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Heino A, Morris JK, Garne E, Baldacci S, Barisic I, Cavero-Carbonell C, García-Villodre L, Given J, Jordan S, Loane M, Lutke LR, Neville AJ, Santoro M, Scanlon I, Tan J, de Walle HEK, Kiuru-Kuhlefelt S, Gissler M. The Association of Prenatal Diagnoses with Mortality and Long-Term Morbidity in Children with Specific Isolated Congenital Anomalies: A European Register-Based Cohort Study. Matern Child Health J 2024; 28:1020-1030. [PMID: 38438690 PMCID: PMC11059158 DOI: 10.1007/s10995-024-03911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 03/06/2024]
Abstract
OBJECTIVES To compare 5-year survival rate and morbidity in children with spina bifida, transposition of great arteries (TGA), congenital diaphragmatic hernia (CDH) or gastroschisis diagnosed prenatally with those diagnosed postnatally. METHODS Population-based registers' data were linked to hospital and mortality databases. RESULTS Children whose anomaly was diagnosed prenatally (n = 1088) had a lower mean gestational age than those diagnosed postnatally (n = 1698) ranging from 8 days for CDH to 4 days for TGA. Children with CDH had the highest infant mortality rate with a significant difference (p < 0.001) between those prenatally (359/1,000 births) and postnatally (116/1,000) diagnosed. For all four anomalies, the median length of hospital stay was significantly greater in children with a prenatal diagnosis than those postnatally diagnosed. Children with prenatally diagnosed spina bifida (79% vs 60%; p = 0.002) were more likely to have surgery in the first week of life, with an indication that this also occurred in children with CDH (79% vs 69%; p = 0.06). CONCLUSIONS Our findings do not show improved outcomes for prenatally diagnosed infants. For conditions where prenatal diagnoses were associated with greater mortality and morbidity, the findings might be attributed to increased detection of more severe anomalies. The increased mortality and morbidity in those diagnosed prenatally may be related to the lower mean gestational age (GA) at birth, leading to insufficient surfactant for respiratory effort. This is especially important for these four groups of children as they have to undergo anaesthesia and surgery shortly after birth. Appropriate prenatal counselling about the time and mode of delivery is needed.
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Affiliation(s)
- Anna Heino
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270, Helsinki, Finland.
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Ester Garne
- Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Silvia Baldacci
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ingeborg Barisic
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Klaiceva 16, 10000, Zagreb, Croatia
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Laura García-Villodre
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Joanne Given
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Sue Jordan
- Faculty Health and Life Sciences, Swansea, Wales
| | - Maria Loane
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - L Renée Lutke
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Amanda J Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), Center for Clinical and Epidemiological Research, University of Ferrara, 44121, Ferrara, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Joachim Tan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sonja Kiuru-Kuhlefelt
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270, Helsinki, Finland
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Pohjola V, Sarttila K, Kuusela M, Nikander R, Lundqvist A, Lahti J. Association between physical fitness and perceived work ability among Finnish population: a cross-sectional study. Int Arch Occup Environ Health 2024; 97:451-460. [PMID: 38526567 PMCID: PMC10999380 DOI: 10.1007/s00420-024-02058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE This cross-sectional study aims to examine association between different components of physical fitness and perceived work ability among working age population. METHODS The population-based study sample included 2050 participants aged 18-74 from the Finnish national Health 2011 study. Physical fitness was assessed by the single leg stand test, the modified push-up test, the vertical jump test and the six-minute walk test, and perceived work ability was assessed via interview. Logistic regression was used for examining the associations between physical fitness and work ability. RESULTS After adjusting for potential confounders (age, sex, marital status, educational level, work characteristics, total physical activity, daily smoking, BMI and number of diseases), odds ratios indicated that good work ability was more likely among those who had better balance in single leg stand test (OR = 1.54; 95% CI 1.07-2.24), and who belonged in the high fitness thirds in six-minute walking test (OR = 2.08; 95% CI 1.24-3.49) and in vertical jump test (OR = 2.51; 95% CI 1.23-5.12) compared to lowest third. Moreover, moderate (OR = 1.76; 95% CI 1.02-3.05) to high fitness (OR = 2.87; 95% CI 1.40-5.92) in modified push-up test increased the likelihood of good work ability compared to lowest third. CONCLUSION These study results indicate that good musculoskeletal as well as cardiorespiratory fitness are associated with better perceived work ability. Promoting physical fitness in individual and societal level may be potential targets for maintaining good work ability in working age population.
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Affiliation(s)
- Valtteri Pohjola
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
| | - Katariina Sarttila
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Markus Kuusela
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Riku Nikander
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Physical Medicine and Rehabilitation, Central Hospital of Central Finland and Central Finland Wellbeing Services County, Jyväskylä, Finland
| | - Annamari Lundqvist
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Jouni Lahti
- Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
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Rantala E, Vanhatalo S, Valtanen M, Lindström J, Pihlajamäki J, Poutanen K, Absetz P, Karhunen L. Effectiveness of workplace choice architecture modification for healthy eating and daily physical activity. BMC Public Health 2024; 24:939. [PMID: 38561724 PMCID: PMC10986070 DOI: 10.1186/s12889-024-18482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Modifying the choice architecture of behavioural contexts can facilitate health behaviour change, but existing evidence builds mostly on small-scale interventions limited in duration, targets, strategies, and settings. We evaluated the effectiveness of a one-year hybrid type 2 implementation-effectiveness trial aimed at promoting healthy eating and daily physical activity with subtle modifications to the choice architecture of heterogeneous worksites. The intervention was contextualised to and integrated into the routine operations of each worksite. Effectiveness was evaluated in a quasi-experimental pre-post design. METHODS Intervention sites (n = 21) implemented a median of two (range 1-9) intervention strategies for healthy eating and one (range 1-5) for physical activity. Questionnaires pre (n = 1126) and post (n = 943) intervention surveyed employees' behavioural patterns at work (food consumption: vegetables/roots, fruit/berries, nuts/almonds/seeds, sweet treats, fast food, water; physical activity: restorative movement, exercise equipment use, stair use). The post-intervention questionnaire also measured employees' perception of and response to three intervention strategies: a packed lunch recipe campaign, a fruit crew-strategy, and movement prompts. Multi- and single-level regression models evaluated effectiveness, treating intervention as a continuous predictor formed of the site-specific dose (n intervention strategies employed) and mean quality (three-point rating per strategy halfway and at the end of the intervention) of implementation relevant to each outcome. RESULTS Multinomial logistic regression models found the intervention significantly associated with a favourable change in employees' fruit and berry consumption (interaction effect of time and implementation p = 0.006) and with an unfavourable change in sweet treat consumption (p = 0.048). The evidence was strongest for the finding concerning fruit/berry consumption-an outcome that sites with greater dose and quality of implementation targeted by using strategies that reduced the physical effort required to have fruit/berries at work and by covering multiple eating-related contexts at the worksite. The quality of implementation was positively associated with the perception of (p = 0.044) and response to (p = 0.017) the packed lunch recipes, and with response to the fruit crew-strategy (p < 0.001). CONCLUSIONS The results suggest that a contextualised, multicomponent choice architecture intervention can positively influence eating behaviour in diverse real-world settings over a one-year period, and that higher implementation quality can enhance intervention perception and response. However, outcomes may depend on the type of intervention strategies used and the extent of their delivery.
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Affiliation(s)
- Eeva Rantala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland.
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland.
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Mikko Valtanen
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
- Department of Mathematics and Statistics, University of Turku, 20014, Turku, Finland
| | - Jaana Lindström
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS, Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520, Tampere, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
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Tammi R, Männistö S, Maukonen M, Kaartinen NE. Whole grain intake, diet quality and risk factors of chronic diseases: results from a population-based study in Finnish adults. Eur J Nutr 2024; 63:397-408. [PMID: 37934237 PMCID: PMC10899358 DOI: 10.1007/s00394-023-03272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Better diet quality of whole grain consumers could contribute to the associations between whole grain intake and chronic disease risk factors. We examined whole grain intake in relation to diet quality and chronic disease risk factors (anthropometrics, blood pressure, cholesterol, triglycerides, C-reactive protein and glucose) and the role of diet quality in whole grains' associations with each risk factor. METHODS Our data included 5094 Finnish adults who completed a validated food frequency questionnaire and participated in a health examination within the National FinHealth 2017 Study. We assessed diet quality by the modified Baltic Sea Diet Score. P trends were calculated across whole grain intake quintiles by linear regression analysis. Interactions were assessed by including an interaction term in the analyses. RESULTS Higher whole grain intake was associated with slightly better diet quality compared with lower intakes in both sexes (P < 0.001). Whole grain intake was inversely associated with body mass index (P < 0.001), waist circumference (P < 0.001) and total cholesterol (P = 0.02) in men. Adjusting for medication use attenuated the inverse associations with diastolic blood pressure (P = 0.06) and HDL cholesterol (P = 0.14) in men. We observed no associations in women. Diet quality did not modify the associations between whole grain intake and chronic disease risk factors. CONCLUSIONS Our results suggest that whole grain intake was associated with small improvements in the chronic disease risk factors in men, regardless of diet quality. The sex differences may arise from varying health associations of whole grains from different cereal sources.
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Affiliation(s)
- Rilla Tammi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P. O. Box 30, 00271, Helsinki, Finland.
| | - Satu Männistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P. O. Box 30, 00271, Helsinki, Finland
| | - Mirkka Maukonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P. O. Box 30, 00271, Helsinki, Finland
| | - Niina E Kaartinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P. O. Box 30, 00271, Helsinki, Finland
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Rantala E, Vanhatalo S, Perez-Cueto FJA, Pihlajamäki J, Poutanen K, Karhunen L, Absetz P. Acceptability of workplace choice architecture modification for healthy behaviours. BMC Public Health 2023; 23:2451. [PMID: 38062407 PMCID: PMC10704714 DOI: 10.1186/s12889-023-17331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Altering the choice architecture of decision contexts can assist behaviour change, but the acceptability of this approach has sparked debate. Considering hypothetical interventions, people generally welcome the approach for promoting health, but little evidence exists on acceptance in the real world. Furthermore, research has yet to explore the implementers' perspective, acknowledging the multidimensionality of the acceptability construct. Addressing these knowledge gaps, this study evaluated the acceptability of a quasi-experimental implementation-effectiveness trial that modified the worksite choice architecture for healthy eating and daily physical activity. METHODS Fifty-three worksites participated in the 12-month intervention and implemented altogether 23 choice architecture strategies (Mdn 3/site), including point-of-choice prompts and changes to choice availability or accessibility. Retrospective acceptability evaluation built on deductive qualitative content analysis of implementer interviews (n = 65) and quantitative analysis of an employee questionnaire (n = 1124). Qualitative analysis examined implementers' thoughts and observations of the intervention and its implementation, considering six domains of the Theoretical Framework of Acceptability: ethicality, affective attitude, burden, intervention coherence, opportunity costs, and perceived effectiveness. Quantitative analysis examined employees' acceptance (7-point Likert scale) of eight specific intervention strategies using Friedman test and mixed-effects logistic regression. RESULTS Implementers considered the choice architecture approach ethical for workplace health promotion, reported mostly positive affective attitudes to and little burden because of the intervention. Intervention coherence supported acceptance through increased interest in implementation, whereas low perceived utility and high intensity of implementation reduced cost acceptance. Perceived effectiveness was mixed and varied along factors related to the implementer, social/physical work environment, employer, and employee. Employees showed overall high acceptance of evaluated strategies (Mdn 7, IQR 6.4-7), though strategies replacing unhealthy foods with healthier alternatives appeared less supported than providing information or enhancing healthy option availability or accessibility (p-values < 0.02). Greater proportion of male employees per site predicted lower overall acceptance (OR 4.4, 95% CI 1.2-16.5). CONCLUSIONS Work communities appear to approve workplace choice architecture interventions for healthy eating and physical activity, but numerous factors influence acceptance and warrant consideration in future interventions. The study contributes with a theory-based, multidimensional evaluation that considered the perspectives of implementers and influenced individuals across heterogeneous real-world settings.
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Affiliation(s)
- Eeva Rantala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland.
- VTT Technical Research Centre of Finland, Kuopio, 70211, Finland.
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland.
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | | | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS, Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
- VTT Technical Research Centre of Finland, Kuopio, 70211, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520, Tampere, Finland
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Anttila M, Koivisto J, Luoma ML, Anttila H. How to adopt technologies in home care: a mixed methods study on user experiences and change of home care in Finland. BMC Health Serv Res 2023; 23:1342. [PMID: 38042800 PMCID: PMC10693073 DOI: 10.1186/s12913-023-10368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND There is a need for better adoption of technology to meet the needs of home care professionals, older people, and informal caregivers. METHODS Mixed methods were used to describe and analyse quantitative and qualitative data in a Finnish governmental programme called KATI. The study was three-fold: it 1) listed what kinds of technologies were piloted and deployed in a national study, 2) provided information from the perspectives of home care professionals about requirements to use technology by using focus-group interviews, and 3) assessed experiences of how the adoption of technology changes work and work processes over time by using repeated surveys. Informants in interviews (n = 25) and surveys (n = 90) were home care professionals, who also described the perspectives of older people and informal caregivers. The conceptual models framing the study were adapted from the Technology Acceptance Model and DirVA PROVE-IT. RESULTS There were 80 technology pilots, in which variety of technologies were followed in home care. Familiarity with, commitment to and understanding of technology benefits were considered to be requirements for the technology to be used. The adoption of technology provided new skills and information about older people's wellbeing, realisation of treatment and new possibilities in home care. It developed new procedures to focus on older people's needs and motivated professionals by gained concrete aid. It enabled them to leave out some concrete procedures as unnecessary. On the other hand, there were also pessimistic and negative experiences when technology use provided nothing new or did not change anything. CONCLUSIONS The adoption of technology is dependent on the technology and its integration into the prevailing service practice. When they both work, it is possible to leave out unnecessary procedures in care, allocate resources and save time. It is possible to be aware of older people's safety and how they cope at home, find new ways to get involved in older people's lives, gain insight, and make changes at work. Continuous on-site training, modifications in service practices and communication throughout organisations is needed.
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Affiliation(s)
- Minna Anttila
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Juha Koivisto
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Heidi Anttila
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Virtanen L, Kaihlanen AM, Saukkonen P, Reponen J, Lääveri T, Vehko T, Saastamoinen P, Viitanen J, Heponiemi T. Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample. BMC Med Inform Decis Mak 2023; 23:252. [PMID: 37940995 PMCID: PMC10631156 DOI: 10.1186/s12911-023-02351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Physicians' work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations. METHODS We used representative survey data on Finnish physicians' (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions. RESULTS Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1-5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16-.30]), facilitates access to patient information (b = .15 [.07-.23]), and supports decision-making (b = .11 [.05-.18]). Disagreement with accelerated clinical encounters (b = .12 [.04-.20]), and agreements with patients' more active role in care (b = .11 [.04-.19]) and interprofessional collaboration (b = .10 [.02-.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06-1.48]) and agreeing with patients' active role (OR = 1.19 [1.02-1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure. CONCLUSIONS Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians' satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.
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Affiliation(s)
- Lotta Virtanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland.
| | - Anu-Marja Kaihlanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
| | - Petra Saukkonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
| | - Jarmo Reponen
- Research Unit of Health Sciences and Technology, University of Oulu, P.O.Box 5000, 90014, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, P.O.Box 8000, 90014, Oulu, Finland
| | - Tinja Lääveri
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O.Box 700, 00029, Helsinki, Finland
- Department of Computer Science, Aalto University, P.O.Box 15400, 00076, Espoo, Finland
| | - Tuulikki Vehko
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
| | | | - Johanna Viitanen
- Department of Computer Science, Aalto University, P.O.Box 15400, 00076, Espoo, Finland
| | - Tarja Heponiemi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland
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Kaihlanen AM, Ruotsalainen S, Väisänen V, Corneliusson L, Pesonen T, Sinervo T. Job demand and job resource factors explaining stress and job satisfaction among home care nurses - a mixed-methods sequential explanatory study. BMC Nurs 2023; 22:404. [PMID: 37891583 PMCID: PMC10612316 DOI: 10.1186/s12912-023-01568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Increasing home care has been seen as a way to respond to the growing care needs of the aging population. To secure a sufficient number of nurses to provide home care, it is essential to identify and take into account the factors related to their well-being and job satisfaction. This study examined associations of both objective and subjective job demands and resources with stress and job satisfaction among nurses working in home care. METHODS This study used a mixed-methods sequential explanatory design. First, quantitative data was collected with a survey, followed by a qualitative survey with open-ended questions. Linear regression analyses and qualitative content analysis with an inductive approach were used to analyze the quantitative and qualitative data, respectively. Joint display in a form of a table was used to integrate the results. RESULTS Of the objectively measured job demands and resources, higher proportion of direct care time and higher number of interruptions were associated with higher stress in the fully adjusted models. Of the subjective measures, higher time pressure, role conflicts and disruptions were associated with higher stress. Higher time pressure, role conflicts, and disruptions in the workday were associated with lower job satisfaction, whereas higher care continuity and having more autonomy were associated with higher job satisfaction. The results of the qualitative study, in which the nurses described their experiences of their working week, partly explained and confirmed the results of the quantitative study but were also contradictory in some respects. CONCLUSIONS Many demands, both subjectively experienced and objectively measured in terms of work organization, may undermine home care nurses' well-being and enjoyment at work. A severe nursing shortage combined with a growing number of clients is the reality of home care, significantly increasing the risk of burnout and turnover among employees. Strategies must be developed urgently to ensure sufficient personnel in home care. For example, investments should be made in opportunities for autonomous planning of work, and promotion of good cooperation and functionality of work teams.
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Affiliation(s)
- Anu-Marja Kaihlanen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland.
| | - Salla Ruotsalainen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Visa Väisänen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Laura Corneliusson
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Tiina Pesonen
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, FI-00271, Finland
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Täubel M, Jalanka J, Kirjavainen PV, Tuoresmäki P, Hyvärinen A, Skevaki C, Piippo-Savolainen E, Pekkanen J, Karvonen AM. Fungi in Early-Life House Dust Samples and the Development of Asthma: A Birth Cohort Study. Ann Am Thorac Soc 2023; 20:1456-1464. [PMID: 37535826 PMCID: PMC10559140 DOI: 10.1513/annalsats.202303-187oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/03/2023] [Indexed: 08/05/2023] Open
Abstract
Rationale: Fungal exposure has been associated with predisposing and protective effects on the development of childhood asthma. Objectives: To study whether early-life house dust mycobiota composition is associated with the development of asthma. Methods: Mycobiota were determined by amplicon sequencing from 382 dust samples collected from living room floors 2 months after birth in homes of the LUKAS cohort. Asthma status by 10.5 years of age was defined from questionnaires and assigned as ever asthma (n = 68) or current asthma (n = 27). Inhalant atopy was clinically determined at the same age. β-composition was analyzed using PERMANOVA-S, and asthma and atopy analyses were performed using discrete time hazard models and logistic regression, respectively. Results: The house dust mycobiota composition based on Bray-Curtis distance was different in the homes of children who later did or did not develop asthma. The first and the fourth axes scores of principal coordinates analysis based on Bray-Curtis were associated with ever asthma. Of the genera with the strongest correlation with these axes, the relative abundance of Boeremia, Cladosporium, Microdochium, Mycosphaerella, and Pyrenochaetopsis showed protective associations with asthma. None of these associations remained significant after mutual adjustment among the five genera or when mutually adjusted for other microbial cell wall markers and previously identified asthma-protective bacterial indices. Neither fungal α-diversity nor load was associated with asthma in the whole population, but higher fungal richness was a risk factor among children on farms. Higher fungal loads (measured via quantitative polymerase chain reaction) in house dust were associated with the risk of inhalant atopy. Conclusions: The results of our analyses from this well-characterized birth cohort suggest that the early-life house dust mycobiota in Finnish homes, characterized via DNA amplicon sequencing, do not have strong predisposing or protective effects on asthma development.
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Affiliation(s)
- Martin Täubel
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Jonna Jalanka
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Pirkka V. Kirjavainen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Pauli Tuoresmäki
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Anne Hyvärinen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany
- Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Marburg, Germany
| | | | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne M. Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
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10
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Lukkarinen M, Kirjavainen PV, Backman K, Gonzales-Inca C, Hickman B, Kallio S, Karlsson H, Karlsson L, Keski-Nisula L, Korhonen LS, Korpela K, Kuitunen M, Kukkonen AK, Käyhkö N, Lagström H, Lukkarinen H, Peltola V, Pentti J, Salonen A, Savilahti E, Tuoresmäki P, Täubel M, Vahtera J, de Vos WM, Pekkanen J, Karvonen AM. Early-life environment and the risk of eczema at 2 years-Meta-analyses of six Finnish birth cohorts. Pediatr Allergy Immunol 2023; 34:e13945. [PMID: 37102387 DOI: 10.1111/pai.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/28/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Urban-related nature exposures are suggested to contribute to the rising prevalence of allergic diseases despite little supporting evidence. Our aim was to evaluate the impact of 12 land cover classes and two greenness indices around homes at birth on the development of doctor-diagnosed eczema by the age of 2 years, and the influence of birth season. METHODS Data from 5085 children were obtained from six Finnish birth cohorts. Exposures were provided by the Coordination of Information on the Environment in three predefined grid sizes. Adjusted logistic regression was run in each cohort, and pooled effects across cohorts were estimated using fixed or random effect meta-analyses. RESULTS In meta-analyses, neither greenness indices (NDVI or VCDI, 250 m × 250 m grid size) nor residential or industrial/commercial areas were associated with eczema by age of 2 years. Coniferous forest (adjusted odds ratio 1.19; 95% confidence interval 1.01-1.39 for the middle and 1.16; 0.98-1.28 for the highest vs. lowest tertile) and mixed forest (1.21; 1.02-1.42 middle vs. lowest tertile) were associated with elevated eczema risk. Higher coverage with agricultural areas tended to associate with elevated eczema risk (1.20; 0.98-1.48 vs. none). In contrast, transport infrastructure was inversely associated with eczema (0.77; 0.65-0.91 highest vs. lowest tertile). CONCLUSION Greenness around the home during early childhood does not seem to protect from eczema. In contrast, nearby coniferous and mixed forests may increase eczema risk, as well as being born in spring close to forest or high-green areas.
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Affiliation(s)
- Minna Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Pirkka V Kirjavainen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Katri Backman
- Kuopio Birth Cohort (KuBiCo), University of Eastern Finland, Kuopio, Finland
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
| | | | - Brandon Hickman
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sampo Kallio
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Leea Keski-Nisula
- Kuopio Birth Cohort (KuBiCo), University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
| | - Laura S Korhonen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikael Kuitunen
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Kaarina Kukkonen
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Niina Käyhkö
- Department of Geography and Geology, University of Turku, Turku, Finland
| | - Hanna Lagström
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Heikki Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Erkki Savilahti
- FLORA: New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pauli Tuoresmäki
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Martin Täubel
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
| | - Willem M de Vos
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
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Ekström N, Haveri A, Solastie A, Virta C, Österlund P, Nohynek H, Nieminen T, Ivaska L, Tähtinen PA, Lempainen J, Jalkanen P, Julkunen I, Palmu AA, Melin M. Strong Neutralizing Antibody Responses to SARS-CoV-2 Variants Following a Single Vaccine Dose in Subjects With Previous SARS-CoV-2 Infection. Open Forum Infect Dis 2022; 9:ofac625. [PMID: 36519113 PMCID: PMC9745780 DOI: 10.1093/ofid/ofac625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection primes the immune system; thus individuals who have recovered from infection have enhanced immune responses to subsequent vaccination (hybrid immunity). However, it remains unclear how well hybrid immunity induced by severe or mild infection can cross-neutralize emerging variants. We aimed to compare the strength and breadth of antibody responses in vaccinated recovered and uninfected subjects. METHODS We measured spike-specific immunoglobulin (Ig)G and neutralizing antibodies (NAbs) from vaccinated subjects including 320 with hybrid immunity and 20 without previous infection. From 29 subjects with a previous severe or mild infection, we also measured NAb responses against Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), and Omicron (B.1.1.529/BA.1) variants following vaccination. RESULTS A single vaccine dose induced 2-fold higher anti-spike IgG concentrations and up to 4-fold higher neutralizing potency of antibodies in subjects with a previous infection compared with vaccinated subjects without a previous infection. Hybrid immunity was more enhanced after a severe than a mild infection, with sequentially decreasing NAb titers against Alpha, Beta, Delta, and Omicron variants. We found similar IgG concentrations in subjects with a previous infection after 1 or 2 vaccine doses. CONCLUSIONS Hybrid immunity induced strong IgG responses, particularly after severe infection. However, the NAb titers were low against heterologous variants, especially against Omicron.
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Affiliation(s)
- Nina Ekström
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Haveri
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Solastie
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Camilla Virta
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pamela Österlund
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuomo Nieminen
- Data and Analytics Unit, Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lauri Ivaska
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Paula A Tähtinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Johanna Lempainen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Clinical Microbiology, Turku University Hospital, Turku, Finland
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Pinja Jalkanen
- Infection and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Ilkka Julkunen
- Clinical Microbiology, Turku University Hospital, Turku, Finland
- Infection and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Arto A Palmu
- Interventions Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Merit Melin
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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12
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Nguyen L, Jokimäki H, Linnosmaa I, Saloniki EC, Batchelder L, Malley J, Lu H, Burge P, Trukeschitz B, Forder J. Valuing informal carers' quality of life using best-worst scaling-Finnish preference weights for the Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer). Eur J Health Econ 2022; 23:357-374. [PMID: 34468882 PMCID: PMC8964536 DOI: 10.1007/s10198-021-01356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
This study developed Finnish preference weights for the seven-attribute Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer) and investigated survey fatigue and learning in best-worst scaling (BWS) experiments. An online survey that included a BWS experiment using the ASCOT-Carer was completed by a sample from the general population in Finland. A block of eight BWS profiles describing different states from the ASCOT-Carer were randomly assigned to each respondent, who consecutively made four choices (best, worst, second best and second worst) per profile. The analysis panel data had 32,160 choices made by 1005 respondents. A scale multinomial logit (S-MNL) model was used to estimate preference weights for 28 ASCOT-Carer attribute levels. Fatigue and learning effects were examined as scale heterogeneity. Several specifications of the generalised MNL model were employed to ensure the stability of the preference estimates. The most and least-valued states were the top and bottom levels of the control over daily life attribute. The preference weights were not on a cardinal scale. We observed the position effect of the attributes on preferences associated with the best or second-best choices. A learning effect was found. The established preference weights can be used in evaluations of the effects of long-term care services and interventions on the quality of life of service users and caregivers. The learning effect implies a need to develop study designs that ensure equal consideration to all profiles (choice tasks) in a sequential choice experiment.
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Affiliation(s)
- Lien Nguyen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Hanna Jokimäki
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ismo Linnosmaa
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Eirini-Christina Saloniki
- Centre for Health Services Studies (CHSS), University of Kent, Kent, UK
- Personal Social Services Research Unit (PSSRU), University of Kent, Kent, UK
| | - Laurie Batchelder
- Personal Social Services Research Unit (PSSRU), University of Kent, Kent, UK
| | - Juliette Malley
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Hui Lu
- RAND Europe, Cambridge, UK
| | | | - Birgit Trukeschitz
- Research Institute for Economics of Aging, WU Vienna University of Economics and Business, Vienna, Austria
| | - Julien Forder
- Personal Social Services Research Unit (PSSRU), University of Kent, Kent, UK
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