Suchergebnisse

This article examines the relationship between digital proficiency, trust in service providers, and the intention to use digital health care and social welfare services among prisoners and people with mental health conditions in Finland. Based on cross-sectional data, which includes responses from 225 prisoners and 120 people with mental health conditions between September 2020 and May 2021, a study utilizing latent profile analysis (LPA) reveals that although high digital skills were observed, trust in providers of digital services within the health care and social welfare sector remained low, particularly among younger participants. Despite trust issues, the intention to use digital services remained high, particularly among inmates. This suggests that trust is not the sole factor influencing digital service adoption; age and perceived digital competence also play significant roles. Prisoners demonstrated higher levels of advanced internet skills than individuals with mental health backgrounds, possibly due to overestimating their abilities. Alternative approaches, such as social support and hands-on learning, are vital for enhancing digital skills in socially marginalized groups. Understanding these determinants can guide policymakers and practitioners in developing targeted interventions to promote digital inclusion effectively by considering broadly the factors that promote the accessibility of digital health care and social welfare services. Future research combining objective proficiency testing and self-reported data can offer deeper insights for more successful strategies.

Governments are rapidly digitalising public services to increase cost-effectiveness of the public sector. This study examines older migrants' use of digital public health and social welfare services from the perspective of social exclusion. The study uses a mixed methods approach, drawing on representative survey data of Russian-speaking migrants in Finland and qualitative interviews with third-sector representatives who assist Russian-speaking migrants with digital service use. Our quantitative results show that a sizeable proportion of Russian-speaking older adults are excluded from digital services. In particular, those with lower socio-economic status, poor local language skills and without Finnish education are at higher risk of exclusion. Our qualitative results describe the multiple ways the exclusion from digital services intersects with other disadvantages in the everyday lives of Russian-speaking older adults. We argue that digitalisation of these services may foster social exclusion and endanger the realisation of these people's social rights.

BackgroundResearch has shown that the health of migrants can vary dramatically from the health of the settled population of their countries. Whilst migrant health has been studied in other areas of the UK, it is especially important to research the mental health of migrants in Northern Ireland specifically, due to the country's unique mental health situation.
ObjectivesThis study aims to assess the mental health of migrants in Northern Ireland as compared to the settled majority population, both by way of reported poor mental health, and psychotropic prescription medication uptake.
MethodsThis study uses a cohort of 1,019,769 people in Northern Ireland, taken from the 2011 Census of Northern Ireland and the BSO Enhanced Prescribing Dataset (2011-2014). The migrant population of Northern Ireland is described in terms of demographic and socioeconomic factors, and logistic regression models are used to analyse the relative risks of reporting poor mental health and uptake of psychotropic medication within the migrant population as compared to the settled population.
FindingsThe results show that migrants were significantly less likely to report poor mental health than the settled population of Northern Ireland, when adjusted for demographic characteristics, socioeconomic factors, and reported poor physical health. Migrants were also significantly less likely to use any form of psychotropic prescription medication than the settled population.
ConclusionsThese findings are in concordance with most research conducted in other countries. The roles of the healthy migrant effect, the salmon bias, stigma, and lack of access to healthcare are discussed as possible reasons for the percieved migrant mental health advantage. However, such a dramatic difference between the health of migrants and the settled population of Northern Ireland may be due, in part, to certain limitations of the datasets used.

Purpose. Examine the associations among social support, network heterogeneity, and smoking behavior in a large sample of Finnish female municipal employees. Design. Cross-sectional observational study. Setting. Workplaces in 10 towns in Finland. Measures. Smoking behavior and social support from one's partner, relatives, friends, supervisor, and coworkers was assessed by a questionnaire survey in 2000 to 2001. Analysis. Logistic regression analysis. Subjects. Total of 23,069 female employees (mean age = 45 years). Separate models for heavy smoking (≥ 20 cigarettes per day) were calculated for 4119 current smokers. The association between social support and ex-smoking was examined in 7352 ever-smokers. Results. After adjustment for various confounders, women who reported low heterogeneity of their support network or no support from their partners or relatives were approximately 1.2 times more likely to be smokers compared with their counterparts with high heterogeneity or high support. Low network heterogeneity was also significantly associated with an elevated prevalence of heavy smoking in current smokers (odds ratio [OR] = 1.52; 95% confidence intervals [CI] = 1.06, 2.19) and a lower likelihood of ex-smoking in ever-smokers (OR = 0.74; 95% CI = 0.63, 0.87). The associations were more pronounced among nonmanual vs. manual employees. Conclusion. Our findings suggest an association among network heterogeneity, sources of social support, and smoking in female employees. The preventive impact of these social resources on smoking behavior is stronger among nonmanual female employees.

Tutkimme Suomessa asuvien ikääntyvien venäjänkielisten ylirajaista terveyspalvelujen käyttöä ja käytön syitä. Analysoimme vuonna 2019 kerättyä CHARM-kyselyaineistoa ja syvennämme tuloksia haastatteluaineiston temaattisen analyysin avulla. Lähes 30 prosenttia yli 50-vuotiaista Suomessa asuvista venäjänkielisistä oli käynyt kyselyä edeltävän vuoden aikana Suomen ulkopuolella lääkärissä. Ulkomailla lääkärissä käynti oli yleisempää naisilla, työttömillä, korkeasti koulutetuilla sekä vastaajilla, joiden kotitalouden nettotulot olivat yli 2 500 euroa kuukaudessa. Kansalaisuus jossain muussa maassa kuin Suomessa lisäsi käytön todennäköisyyttä ja pidempi asumisaika Suomessa puolestaan vähensi sitä. Eläminen kroonisen sairauden kanssa sekä täyttämätön hoidontarve olivat yhteydessä ylirajaiseen palveluiden käyttöön. Kyselyaineistossa tärkeimmiksi syiksi palveluiden ylirajaiselle käytölle nousivat halvempi hinta, nopeampi hoitoon pääsy ja omankieliset palvelut. Haastatteluaineistossa esiintyivät nämä samat syyt, mutta esiin nousivat myös koetut pettymykset suomalaisessa terveydenhuollossa. Tulokset osoittavat, että ikääntyvät venäjänkieliset kohtaavat monenlaisia esteitä hoitoon pääsylle ja toimivalle hoidolle Suomessa. Sivuutetuksi tulemisen kokemukset ja väärinymmärrykset voivat johtaa avun hakemiseen Suomen ulkopuolelta. Terveyspalvelujen laatua ja saavutettavuutta tulisi kehittää vastaamaan moninaistuvan ikääntyvän väestön tarpeita.

In this article, we examine the transnational use of health services and the reasons given for their use by older Russian-speaking migrants living in Finland. We analyse the CHARM survey data collected in 2019, and elaborate the results with thematic analysis of the interview data. Almost 30 per cent of Russian-speakers over the age of 50 living in Finland had seen a doctor outside Finland in the year before the survey. Visiting a doctor abroad was more common among women, the unemployed, the highly educated and respondents with a net household income of more than 2,500 euros per month. Having citizenship in a country other than Finland increased the likelihood of use and having a longer period of residence in Finland reduced it. People living with a chronic illness and those who had an unmet need for care used more health services abroad. In the survey data, the main reasons for the cross-border use of services were cheaper prices, faster access to treatment and the delivery of services in one's own language. These same reasons appeared in the interview material, but the interviewees also mentioned perceived disappointments with Finnish health care. The results show that older Russian-speakers face a variety of barriers to accessing and navigating care in Finland. Experiences of misunderstanding and of being ignored can lead to seeking help from outside Finland. The quality and accessibility of health services should be developed to meet the needs of a diversifying ageing population.

BackgroundResearch has highlighted the poor mental health of looked after children compared to those never in care. However, little is known on what becomes of these children and their mental health trajectories after they leave the care of social services. In addition, previous studies are limited in their ability to differentiate between type of social care intervention received; kinship care, foster care or residential care.
AimTo utilise nationwide social services data from two countries (Northern Ireland (NI) and Finland), with similar populations but different intervention policies, linked to a range of demographic and health datasets to examine the mental health outcomes of young adults in the years following leaving care.
MethodsData from both countries on children born 1991-2000 were linked to social services data, hospital admissions, prescribed medication data and death records. Mental health outcomes were defined after the age of 18years (when statutory care provision ends) examined by care intervention and included admissions to psychiatric hospital, for self-harm and death by suicide.
ResultsThe gender split in care in Finland is reflective of the population but more males are in care in NI. Initial results from Finnish data suggest those exposed to care in childhood have an increased risk of self-harm, psychiatric hospital admission and suicide after the age of 18years compared to those never in care. After adjusting for gender, age of entry to care and deprivation at birth those exposed to any care intervention had 3 times the risk of suicide (HR=3.06, 95% CI 1.18,7.98). Risk increased with duration in care but was equivalent across care intervention types. Analysis on the NI data is underway.
ConclusionFull results will be available December 2019 and will explore which care pathways are most associated with poor mental health outcomes informing discussion around intervention opportunities and policy.

Background: The workplace social capital is one of the important features of clinical work environment that improves the productivity and quality of services and safety through trust and social participation. Evaluation of workplace social capital requires a valid and reliable scale. The short-form workplace social capital questionnaire developed by Kouvonen has long been used to evaluate the workplace social capital. Objective: To evaluate the psychometric properties of the Persian version of the questionnaire among a group of female Iranian health care workers. Methods: The Persian version of the short-form questionnaire of workplace social capital was finalized after translation and back-translation. 500 female health care workers completed the questionnaire. Then, the content validity and the construct validity of the questionnaire were assessed. The reliability of the questionnaire was assessed by Cronbach's a, theta, and McDonald's Omega. The construct reliability and ICC were also evaluated. Results: Based on the maximum likelihood exploratory factor analysis (n=250) and confirmatory factor analysis (n=250), two factors were identified. The factors could explain 65% of the total variance observed. The model had an acceptable fit: GFI=0.953, CFI=0.973, IFI=0.974, NFI=0.953, PNFI=0.522, RAMSEA=0.090, CMIN/DF=2.751, RMR=0.042. Convergent and divergent validity as well as internal consistency and construct reliability of the questionnaire were confirmed. Conclusion: The Persian version of Kouvonen workplace social capital has acceptable validity and reliability. The questionnaire can thus be used in future studies to assess the workplace social capital in Iranian health care workers. ; Peer reviewed

Objectives: To investigate whether low perceived organisational injustice predicts heavy drinking among employees. Methods: Data from the prospective occupational cohort study, the 10-Town Study, related to 15 290 Finnish public sector local government employees nested in 2432 work units, were used. Non-drinkers were excluded. Procedural, interactional and total organisational justice, heavy drinking (>=210 g of absolute alcohol per week) and other psychosocial factors were determined by means of questionnaire in 2000-2001 (phase 1) and 2004 (phase 2). Multilevel logistic regression analyses taking into account for the hierarchical structure of the data were conducted and adjustments were made for sex, age, socio-economic position, marital status, baseline heavy drinking, psychological distress and other psychosocial risk factors such as job strain and effort/reward imbalance. Results: After adjustments, participants who reported low procedural justice at phase 1 were about 1.2 times more likely to be heavy drinkers at phase 2 compared with their counterparts with high justice. Low perceived justice in interpersonal treatment and low perceived total organisational justice were associated with an elevated prevalence of heavy drinking only in the socio-demographics adjusted model. Conclusions: This is the first longitudinal study to show that low procedural justice is weakly associated with an increased likelihood of heavy drinking.

OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured = 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured = 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.