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1.  Childhood adversities and adult-onset asthma: a cohort study 
BMJ Open  2012;2(5):e001625.
Objectives
Childhood adversities may be important determinants of later illnesses and poor health behaviour. However, large-scale prospective studies on the associations between childhood adversities and the onset of asthma in adulthood are lacking.
Design
Prospective cohort study with 7-year follow-up.
Setting
Nationally representative study. Data were collected from the Health and Social Support (HeSSup) survey and national registers.
Participants
The participants represent the Finnish population from the following age groups: 20–24, 30–34, 40–44, and 50–54 years at baseline in 1998 (24 057 survey participants formed the final cohort of this study). The occurrence of childhood adversities was assessed at baseline with a six-item survey scale. The analyses were adjusted for sociodemographic characteristics, behavioural health risks and common mental disorders.
Primary and secondary outcomes
The survey data were linked to data from national health registers on incident asthma during a 7-year follow-up to define new-onset asthma cases with verified diagnoses.
Results
A total of 12 126 (59%) participants reported that they encountered a childhood adversity. Of them 3677 (18% of all) endured three to six adversities. During a follow-up of 7 years, 593 (2.9%) participants were diagnosed with incident asthma. Those who reported three or more childhood adversities had a 1.6-fold (95% CI 1.31 to 2.01) greater risk of asthma compared to those without childhood adversities. This hazard attenuated but remained statistically significant after adjustment for conventional risk factors (HR 1.33; 95% CI 1.06 to 1.67).
Conclusions
Adults who report having encountered adversities in childhood may have an increased risk of developing asthma.
doi:10.1136/bmjopen-2012-001625
PMCID: PMC3488721  PMID: 23069774
Psychiatry; Epidemiology
2.  Non-response in a nationwide follow-up postal survey in Finland: a register-based mortality analysis of respondents and non-respondents of the Health and Social Support (HeSSup) Study 
BMJ Open  2012;2(2):e000657.
Objective
To examine difference in mortality between postal survey non-respondents and respondents.
Design
A prospective cohort study with baseline survey in 1998 and comprehensive linkage to national mortality registers until 2005, the Health and Social Support study.
Setting
A population-based postal survey of the working-aged population in Finland in 1998.
Participants
The original random sample comprised 64 797 working-aged individuals in Finland (20–24, 30–34, 40–44, 50–54 years of age; 32 059 women and 32 716 men), yielding 25 898 (40.0%) responses in the baseline postal survey in 1998.
Primary outcome measure
Registry-based primary causes of death encoded with the International Classification of Diseases (ICD-10).
Results
In women, HR for total mortality was 1.75 (95% CI 1.40 to 2.19) times higher among the non-respondents compared with the respondents. In men, non-response was associated with a 1.41-fold (1.21–1.65) excess risk of total mortality. Non-response associated in certain age groups with deaths due to diseases in women and with deaths due to external causes in men. The most prominent excess mortality was seen for total mortality for both genders and for mortality due to external causes among men.
Conclusions
Postal surveys result in slight underestimation of illness prevalence.
Article summary
Article focus
Women and individuals from upper social strata tend to participate more actively in postal health surveys.
What this exactly means in terms of health selection among respondents is unclear.
Postal health surveys are believed to produce underestimates of illness prevalence.
Key messages
Total mortality was consistently and for women in the age group ≥50 years and for men in the age groups ≥40 years significantly higher among non-respondents compared with respondents during a 7-year follow-up among a total Finnish nationwide sample in working age comprising almost 65 000 individuals.
The excess mortality observed was 1.5–2 fold. Among men, it was explained by external causes, whereas among women, it was due to diseases and was statistically significant only in the age group 50–54 years.
Postal surveys result in slight underestimation of illness prevalence.
Strengths and limitations of the study
The linkage to mortality data was successful for virtually all individuals of the original sample comprising nearly 65 000 individuals. The sample size secures the reliability of the conclusions drawn. Furthermore, the registry data on mortality in Finland can be considered as reliable. To the best of the authors' knowledge, a corresponding study based on an as large a sample as in this study has not previously been carried out.
Some inaccuracy concerning the final diagnosis of death is possible. A further study limitation is that data of socioeconomic status or educational level of non-respondents were not available, and hence, adjustments of the statistical analyses for these variables were not possible.
doi:10.1136/bmjopen-2011-000657
PMCID: PMC3307122  PMID: 22422917
3.  Low pessimism protects against stroke: the Health and Social Support (HeSSup) prospective cohort study 
Background and Purpose
The association between optimism and pessimism and health outcomes has attracted increasing research interest. To date, the association between these psychological variables and risk of stroke remains unclear. We examined the relationship between pessimism and the 7-year incidence of stroke.
Methods
A random sample of 23 216 adults (9 480 men, 13 796 women) aged 20–54 years completed the pessimism scale in 1998, i.e., at study baseline. Fatal and first non-fatal stroke events during a mean follow-up of 7.0 years were documented by linkage to the National-hospital-discharge and mortality registers, leading to 105 events.
Results
Unadjusted hazard ratio was 0.44 (95% CI 0.25–0.77) for participants in the lowest quartile (a low pessimism level) when compared to those in the highest quartile (a high pessimism level). After serial adjustments for sociodemographic characteristics, cardiovascular biobehavioral risk factors, depression, general feeling of stressfulness, and ischemic-heart disease the fully-adjusted hazard ratio was 0.52 (95% CI 0.29–0.93).
Conclusions
In this population of adult men and women, low level of pessimism had a robust association with reduced incidence of stroke.
doi:10.1161/STROKEAHA.109.565440
PMCID: PMC2884028  PMID: 19892995
Adult; Attitude; Cohort Studies; Female; Follow-Up Studies; Health Status; Humans; Male; Middle Aged; Prospective Studies; Risk Factors; Social Support; Stroke; prevention & control; psychology; Young Adult
4.  Childhood adversities as a predictor of disability retirement 
Background
There is a large body of research on adulthood risk factors for retirement due to disability, but studies on the effect of adverse childhood experiences are scarce.
Aim
To examine whether adverse childhood experiences predict disability retirement.
Methods
Data were derived from the Health and Social Support Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow‐up questionnaire). The analysed data consisted of 8817 non‐retired respondents aged 40–54 years (5149 women, 3668 men). Negative childhood experiences, such as financial difficulties, serious conflicts and alcohol‐related problems, were assessed at baseline and disability retirement at follow‐up.
Results
The risk of disability retirement increased in a dose–response manner with increasing number of childhood adversities. Respondents who had experienced multiple childhood adversities had a 3.46‐fold increased risk (95% CI 2.09 to 5.71) of disability retirement compared with those who reported no such adversities. Low socioeconomic status, depression (Beck Depression Inventory‐21), use of drugs for somatic diseases as well as health‐related risk behaviour, such as smoking, heavy alcohol consumption and obesity, were also predictors of disability retirement. After simultaneous adjustments for all these risk factors, the association between childhood adversities and the risk of disability retirement attenuated, but remained significant (OR 1.90, 95% CI 1.07 to 3.37).
Conclusions
Information on childhood conditions may increase our understanding of the determinants of early retirement, especially due to mental disorders. Childhood adversities should be taken into account when considering determinants of disability retirement and identifying groups at risk.
doi:10.1136/jech.2006.052670
PMCID: PMC2465717  PMID: 17496255
5.  Sexual activity and perceived health among Finnish middle-aged women 
Background
An increasing awareness of the need to address sexual and orgasm experiences as part of life quality and an understanding of the great individual differences between women play roles in women's health and medical care across the specialities. Information is lacking as to how negative attitude toward self (NATS) and performance impairment (PI) are associated with sexual activity of middle-aged women. We examined the associations of sexual experience, orgasm experience, and lack of sexual desire with perceived health and potential explanatory variables of NATS and PI.
Methods
Questionnaire was mailed to 2 population-based random samples of menopausal or soon-to-be menopausal women (n = 5510, 70% response) stratified according to age (42–46 and 52–56 years). In multivariate analyses of the associations with the outcome variables, perceived health, NATS, and PI were used as covariates in 6 models in which exercise, menstrual symptoms, and illness indicators were taken into account as well.
Results
Sexual activity variables were associated with perceived health. When present, NATS formed associations with sexual and orgasm experiences, whereas strenuous exercise formed associations with orgasm among 42–46-year-old women alone. Strenuous exercise was not associated with orgasm experience among older women.
Conclusion
NATS and PI are closely tied to orgasm experiences and the meaning of the roles needs to be exposed. Sexual activity deserves to be addressed more actively in patient contact at least with perimenopausal women.
doi:10.1186/1477-7525-4-29
PMCID: PMC1513197  PMID: 16686959

Results 1-5 (5)