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Toffol E, Partonen T, Latvala A, But A, Heikinheimo O, Haukka J. Use of hormonal contraception and attempted suicide: a nested case-control study. Eur Psychiatry 2022. [PMCID: PMC9564136 DOI: 10.1192/j.eurpsy.2022.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
In Finland more than 40% of fertile aged women used some type of hormonal contraception (HC) in the period 2010-2013. A proportion of women using HC complains of side effects, including mood symptoms. The relationship between the use of HC and the risk of attempted suicide (AS) is still a matter of debate.
Objectives
To assess the association of the use of HC with the risk of AS during 2017-2019.
Methods
Data were retrieved from the Prescription Centre, Care Register of Health Care, Register of Primary Health Care Visits and Statistics Finland. A total of 587 823 women, aged 15-49 years, using and not using HC in 2017 were analysed in the initial incidence study. All incident AS cases during 2018-2019, and their 4:1 age-matched controls (1 174 346 person-years) were analysed in a nested case-control setting via conditional logistic regression models.
Results
Altogether 818 AS cases occurred during the follow-up (incidence rate: 0.70/1000 person-years, 95% CI 0.65–0.75), with an IRR of HC vs. no-HC use of 0.73 (0.63–0.83). Current use (in the 180 days before the event) of estradiol- or ethinylestradiol-containing HC was associated with a lower risk of AS (0.53, 0.33–0.87; 0.49, 0.37–0.64, respectively) compared to non-use of HC. After controlling for covariates (marital and socioeconomic status, education level, use of psychotropic medications), only current use of HC containing ethinylestradiol remained significant (0.39, 0.23–0.65).
Conclusions
A lower risk of AS is associated with the use of HC, and specifically of ethinylestradiol-containing
HC.
Disclosure
No significant relationships.
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Toffol E, But A, Heikinheimo O, Latvala A, Partonen T, Haukka J. Nation-wide profile of women using hormonal contraception in Finland in 2017. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Up to 69% of European women use contraception. Nordic countries have traditionally high levels of contraception use, of welfare and social equality. However, the uneven population distribution across the Finnish territory makes the easiness of access to health care structures and trained professionals an important issue in relation to effective contraception use. Understanding the patterns of contraception prescription and their underlying determinants is crucial to guarantee the best contraceptive option for each woman.
Methods
In Finland, users of hormonal contraception (HC) can be identified from register records only starting from 2017. This nationwide, register-based study includes all women with at least one HC prescription in 2017, and a reference cohort of non-users, matched by age and municipality. Through linkages to Finnish National Registers we retrieved sociodemographic data. We calculated national and regional rates and distributions, and compared distributions with t-test, Kruskal Wallis or Chi-squared test.
Results
The HC cohort included 294445 women aged 15-49 years (mean 28.9, SD 8.6), 25.8% of Finnish women of that age range. The majority of them were unmarried (71.8%) and employed (71.6%). Compared to non-users, HC users were more often unmarried, a cohabiting couple without common children, employed, had upper secondary or bachelor level education, and higher annual income (p < 0.001). Differences between HC users and non-users were non-homogenous across 70 Finnish regions.
Conclusions
These preliminary results show different sociodemographic correlates of HC use across Finnish regions. Our findings will guide public health strategies aimed at guaranteeing the best contraceptive option for each woman across the whole country.
Key messages
Sociodemographic correlates of HC use differ across Finnish regions. These differences may reflect differences in access to health care services, in prescribers’ characteristics and in HC methods.
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Affiliation(s)
- E Toffol
- University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - A But
- University of Helsinki, Helsinki, Finland
| | - O Heikinheimo
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Latvala
- University of Helsinki, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki, Finland
| | - T Partonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - J Haukka
- University of Helsinki, Helsinki, Finland
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Affiliation(s)
- H. Jaakkola
- Research Institute for Information Technology, Tampere University of Technology
P.O. Box 527, SF-33101
Tampere Finland
| | - H. Tenhunen
- Signal Processing Laboratory, Tampere University of Technology
P.O. Box 527, SF-33101
Tampere Finland
| | - A. Latvala
- Research Institute for Information Technology, Tampere University of Technology
P.O. Box 527, SF-33101
Tampere Finland
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Verweij KJ, Creemers H, Korhonen T, Latvala A, Dick D, Rose RJ, Huizink A, Kaprio J. Role of overlapping genetic and environmental factors in the relationship between early adolescent conduct problems and substance use in young adulthood. Addiction 2016; 111:1036-45. [PMID: 26748618 PMCID: PMC4861688 DOI: 10.1111/add.13303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/13/2015] [Accepted: 01/07/2016] [Indexed: 11/26/2022]
Abstract
AIMS To determine (1) the prospective associations of conduct problems during early adolescence with tobacco, alcohol and cannabis use in young adulthood and (2) to what extent these associations are due to overlapping genetic versus environmental influences. DESIGN A prospective twin study using biometric twin modelling. SETTING Finland. PARTICIPANTS A total of 1847 Finnish twins (943 males and 904 females) were interviewed in early adolescence, 73% of whom (n = 1353, 640 males and 713 females) were retained in young adulthood. MEASUREMENTS Symptom counts of conduct disorder (CD) criteria were obtained from a semi-structured clinical interview in early adolescence [age 14-15 years, mean = 14.2, standard deviation (SD) = 0.15]. Frequency of alcohol, tobacco and cannabis use was obtained from a semi-structured clinical interview in young adulthood (age 19.9-26.6 years, mean = 22.4, SD = 0.7). FINDINGS We found modest to moderate phenotypical correlations (r = 0.16-0.35) between early adolescent CD symptoms and substance use in young adulthood. In males, the phenotypical correlations of CD symptoms with all three substance use variables are explained largely by overlapping genetic influences. In females, overlapping shared environmental influences predominantly explain the phenotypical correlation between CD symptoms and tobacco and cannabis use. CONCLUSIONS Conduct disorder symptoms in early adolescence appear to moderately predict substance use in early adulthood. In males, genetic influences seem to be most important in explaining the relationship between conduct disorder symptoms and substance use whereas in females, shared environmental influences seem to be most important.
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Affiliation(s)
- Karin J.H. Verweij
- VU University, Department of Clinical Developmental Psychology and EMGO Institute for Health and Care Research, 1081 BT Amsterdam, the Netherlands,Department of Biological Psychology/Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - H.E. Creemers
- Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, The Netherlands,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T. Korhonen
- Department of Public Health, University of Helsinki, Helsinki, Finland,National Institute for Health and Welfare, Helsinki, Finland,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - A. Latvala
- Department of Public Health, University of Helsinki, Helsinki, Finland,National Institute for Health and Welfare, Helsinki, Finland
| | - D.M. Dick
- Departments of Psychiatry, Psychology and Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - R. J. Rose
- Department of Public Health, University of Helsinki, Helsinki, Finland,Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - A.C. Huizink
- VU University, Department of Clinical Developmental Psychology and EMGO Institute for Health and Care Research, 1081 BT Amsterdam, the Netherlands
| | - J. Kaprio
- Department of Public Health, University of Helsinki, Helsinki, Finland,National Institute for Health and Welfare, Helsinki, Finland,Finnish Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland
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Latvala A, Tuulio-Henriksson A, Dick DM, Vuoksimaa E, Viken RJ, Suvisaari J, Kaprio J, Rose RJ. Genetic origins of the association between verbal ability and alcohol dependence symptoms in young adulthood. Psychol Med 2011; 41:641-651. [PMID: 20529418 PMCID: PMC8094064 DOI: 10.1017/s0033291710001194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive deficits in alcohol dependence (AD) have been observed, poorer verbal ability being among the most consistent findings. Genetic factors influence both cognitive ability and AD, but whether these influences overlap is not known. METHOD A subset of 602 monozygotic (MZ) and dizygotic (DZ) twins from FinnTwin16, a population-based study of Finnish twins, was used to study the associations of verbal ability with DSM-III-R diagnosis and symptoms of AD, the maximum number of drinks consumed in a 24-h period, and the Rutgers Alcohol Problem Index (RAPI) scores. These twins, most of them selected for within-pair discordance or concordance for their RAPI scores at age 18.5 years, were studied with neuropsychological tests and interviewed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) in young adulthood (mean age 26.2 years, range 23-30 years). RESULTS All alcohol problem measures were associated with lower scores on the Vocabulary subtest of the Wechsler Adult Intelligence Scale - Revised (WAIS-R), a measure of verbal ability. In bivariate genetic models, Vocabulary and the alcohol problem measures had moderate heritabilities (0.54-0.72), and their covariation could be explained by correlated genetic influences (genetic correlations -0.20 to -0.31). CONCLUSIONS Poorer verbal ability and AD have partly overlapping biological etiology. The genetic and environmental influences on the development of cognitive abilities, alcohol problems and risk factors for AD should be studied further with prospective longitudinal designs.
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Affiliation(s)
- A Latvala
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
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Mustelin L, Latvala A, Pietiläinen KH, Piirilä P, Sovijärvi AR, Kujala UM, Rissanen A, Kaprio J. Associations between sports participation, cardiorespiratory fitness, and adiposity in young adult twins. J Appl Physiol (1985) 2010; 110:681-6. [PMID: 21193564 DOI: 10.1152/japplphysiol.00753.2010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise behavior, cardiorespiratory fitness, and obesity are strongly influenced by genetic factors. By studying young adult twins, we examined to what extent these interrelated traits have shared genetic and environmental etiologies. We studied 304 twin individuals selected from the population-based FinnTwin16 study. Physical activity was assessed with the Baecke questionnaire, yielding three indexes: sport index, leisure-time index, and work index. In this study, we focused on sport index, which describes sports participation. Body composition was determined using dual-energy X-ray absorptiometry and cardiorespiratory fitness using a bicycle ergometer exercise test with gas exchange analysis. The Baecke sport index was associated with high maximal oxygen uptake adjusted for lean body mass (Vo(2max)[adj]) (r = 0.40), with low body fat percentage (BF%) (r = -0.44) and low waist circumference (WC) (r = -0.29). Heritability estimates for the key traits were as follows: 56% for sport index, 71% for Vo(2max)[adj], 77% for body mass index, 66% for WC, and 68% for BF%. The association between sport index and Vo(2max) was mostly explained by genetic factors (70%), as were both the association between sport index and BF% (71%) and that between sport index and WC (59%). Our results suggest that genetic factors explain a considerable part of the associations between sports participation, cardiorespiratory fitness, and obesity.
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Affiliation(s)
- L Mustelin
- Hjelt Institute, Dept. of Public Health, Twin Research Unit, PB 41, 00014 Univ. of Helsinki, Finland.
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Latvala A, Syrjänen K, Salmenoja H, Salminen E. Anaemia and other predictors of fatigue among patients on palliative therapy for advanced cancer. Anticancer Res 2009; 29:2569-2575. [PMID: 19596930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The association of anaemia and other predictors of fatigue was studied in cancer patients on palliative treatment. A cohort of 128 consecutive patients (61 men and 67 women, mean age 63.6 years; range 36-85) was interviewed using the Edmonton Symptom Assessment System (ESAS) questionnaire, with 11 items describing cancer-related symptoms in visual analogue scale (VAS). Routine haematological samples were analysed at the time of interview. Both univariate and multivariate analyses were used to assess the independent predictors of fatigue. Out of the 10 symptoms recorded, fatigue was the single most frequent, reported by 91.3% of the patients, followed by pain (74.8%), sleeplessness (78.0%) and depression (74.2%). Anaemia was a significant determinant of fatigue (p=0.040)(OR=5.09; 95% CI 1.013-25.647). Out of the symptoms recorded, fatigue was significantly associated with depression (p=0.035), loss of appetite (p=0.016), anxiety (p=0.050), and sleeplessness (p=0.016). Total wellbeing was negatively associated with fatigue (OR=0.48, 95% CI 0.011-0.020)(p=0.0001). In multivariate analysis, anaemia was the most powerful independent predictor of fatigue, with OR=38.27 (95% CI 2.62-559.19)(p=0.008), followed by sleeplessness (OR=14.06 95% CI 1.44-137.02 p=0.023) and loss of appetite (OR=10.30 95% CI 1.04-101.10, p=0.045). Fatigue was unrelated to sex or age, or to the type of cancer, or the treatment category. Fatigue was common among cancer patients on palliative care. The single most powerful independent explanatory factor of fatigue was anaemia, implicating a need for interventional studies.
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Affiliation(s)
- A Latvala
- Department of Oncology and Radiotherapy, Turku University Hospital, Savitehtaankatu 1, FIN-20521 Turku, Finland
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Suvisaari J, Aalto-Setälä T, Tuulio-Henriksson A, Härkänen T, Saarni SI, Perälä J, Schreck M, Castaneda A, Hintikka J, Kestilä L, Lähteenmäki S, Latvala A, Koskinen S, Marttunen M, Aro H, Lönnqvist J. Mental disorders in young adulthood. Psychol Med 2009; 39:287-299. [PMID: 18507875 DOI: 10.1017/s0033291708003632] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of mental disorders may be particularly detrimental in early adulthood, and information on mental disorders and their correlates in this age group is important. METHOD A questionnaire focusing on mental health was sent to a nationally representative two-stage cluster sample of 1863 Finns aged 19 to 34 years. Based on a mental health screen, all screen-positives and a random sample of screen-negatives were asked to participate in a mental health assessment, consisting of the Structured Clinical Interview for DSM-IV (SCID-I) interview and neuropsychological assessment. We also obtained case-notes from all lifetime mental health treatments. This paper presents prevalences, sociodemographic associations and treatment contacts for current and lifetime mental disorders. RESULTS Forty percent of these young Finnish adults had at least one lifetime DSM-IV Axis I disorder, and 15% had a current disorder. The most common lifetime disorders were depressive disorders (17.7%) followed by substance abuse or dependence (14.2%) and anxiety disorders (12.6%). Of persons with any lifetime Axis I disorder, 59.2% had more than one disorder. Lower education and unemployment were strongly associated with current and lifetime disorders, particularly involving substance use. Although 58.3% of persons with a current Axis I disorder had received treatment at some point, only 24.2% had current treatment contact. However, 77.1% of persons with a current Axis I disorder who felt in need of treatment for mental health problems had current treatment contact. CONCLUSIONS Mental disorders in young adulthood are common and often co-morbid, and they may be particularly harmful for education and employment in this age group.
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Affiliation(s)
- J Suvisaari
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
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