Finnish Institute for Health and Welfare

Understanding how energy retrofits affect indoor environments is essential for ensuring occupant health and revealing underlying mechanisms. This intervention study examined whether energy retrofits influence the in vitro toxicity and inflammatory potential of indoor dust, and whether these outcomes, reflecting overall exposure rather than individual pollutants, could explain observed improvements in self-reported health post retrofits. Additionally, associations with measured indoor environmental quality (IEQ) indicators were explored to identify factors driving indoor toxicity. Settled dust was collected before and after energy retrofits from 75 apartments in Finland and Lithuania. Toxicity was assessed via effects on cell metabolic activity and viability, and inflammatory potential was measured through interleukin (IL)6 and IL8 production in co-cultures of lung epithelial (A549) and monocyte (THP1) cells. Their associations with retrofit status, IEQ variables and self-reported health outcomes were analysed using pairwise pre-post testing and generalised linear mixed modelling (GLMM). Results suggest a context-dependent effect of energy retrofits on dust toxicity, indicating that impacts may be shaped by factors such as climate, building type, and the extent or type of retrofit measures. The inflammatory potential correlated strongly with dust microbial load and diversity in house dust, regardless of retrofit status. Dust toxicity and inflammatory potential were associated with self-reported health outcomes but did not explain the observed reduction in infection-related absence from work or school after the retrofits. Finally, the observed associations with IEQ were country-specific and findings emphasise that indoor dust toxicity is influenced by numerous factors, many of them unrelated to the building itself.

We appreciate the thoughtful feedback from Shu Song, Xiaomei Zhu on our study regarding neonatal gene expression patterns associated with delivery mode [1]. The commendations are valued, and we agree that understanding the biological impact of labour associated procedures on neonatal development is crucial. As correctly pointed out by Shong et al., the upregulation of genes involved in stress and immune-response pathways, such as NF-κB signalling and cytokine production, highlights significant biological processes influenced by vaginal delivery. We acknowledge the limitation Song and Zhu mentioned regarding the absence of detailed perioperative intervention data. The influence of pharmacological agents, like antibiotics and anaesthetics, on neonatal physiology is indeed a critical factor that could confound the observed differences in gene expression. The impact of intrapartum and early childhood exposure to antibiotics on a child's future health is well-established in prior research [2]. In contrast, there is limited evidence regarding the effects of anaesthetic agents on a child's long-term health. In our study, all performed caesarean sections were elective and performed under either spinal or epidural anaesthesia. The antibiotic used before incision was cefuroxime. The transcriptional variations observed in genes such as IL1B and TNF are likely influenced by a combination of mechanical stress and hormonal factors. Although our protein-level findings did not retain statistical significance after correction, they do suggest a regulated inflammatory transition. With these changes to our interpretation, the fetus prepares to face the outside world. Research has indicated that the mode of delivery can impact the likelihood of various conditions, including allergies, asthma and autoimmune diseases in later life [3]. The activation of the immune system linked to vaginal birth observed in the study could offer protective advantages against such conditions. We concur with your advocacy for future investigations to include detailed perioperative protocols. Incorporating obstetric covariates with multi-omics approaches will undoubtedly enhance our ability to distinguish labour-specific effects from potential iatrogenic influences. Thank you for your valuable insights, which will guide future research in this important area. Noora Carpén: writing – original draft. Otto Helve: writing – review and editing. Sture Andersson: writing – review and editing. Emmi Helle: writing – review and editing. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

The significance of a reciprocal link between public opinion and policy making is widely acknowledged in literature. The aim of this study is to explore public opinion on gambling policy by identifying distinct latent classes of attitudes towards policy goals. The findings can provide insights into future gambling regulation and policy making. Data were derived from a 2023 population-based Finnish Gambling Study (n = 5977) representing the population aged 15-74-year-olds. A set of questions regarding gambling policy attitudes were measured. By using a latent class analysis (LCA) we identified classes of individuals with regard to their respond patterns towards gambling policy questions, considering age, gender, gambling frequency and problem gambling status. Logistic regression was then used to predict class membership by demographic background, gambling behavior, and attitude towards gambling. Harm prevention, crime reduction, and control of unauthorized operators were the most endorsed gambling policy goals. Women, non-gamblers, and those affected by others’ gambling more often supported harm reduction and marketing restrictions, while men and recent gamblers prioritized consumer protection, player choice, and competition. Latent class analysis identified three groups: Traditionalists (54.8%), Harm-reducers (32.5%), and Libertarians (12.7%). Compared to Traditionalists, Harm-reducers were more likely to be younger and non-gamblers, while Libertarians were typically male, offshore, with at-risk/problem gambling, and held more pro-gambling attitudes. Most respondents supported harm-reduction or even stricter gambling policies, while only a minority – mainly younger males, offshore gamblers, and those with at-risk or problem gambling behavior – favored liberalization and increased consumer choice. This reveals a clear mismatch between public preferences and current policy trends in Finland, which are moving toward more liberal gambling policy. Attitudes were closely tied to personal gambling behavior, with younger non-gamblers supporting gambling reduction and older gamblers without harms backing stronger regulation.

Purpose This study aims to examine the role of absence of family on the education outcomes, labor market position and mental health of unaccompanied refugee minors (URMs) in Finland. Design/methodology/approach The authors used Finnish register data covering 1991–2015 from a Nordic study titled Coming of Age in Exile that studied how socio-economic and health inequities develop during the formative years in young refugees (in Finland born between 1976 and 1999). From this data the authors identified 1,361 unaccompanied URMs born before 1997 who settled in Finland before 2010 and whom they followed until 2015. The comparison groups were accompanied refugee-origin minors (n = 10,264) and URMs whose parents immigrated later (n = 233). The methods were descriptive statistics and logistic regression analysis. Findings Accompanied refugee-origin youth completed more education and were more often employedthan URMs who lived in Finland without their families. This was mainly connected to their early migration age and living with their parents. URMs without a parent had the worst mental health outcomes: they had higher odds of using psychiatric care, had more mood and anxiety diagnoses and were prescribed antidepressants, anxiolytics or sedatives more often. Research limitations/implications One limitation of this study is that the authors do not know exactly how representative the register data on URMs is, as there are no means to validate it. They were able to obtain information on 1,594 URMs, comprising 36.2 % of the approximately 4,400 URMs who arrived in Finland between 1991 and 2010, by using other sources. Since demographic, socioeconomic and health information on URMs appears in national registers, they must have been granted residence permits in Finland. In addition, the subjective experiences of URMs who settled in Finland were missing in this register study. Practical implications The negative impact of family separation on children’s wellbeing stress the importance of family and that transnational family connections should be acknowledged in social work with URMs (Seidel et al., 2022). In addition to revisiting family reunification policies in Finland and elsewhere, family-based foster care could support the wellbeing of unaccompanied refugee minors (Kauhanen et al., 2022; Kuusisto-Arponen, 2016). Social implications In the absence of family, the formation of family-like relationships (Tiilikainen et al., 2023) could become an important foundation for wellbeing of URMs. Living with one’s family markedly improves the wellbeing of URMs and should be considered in migration policies that deal with family reunification. Originality/value There are few register-based studies of URMs. Living without family when settling into a new country as a teenager may cause a deterioration in the mental health of URMs, which in turn may lower their study skills and ability to work. Living with one’s family markedly improves the wellbeing of URMs and should be considered in migration policies that deal with family reunification

The gut microbiome may modify the associations between lifestyle factors and colorectal cancer (CRC) risk, but their complex interplay, including the interactions between lifestyle factors, remain underexplored. We examined associations between CRC-related lifestyle patterns and gut microbiome diversity and composition in Finnish adults. Our data included 1,228 adults aged 25-64years from the National FINRISK/FINDIET 2002 Study. Information on lifestyle and background factors was obtained through self-administered questionnaires. Dietary data were gathered using a 48-h dietary recall. CRC-related lifestyles were modelled using a CRC lifestyle index based on nine major risk factors for CRC. Lower index points reflected higher-risk lifestyles. The gut microbiome profiles were analyzed using shallow shotgun metagenome sequencing. Associations between the index and microbial diversity and composition were assessed using, e.g., linear regression and permutational multivariate ANOVA adjusted for relevant confounders. The index explained 0.2% of the variation in microbial composition between participants (p < 0.05). Higher-risk lifestyles for CRC were associated with lower microbial diversity (β 0.037, p 0.009). Higher-risk lifestyles were also associated with a higher relative abundance of species representing primarily the family Lachnospiraceae and genera such as Dorea and Mediterraneibacter, and lower relative abundance of species within the genus Bifidobacterium (< 0.0001). Participants with higher- and lower-risk lifestyles showed clear differences in their gut microbiome diversity and composition, higher-risk lifestyles being associated with potentially adverse microbial traits. These findings contribute to identifying microbial features that may characterize early stages of CRC development in individuals with high-risk lifestyles.

Effective multilingual crisis communication can improve equity, inclusion, and access to information of linguistic minorities during crises. Adequate and accessible health information also improves linguistic minorities’ ability to make informed health choices and can help reduce inequalities. However, studies examining the perceived effectiveness of multilingual crisis communication are scarce. This study explored the experiences and strategies employed in multilingual communication during the Covid-19 pandemic in Finland from the perspective of professionals responsible for the provision and dissemination of this information. A qualitative design, using semi-structured interviews to collect data, was used. Interviews (n = 25) with persons responsible for multilingual Covid-19 communications were conducted in 2022. The participants worked in municipalities (n = 8), non-governmental organisations (n = 7), or governmental institutions (n = 10). The data were analysed via deductive theory-directed content analysis. The hierarchical model of social marketing served as an analytical lens to systematically examine the results. The main effort was placed on understanding the needs of linguistic minorities and gaining insights into how to reach them effectively. Respondents mentioned co-creation, collaboration, use of existing networks, community dialogues, and creative combination of aforementioned, as effective strategies. Although these key strategies were consistent with the social marketing framework, the respondents also encountered considerable challenges in operationalising these strategies, and their implementation lacked explicit use of systematic frameworks. More effort is needed to utilise communication strategies more efficiently and coherently in future crisis preparedness. Different social marketing frameworks can provide useful tools for developing and operationalising these. In addition, multilingual crisis communication plans should be included into preparedness plans for future crises in the public and third sectors.

BackgroundHardly any previous studies have examined technology-based interventions among cardiac rehabilitees. The added value of technology and biopsychosocial factors in weight management should be studied more in cardiac rehabilitation.ObjectiveThis mixed method study aimed to examine what biopsychosocial factors predict WC reduction and what factors arise from the talk of cardiac rehabilitees during 12-month cardiac rehabilitation.MethodsA total of 59 rehabilitees (mean age 60, SD 6 years; 48/59, 81.3% male) were randomly assigned in pairs into the experimental group (n=29) or the reference group (n=30). Biopsychosocial outcomes were measured at baseline and after 6 and 12 months with a 6-minute walk test (6MWT), the World Health Organization Quality of Life Brief Form questionnaire, body mass, BMI, WC, age, and sex. Rehabilitees’ experiences were investigated using focus group interviews. Both groups received conventional cardiac rehabilitation. In addition, the experimental group used technology. Multiple linear regression was used to predict WC change in 0-6 months and 0-12 months. The qualitative data were analyzed with thematic analysis. Integrative analysis was used to create a research-based model.ResultsGroup allocation predicted WC reduction (P=.007), with the experimental group showing a greater reduction (b=2.5 cm) than the reference group in the 0-6 month analysis. A significant interaction between the reference group and 6MWT was observed (P=.04), meaning that improvement in 6MWT was associated with WC reduction. Baseline WC was marginally associated with a greater reduction in WC (P=.05). None of the independent variables predicted WC reduction in 0- to 12-month analyses. Three themes arose from the interviews with the experimental group: meaningful factors related to weight management, a goal-oriented approach to weight loss, and monitoring body composition. Two themes emerged from the reference group: motivation for change and unstable weight management. According to the integrative analysis, belonging to the experimental group was important. The research-based model highlighted that the added value of remote technology on WC reduction was largest at the beginning of rehabilitation (0-6 months). The rehabilitees’ talk in the experimental group was goal-oriented, and they talked about the achieved changes. In the reference group, the talk remained motivational, and their body composition changes were unstable.ConclusionsThe integrative model emphasizes the differences between the experimental and reference groups in weight management. The use of added remote technology seemed to explain the WC reduction. The rehabilitees reflected on behavioral changes in weight management. In the reference group, improved 6MWT distance was associated with decreased WC, but they talked about motivation for weight management and unstable changes in body composition. In the future, results should be verified by larger research groups and individual interviews, which can be combined with personal quantitative data.Trial RegistrationISRCTN Registry ISRCTN61225589; https://www.isrctn.com/ISRCTN61225589

Annual reformulation and approval of seasonal influenza vaccines necessitate yearly evaluation of their effectiveness. Regulatory agencies, including the European Medicines Agency (EMA), rely on timely, real-world evidence to inform product-specific benefit-risk assessments. We explored the feasibility of conducting annual, brand-specific influenza vaccine effectiveness studies in Denmark, Finland and Sweden, starting with the 2024/25 season. These countries maintain population-wide vaccination, clinical and laboratory registers, linkable via personal identification numbers and updated in near real-time. We discuss suitable study designs and document that cohort studies using a target trial emulation (TTE) framework are feasible in all three countries; register-based test-negative case-control design (TND) studies are currently only feasible in Denmark. Supplementary methods, including regression discontinuity and negative control outcome analyses, can address residual bias. This Nordic collaboration has proven capacity for large-scale register-based studies and its infrastructure is able to address EMA's requirements for timely, robust post-authorisation evidence to guide public health and regulatory decisions.