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Protocol of a research project 'Projections of the burden of disease and disability in Finland - health policy prospects' using cross-sectional health surveys and register-based follow-up.

ABSTRACT: INTRODUCTION:With the rapid ageing of the population in Europe, reliable estimates of the future development of the disease and disability burden as well as healthy life years in the older sections of the population are crucial. Meanwhile, the future prospects of the health and functional ability of the working-aged population are critical. The aims of the Projections of the burden of disease and disability in Finland - health policy prospects research project are to provide information about the long-term consequences of health-related behaviours of the population and to project the potential improvement of the burden of disease and disability based on realistic scenarios about the development of risk behaviours in the total population and its subgroups. METHODS AND ANALYSIS:The analyses will be based on data from representative cross-sectional and longitudinal health examination surveys (HESs) conducted between 1972 to 2017 in Finland, and register data from several national administrative registers. Included HESs (FINRISK Surveys from 1972 to 2012, Mini-Finland Survey from 1978 to 1980, the Health 2000/2011 Surveys and the FinHealth 2017 Study) provide abundant information about biological and behavioural risk factors and the health and morbidity of the population. The modifiable risk factors used as predictors include hypertension, hyperlipidaemia, obesity, diabetes, physical inactivity, smoking, alcohol use and unfavourable diet. The main outcomes are ischaemic heart disease, cerebrovascular diseases, lung cancer, chronic obstructive pulmonary disease, Alzheimer's disease and diabetes. Within the project, novel projection techniques of data-driven Bayesian hierarchical models to provide robust and comparable estimates will be developed. ETHICS AND DISSEMINATION:The prevailing legislation and regulations have been followed for all surveys. Surveys since 1997 have been approved by the respective Ethics Committees covering the scope of this project. A written informed consent was obtained from participants since 1997. The outputs of the project will include 8 to 10 scientific papers in peer-reviewed journals.

SUBMITTER: Paalanen L

PROVIDER: S-EPMC6596950 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Protocol of a research project 'Projections of the burden of disease and disability in Finland - health policy prospects' using cross-sectional health surveys and register-based follow-up.

Paalanen Laura L Härkänen Tommi T Tolonen Hanna H

BMJ open 20190620 6

<h4>Introduction</h4>With the rapid ageing of the population in Europe, reliable estimates of the future development of the disease and disability burden as well as healthy life years in the older sections of the population are crucial. Meanwhile, the future prospects of the health and functional ability of the working-aged population are critical. The aims of <i>the Projections of the burden of disease and disability in Finland - health policy prospects</i> research project are to provide infor ...[more]

PMID: 31227540

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Project description:Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967-1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26-1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967-1976. In conclusion, health problems-in particular mental problems-during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.

Project description:BackgroundThe institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning.MethodsThis study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase.ResultsWe identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the "generation of evidence" (push side), 41 on the "use of evidence" (pull side) and 21 on the "interaction between these two" (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions).ConclusionThe policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country's EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability. Video abstract.

Project description:IntroductionThe European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health.Methods and analysisDAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration.Ethics and disseminationThe study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Project description:BACKGROUND:Health questionnaires and health checks are an established part of preventive health care services in Finland. However, only very limited research of these has been conducted. The Finnish Student Health Service (FSHS) provides primary health care services to all bachelor's and master's degree university students (approximately 134,500 students) in Finland. FSHS's statutory health examination process of university entrants includes an electronic health questionnaire (eHQ) and, based on the students' eHQ responses, a subsequent health check if necessary. To our knowledge, no previous studies have been published on the use of questionnaires for screening students for general health checks. OBJECTIVE:The general aim of the study is to evaluate the health examination process of university entrants. The objectives are to determine how students' self-reported health in the eHQ and participation in the health examination process are associated with graduation, mental health problems, and the use of student health care services. METHODS:This is an ongoing, nationwide, retrospective, register-based cohort study with a 6-year follow-up. The study population is the cohort of university entrants (N=15,723) from the 2011-2012 academic year. These students were sent the eHQ, which consisted of 26 questions about health, health habits, social relations, and studying. Based on the eHQ responses, students were referred to one of the following interventions: (1) a health check, (2) an appointment other than a health check (eg, physiotherapy), or (3) electronic feedback to support a healthy lifestyle, when the other interventions were not necessary. Multiple comparisons will be made within these groups using logistic regression. The primary outcome variables are graduation, having a mental health problem, and attending a health check. The use of FSHS health care services will be studied with the cluster analysis method. The data have been obtained from three nationwide registers: the eHQ register, the medical records of FSHS, and the Higher education achievement register. The data have been linked using personal identity codes. RESULTS:As of August 2019, the data collection and processing are complete and the statistical analyses are in progress. Preliminary results are expected in autumn 2019. Further publications are expected in 2020, and two PhD theses are expected to be completed by the end of 2022. CONCLUSIONS:Studying practical procedures in primary health care is highly important for resource allocation and the development of evidence-based processes. This study will be the first to assess the usage of a health questionnaire in screening students for health checks. The findings of this study will contribute to the field of preventive health care. The main practical implication is the development of the FSHS's health examination process. We hypothesize that participation in the health examination process enhances academic achievement and the detection of university students' mental health problems early on in their studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/14535.

Dataset Information

Protocol of a research project 'Projections of the burden of disease and disability in Finland - health policy prospects' using cross-sectional health surveys and register-based follow-up.

Publications

Protocol of a research project 'Projections of the burden of disease and disability in Finland - health policy prospects' using cross-sectional health surveys and register-based follow-up.

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