examine the consequences of a father's death on children's educational trajectories, using a Finnish register-based sample of children born between 1982 and 1987. The results based on multilevel linear probability models both support and contradict our compensation hypothesis. Children who lost their father were not more likely to drop out of upper secondary school, as long as their surviving mother had high levels of socioeconomic resources. Similar compensation processes were visible in the case of entering polytechnic higher education. However, with regard to university attendance, bereavement noticeably reduced the traditional advantage of children with high-resource parents.

What do register-based studies tell us about migrant mental health? A scoping review

BACKGROUND

Previous studies investigating the mental health of migrants have shown mixed results. The increased availability of register data has led to a growing number of register-based studies in this research area. This is the first scoping review on the use of registry and record-linkage data to examine the mental health of migrant populations. The aim of this scoping review is to investigate the topics covered and to assess the results yielded from these studies.

METHODS

We used a scoping review methodology to search MedLine, PubMed, PsychINFO, Web of Science, and SCOPUS for all register-based studies on the mental health of migrants. Two reviewers screened all papers, independently, using iteratively applied inclusion and exclusion criteria. Using gradually broadening inclusion and exclusion criteria for maximum "scope," newly published criteria developed to appraise the methodological quality of record-linkage studies were applied to eligible papers and data were extracted in a charting exercise.

RESULTS

A total of 1309 papers were screened and appraised, 51 of which met the eligibility and quality criteria and were included in the review. This review identified four major domains of register-based research within the topic of migrant mental health: rates and risks of psychiatric disorders, rates and risks of suicide mortality, the use of psychotropic drugs, and health service utilisation and mental health-related hospitalisation rates. We found that whilst migrants can be at an increased risk of developing psychotic disorders and suicide mortality, they are less likely to use psychotropic medication and mental health-related services.

CONCLUSIONS

This review systematically charts the register-based studies on migrants' mental health for the first time. It shows the main topics and gaps in knowledge in this research domain, discusses the disadvantages of register-based studies, and suggests new directions for forthcoming studies.

Perceived stress among 20-21 year-olds and their future labour market participation - an eight-year follow-up study

Background

Labour market participation among young adults is essential for their future socioeconomic status and health. The aim of this study was to investigate the association between perceived stress among 20–21 year-olds and their labour market participation 8 years later as well as investigate any potential gender differences.

Methods

A cohort of 1640 young adults born in 1983 completed a questionnaire in 2004 in which perceived stress was measured. The cohort was followed in a register of social benefits for 12 months in 2011–2012 and was categorized into active and passive labour market participation. Logistic regression was used to analyse the association between perceived stress and future labour market participation, taking into account effects of potential confounders. The analyses were stratified by gender.

Results

The effects of perceived stress on future labour market participation differed significantly among young women and young men (p = 0.029). For young men, higher levels of perceived stress reduced the risk of future passive labour market participation, when adjusting for socioeconomic factors, self-rated health and copings strategies (p = 0.045). For young women, higher levels of perceived stress increased the risk of future passive labour market participation, when adjusting for the same potential confounding factors, although unlike the men, this association was not statistically significant (p = 0.335).

Conclusion

The observed gender difference has important implications from a public health point of view. Healthcare professionals might need to differentiate between the genders in terms of health communication, research and when developing preventive strategies.

Trends of relative and absolute socioeconomic equity in access to coronary revascularisations in 1995-2010 in Finland: a register study

Background

Resources for coronary revascularisations have increased substantially since the early 1990s in Finland. At the same time, ischaemic heart disease (IHD) mortality has decreased markedly. This study aims to examine how these changes have influenced trends in absolute and relative differences between socioeconomic groups in revascularisations and age group differences in them using IHD mortality as a proxy for need.

Methods

Hospital Discharge Register data on revascularisations among Finns aged 45–84 in 1995–2010 were individually linked to population registers to obtain socio-demographic data. We measured absolute and relative income group differences in revascularisation and IHD mortality with slope index of inequality (SII) and concentration index (C), and relative equity taking need for care into account with horizontal inequity index (HII).

Results

The supply of procedures doubled during the years. Socioeconomic distribution of revascularisations was in absolute and relative terms equal in 1995 (Men: SII = −12, C = −0.00; Women, SII = −30, C = −0.03), but differences favouring low-income groups emerged by 2010 (M: SII = −340, C = −0.08; W: SII = −195, C = −0.14). IHD mortality decreased markedly, but absolute and relative differences favouring the better-off existed throughout study years. Absolute differences decreased somewhat (M: SII = −760 in 1995, SII = −681 in 2010; W: SII = −318 in 1995, SII = −211 in 2010), but relative differences increased significantly (M: C = −0.14 in 1995, C = −0.26 in 2010; W: C = −0.15 in 1995, C = −0.25 in 2010). HII was greater than zero in each year indicating inequity favouring the better-off. HII increased from 0.15 to 0.18 among men and from 0.10 to 0.12 among women. We found significant and increasing age group differences in HII.

Conclusions

Despite large increase in supply of revascularisations and decrease in IHD mortality, there is still marked socioeconomic inequity in revascularisations in Finland. However, since changes in absolute distributions of both supply and need for coronary care have favoured low-income groups, absolute inequity can be claimed to have decreased although it cannot be quantified numerically.

The impact of self-reported health and register-based prescription medicine purchases on re-employment chances: A prospective study

In this paper, we investigate the influence of self-reported health and register-based prescription medicine purchases on re-employment chances, and whether these health indicators measure similar aspects of health in this analysis. Data came from a 2006 Danish unemployment survey among a random sample of unemployed individuals enriched with register data (2006–2008, N=1806). The survey participants all received unemployment benefits from the welfare system and had been unemployed for more than 20 weeks at the time of the interview in 2006. We combined these data with longitudinal register data on individual prescription medicine purchases for somatic illnesses and prescription medicine purchases for mental illnesses, information on re-employment and various socio-demographic variables. We conducted binary logistic regression analyses to investigate the impact of self-reported health and prescription medicine purchases measured in 2006 on re-employment chances in 2007 and 2008. Our analyses show that unemployed workers with poor self-reported health and workers who had prescription medicine purchases for mental illnesses were less likely to be re-employed in 2007 and 2008. Furthermore, the impact of both prescription medicine purchases for somatic illnesses and for mental illnesses increased when adding self-reported health to the model although prescription purchases for somatic illnesses became statistically insignificant. The impact of prescription medicine purchases for somatic illnesses was mediated by self-reported health, whilst prescription medicine purchases for mental illnesses was only partly mediated. Finally, SRH seemed a much stronger prediction than prescription medicines. From these results, we propose, when possible, the inclusion of both an indicator of self-reported health and an indicator of mental health in studies on re-employment.

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Poor health negatively affects re-employment chances of unemployed workers.

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Self-reported health indicates somatic health over prescription medicine purchases.

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Both self-reported health and mental health are relevant to re-employment chances.

Obesity and psychotropic medication: a prospective register linkage study among midlife women and men

BACKGROUND

Both obesity and mental health are major public health issues. This study aimed to examine whether overweight and obesity among midlife employees are associated with subsequent psychotropic medication. A further aim was to examine the potential effect of key covariates on the association.

METHODS

The Helsinki Health Study baseline survey was conducted in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland (n = 8960). The participants were classified as of normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), obese (30-34.9 kg/m(2)) or severely obese (≥35 kg/m(2)) based on self-reported body mass index. Data on psychotropic medication purchases from baseline to 2009 were derived from registers of the Social Insurance Institution of Finland. The final analysis included 4760 women and 1338 men. Antidepressants and sedatives were examined separately. Covariates included socio-demographic factors, workload, health behaviours, physical functioning, somatic ill-health and psychotropic medication prior to baseline. Hazard ratios (HR) for the first psychotropic medication purchase were calculated using Cox regression analysis.

RESULTS

Third of women and quarter of men made at least one psychotropic medication purchase during the follow-up. Adjusting for age, obese (HR = 1.57; 95 % CI = 1.10-2.24) and severely obese (HR = 2.15; 95 % CI = 1.29-3.56) men were at risk of having psychotropic medication compared to men of normal weight. These associations disappeared after further adjustment. Severe obesity remained associated with subsequent sedative medication among the men even after full adjustment (HR = 2.12; 95 % CI = 1.17-3.84). No associations were found among the women.

CONCLUSIONS

Obese and severely obese men, but not women, were at risk of psychotropic medication. Further studies are needed to deepen understanding of the relationship between obesity and mental ill-health, and the possible protecting effects of age, employment, and living environment.

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation

Background

Large cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (City of Helsinki) both exceeded that in other types of geographical areas in Finland, and whether those differences were dependent on socioeconomic inequalities.

Methods

We analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (AM) to health care interventions in 1992–2008 in three types of geographical areas in Finland: City of Helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the Causes of Death statistics from Statistics Finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using Gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas.

Results

While mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for AM changed by 54 % in men (p < 0.027) and by 62 % in women (p < 0.016). Only slight differences existed in the time trends of Gini or in the concentration indices between the geographical areas.

Conclusions

No geographical or income-related differences in the distribution of mortality existed between Helsinki and other urban or rural areas of Finland. This suggests that the effect of increasing residential differentiation in the capital may have been mitigated by the policies of positive discrimination and social mixing. One of the main reasons for the increase in health inequalities was growth of alcohol-related mortality, especially among those with the lowest incomes.

Realization of fertility intentions by different time frames

This paper focuses on the realization of positive fertility intentions with different time frames. The analyses are based on a unique combination of survey data and information from Norwegian administrative registers on childbearing in the years following the complete selected sample. Guided by the theoretical and empirical framework of the Theory of Planned Behavior (TPB), the results suggest that a fertility intention's time frame is relevant for childbearing behaviour, but the patterns are somewhat different for respondents who were childless at the time of the interview compared to those who already had children. Overall, childless were less likely to realize their fertility intentions than parents. Following the TPB, childless may underestimate the difficulty of acting on their intentions and therefore have more difficulty realizing their intentions, versus parents who take into account their ability to manage another child. The results also show that childless with an immediate fertility intention are more likely to succeed than those with a longer-term intention. Likewise, parents with an immediate fertility intention are more likely to realize their intention during the two first years after the interview, but after four years the childbearing rate was higher among those with longer-term fertility intentions.

Register data in the evaluation and program planning of addiction treatment programs: using Sweden as an example

Data from large-scale registers is often underutilized when evaluating addiction treatment programs. Since many programs collect register data regarding clients and interventions, there is a potential to make greater use of such records for program evaluation. The purpose of this article is to discuss the value of using large-scale registers in the evaluation and program planning of addiction treatment systems and programs. Sweden is used as an example of a country where register data is both available and is starting to be used in national evaluation and program planning efforts. The article focuses on possibilities, limitations and practicalities when using large-scale register data to conduct evaluations and program planning of addiction treatment programs. Main conclusions are that using register data for evaluation provides large amounts of data at low cost, limitations associated to the use of register data may be handled statistically, register data can answer important questions in planning of addiction treatment programs, and more accurate measures are needed to account for the diversity of client populations.

The association between grandparenthood and mortality

Few studies have so far enquired into the relationship between being a grandparent and health and mortality outcomes, and the majority of these have looked exclusively at grandparents who take over parenting responsibility for their grandchildren. This study aims to fill this gap in the knowledge of how family structure is linked to mortality by focusing on whether being a grandparent in itself is associated with mortality. Norwegian parents in the age groups 40-73 are analysed using register data that encompass the entire population. The analysis is based on discrete-time hazard models, estimated for the years 1980-2008. I find a mortality disadvantage of being a grandfather, which is particularly strong for those who become grandfathers at an early age. Controlling for characteristics of the middle generation such as sex, education and marital status does not remove the association. For men the mortality disadvantage is not influenced by the number of grandchildren or the number of sets of grandchildren. For women there is significantly higher mortality only for those who become grandmothers in their thirties or forties, who are married or who have many children. Becoming a grandmother after age 50 is associated with significantly lower mortality. At least part of these associations are likely due to selection effects, however they may also to some extent be caused by the individuals' relationship with grandchildren, and children who have become parents themselves.

Small Effects of Selective Migration and Selective Survival in Retrospective Studies of Fertility: Faibles effets de sélection de la migration et de la mortalité sur la fécondité dans les études rétrospectives

In this study, we assess the accuracy of fertility estimates that stem from the retrospective information that can be derived from an existing cross-sectional population. Swedish population registers contain information on the childbearing of all people ever registered as living in Sweden, and thus allow us to avoid problems of selectivity by the virtue of survival or nonemigration when estimating the fertility measures for previous calendar periods. We calculate two types of fertility rates for each year in 1961-1999: (i) rates that are based on the population that was living in Sweden at the end of 1999, and (ii) rates that also include information on people who had died or emigrated before the turn of the twentieth century. We find that the omission of information on individuals who had emigrated or died, as the situation would be in any demographic survey, most often have negligible effects on fertility measures. However, first-birth rates of immigrants gradually become more biased as we move back in time from 1999 so that they increasingly tend to over-estimate the true fertility of that population.